The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. Historically, the prognosis of a tooth was defined based on tooth loss.3,4 Several authors have formulated and investigated their own prognostication systems with variable results, but showed that systems based on tooth loss were unpredictable over the long term.1. Results: The chance of teeth with apical periodontitis to completely heal after apical surgery is 37 percent to 85 percent, with a weighted average of approximately 70 percent. Another system was introduced by Kwok and Caton, which determines prognosis on future periodontal stability.1,6 Prognosis is considered “favorable” for teeth when the local or systemic factors can be controlled and the periodontal status of the tooth can be stabilized with comprehensive periodontal treatment and maintenance. Therefore, they were given 23 initially treated patients with details on demographics and smoking habits. Endodontic therapy is effective; however if crown lengthening is required because of subgingival caries or tooth fracture, thought needs to be given to removal of the tooth before altering the gingival topography. Possible reasons for these shifts are discussed. It will take 1 to 2 weeks for the socket to heal. One should consider the patient’s ability and consistency in performing plaque control when determining the overall prognosis. With current knowledge about the survival and success of implants a decision is made as to whether to extract or to treat and maintain the tooth. Therefore, we must differentiate risk factors, as those that favor the emergence of oral diseases, from prognostic factors, or characteristics that can predict the outcome once a disease is already set. Although a number of these differences were significant statistically, the actual values were too small to be of appreciable clinical significance. details were obtained from 898 patients aged from 20 to 60 years. The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. In these cases, teeth may be left more vulnerable to decay because the enamel is not able to protect the tooth. It is well known that physicochemical characteristics of the dental implant surface, such as roughness, topography, chemistry, and electrical charge affect the biological reactions occurring at the interface of tissue and implant. No statistically significant difference was found among the three different therapeutic approaches (pocket elimination, curettage, and modified Widman flap) during any of the time periods. The overall prognosis is concerned with the dentition as a whole. While many considerations from the periodontal literature apply, new information and techniques should be considered to retain teeth or not.2. This model suggests that patients are twice as likely to loose their teeth if there is increasing mobility, if they have a parafunctional habit and do not wear a biteguard, or if they smoke. Methods These results seem to indicate that the effect of these clinical parameters on tooth survival is only partially reflected in the assigned prognosis initially, suggesting that perhaps some of the clinical parameters should be weighed more heavily than others when assigning prognosis. One case is presented as an example of treatment for malocclusion with sever periodontitis: The patient was a 23 years 8 months female with a chief complaint of protrusion of upper incisors. The patients averaged 43.8 years of age and consisted of 59 females and 41 males. For teeth with an “unfavorable” prognosis, the local or systemic factors cannot be controlled, and periodontal breakdown is likely to occur even with comprehensive periodontal treatment and maintenance. This article attempted to determine the types of complications that have been reported and to provide data regarding their frequency. Teeth such as the maxillary premolars, which have pronounced root concavities, are also more difficult to instrument and maintain, and likewise have a worse prognosis than teeth with relatively straight roots.8, • Tooth mobility. A random effects model showed weighted mean survival rates of 85.6% (95% confidence interval [CI], 76.7–91.5) for CR and RR procedures OVERALL. Thirty-four articles were obtained for final analysis. Age (low age=worse prognosis) 2. The better his or her plaque control, the better the long-term prognosis.21–23 This determination is an important part of the re-evaluation examination following initial root planning and oral hygiene instructions.1,2,6, • Economic consideration. The key aspects are to determine whether both types of diseases are present, rather than just having manifestations of one disease in the alternate tissue. A dentist evaluates a natural tooth for its quality of health. A factor only becomes a part of standard practice after a great deal of research has shown it’s accurate and reliable. Smoking decreased the likelihood of improvement by 60% and doubled the likelihood of worsening in prognosis at 5 years. A clinician evaluates a tooth for its quality of health. the older patient or the younger patient? The possibility that additional bone loss can compromise a future implant site needs to be considered before providing periodontal therapy. Introduction Survival rates were 68% for root-resected molars and 77% for root-filled single-rooted teeth over a 10-year period. Investigators were unable to judge which patients would be IL-GP or negative based on their clinical presentation or family history of tooth loss due to periodontal disease. This philosophy differed markedly among the two dental schools. The objective of this review of literature is to discuss relevant factors associated with patient’s health, tooth and dentist that could account for a successful RCT. The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. To Conserve or Implant: Which Choice of Therapy? Factors that need to be considered when deciding on an overall periodontal prognosis include the following. The greatest challenge in treatment planning is to assign an accurate prognosis and develop a predictable protocol. 2) Will the tooth itself be lost in the future? The 3 most common complications associated with resin-bonded prostheses were prosthesis debonding (21%), tooth discoloration (18%), and caries (7%). a lot of the same criteria are used in both. 1. A Cox proportional hazards regression model showed that initial probing depth, initial furcation involvement, initial mobility, initial percent bone loss, presence of a parafunctional habit without a biteguard, and smoking were all associated with an increased risk of tooth loss. Dr. Sebastien Dujardin maintains a private practice in periodontics in Lille, France. A large number of studies have demonstrated that the success rate in endodontic therapy is significantly influenced by the presence or absence of a pretherapeutic radiographic lesion (1-7, 9-11). On the contrary, with multiple issues associated with endodontic therapy, minimal coronal tooth structure with decayed root dentine, and/or high caries index, which prohibits crown lengthening, replacement of the tooth with lower value may be prudent to avoid potential complications (Palmer & Howe 1999, ... Tooth loss in most cases is part of a therapeutic treatment plan wherein a clinician extracts a tooth due to acute oral disease (e.g., acute apical periodontitis) or chronic oral disease (e.g., periodontal support loss due to severe periodontitis and nonrestorable caries-affected teeth). It is likely, however, that the most important factor influencing the prognosis of endodontic treatment is the preoperative status of the teeth. Radiographs and clinical information on 573 teeth at baseline (prior to root debridement) and at 9 mo of follow-up were provided. A Medline and an extensive hand search were performed on English-language publications covering the last 50 years. A range of extracellular matrix components, designed peptides, and growth factors have been proposed as the biological moiety. The prognosis of the individual teeth is evaluated first on the basis of the overall prognosis and then on the status of each tooth according to pocket depths, attachment loss, mobility, amount and location of furcation involvement, tooth morphologic features, bone levels, general condition of the tooth, and ability to modify etiologic factors. When fixed partial denture studies were reviewed, the 3 most commonly reported complications were caries (18% of abutments), need for endodontic treatment (11% of abutments), and loss of retention (7% of prostheses). Individual tooth prognosis: • determined after the overall prognosis and is affected by it. Varying numbers of teeth may be affected; After eruption, it … Most individuals with CMT have some amount of physical disability, although some people may never know they have the disease. The results demonstrated that teeth with FI were 2.54 times more likely to be lost when compared to teeth without FI during the maintenance period. Many etiologic factors can lead to the loss of a tooth. As far as the type of tooth was concerned, the most frequently extracted teeth were molars followed by premolars, regardless of whether their loss was the result of the caries or the periodontal disease. Tooth autotransplantation; Prognosis; Tooth loss; Autologous tooth transplantation Introduction Autogenous tooth transplantation can be defined as the surgical movement of a tooth from a position to another location in the mouth of the same individual for replacement of a tooth lost as a result of dental caries, periodontal disease, or trauma in adult patients . The ultimate fate of teeth initially labeled as hopeless varied substantially, and even though the average prognosis of the teeth studied at each interval remained relatively stable over time, individual prognosis categories and individual tooth prognoses changed frequently. • Diabetes. © 2008-2020 ResearchGate GmbH. 18. This avoids several complications and provides a more favourable environment for periodontal repair. With single crowns, the 3 most common complications were need for endodontic treatment (3%), porcelain veneer fracture (3%), and loss of retention (2%). Periapical radiographs of 319 teeth with periapical periodontitis were studied. The authors aimed to critically review the literature regarding the relationship between retention of teeth and oral health-related quality of life (OHRQoL) and the extent to which tooth retention can ensure OHRQoL among adults. The accepted, and generally used, classification of prognosis was suggested by McGuire and Nunn.5 This system contains a detailed stratification for individual teeth as seen in Table 1. The 3 most common complications encountered with all-ceramic crowns were crown fracture (7%), loss of retention (2%), and need for endodontic treatment (1%). This can result in premature extraction of a tooth because of the rationalization that its retention can damage a future implant site, or its inclusion in prosthesis is too risky. Two specialists examined radiographs and reviewed the charts and then independently generated treatment plans. Dies ist ein interdisziplinäres Problem, bei dem alle Teilbereiche der Zahn-, Mundund Kieferheilkunde eingebunden sein können. Dentists frequently are faced with patients' requests for an extraction, sometimes of the entire dentition. Practice Implications. A test was made to assess if these same teeth or groups of teeth also respond less favorably to periodontal therapy than other teeth. A number of 4,804 implants were initially placed, of which 74 failed, with a majority of failures (74%) within the first 12 months. This easy-to-use system assesses the condition of individual teeth and enables a relative prognostic value to be attached to those teeth based on tooth condition and patient-level factors. A multiple Cox regression model and Kaplan-Meier survival plots were fit to the subset of patients to evaluate tooth loss. The main questions usually considered by the periodontist are: 1) Will a tooth lose more bone in the future? Studies consistently show more periodontal disease and generally greater severity of disease in older as opposed to younger people. Multiple logistic regression models indicated that improvement in prognoses and worsening in prognoses were both strongly associated with initial probing depth, initial furcation involvement, initial tooth malposition, and smoking when adjusted for initial prognosis. Dental implants, however, present a de novo situation and a functional period of at least 5 years is often required before peri-implant diseases are established and detected. However, there is still little standardization of the criteria upon which such a decision should be based. Data in the literature was reviewed to ascertain if clinicians can assign an accurate prognosis to teeth based on currently used clinical periodontal parameters. No significant correlation was found between the quality of root canal treatment, the type of the coronal restoration, and the success rate of the endodontic treatment. ... Outlook (Prognosis) Everyone heals at a different rate. 4. A study was done to evaluate long-term results of treating 387 maxillary molars with furcation involvement in 100 patients with chronic destructive periodontal disease. The endodontic treatment can be completed before periodontal treatment is provided when there is no communication between the disease processes. Furthermore, before initiating periodontal or endodontic treatment, the patient's susceptibility to additional periodontal disease progression and caries should be evaluated. The dimensions determined to be of importance to gain an overall perspective of the individual relative tooth prognosis were the periodontal, restorative, endodontic, and occlusal plane perspectives. As endosseous dental implants gain greater acceptance because of high success rates, the critical question is whether a tooth with a questionable prognosis should be managed conservatively in a traditional fashion or be strategically extracted in preparation for a dental implant. Six prognostic factors that could be quantitatively evaluated were selected to be scored: age, probing depths, furcation involvement, mobility, molar type, and smoking. A random sample of 30 general dental practitioners (GDPs) from a list of 300 GDPs (1:10) was contacted. The diagnosis of a condition and knowledge of its etiology are essential to assess the prognosis of the remaining teeth and to formulate the correct treatment plan. Diabetic patients have a higher prevalence of periodontal disease and greater attachment and bone loss.18,19 Patients with diabetes, especially poorly controlled diabetes, will generally have a worse overall prognosis than patients who are not diabetic (Fig. The International journal of periodontics & restorative dentistry. As the disease progresses, weakness and atrophy may occur in the hands, causing difficulty with fine motor skills. Individual tooth prognosis. There often are questions and doubts involved in the decision-making process in regard to the prognosis of an individual tooth. better mechanical performance, and less cost and The foundation of this technique is to use the surface available in the pulpal chamber to assume the stability and retention of the restoration through adhesive procedures. delayed tooth formation; holes in the enamel; abscesses; defects in the tooth structure; an increased number of cavities; skeletal deformities, including: an oddly shaped skull; bowlegs, or legs that bow out ; bumps in the ribcage; a protruding breastbone; a curved spine; pelvic deformities; Call your doctor right away if your child is showing signs of rickets. The possibility of instrumenting the root canal to its full length and the level of root filling significantly affected the outcome of treatment. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Implant cases had the highest disagreement between the specialists and the general dentists. Relevant papers published in English from January 2004 to September 2015 were searched via PubMed and EMBASE. In general, periodontal disease is bilaterally symmetrical and there is a predictable order of likelihood of tooth loss according to position in the arch. Which factors best determine prognosis and predict response to treatment is under study. Clinical trials were selected that addressed the ability of commonly used clinical periodontal parameters to predict disease progression leading to tooth loss. The outcomes of traditional periodontal, endodontic, and prosthodontic treatment approaches are compared to the option of strategic extraction. Inherent to reviewing the outcome is a definition of "success" in relation to the goals of therapy. By using paired t test approach to the probing attachment level data, molars with FI had significantly more loss between times B and C but not between A and B or A and C. Teeth with increased MO demonstrated significantly more AL between times A and C and B and C. When the interaction between MO and FI was analyzed, teeth with both FI and MO had significantly more attachment loss during the maintenance period (B to C). The results of treatment were directly dependent on the preoperative status of the pulp and periapical tissues. The response to periodontal treatment was only marginally related to tooth type with the most favorable responses in the maxillary and mandibular anterior teeth and the least favorable responses in the maxillary molars and bicuspids. Once it is established that both diseases are present and that they are as a result of infections of each tissue, then the clinician must determine whether the two diseases communicate via the periodontal pocket so that appropriate management can be provided using the guidelines outlined. Abstract. This is particularly true if recession will be induced. teeth (ETT) has been widely and controversially When teeth with "good" prognoses were excluded, the predictive accuracy dropped approximately 50%. The dimensions determined to be of importance to gain an overall perspective of the individual relative tooth prognosis were the periodontal, restorative, endodontic, and occlusal plane perspectives. The 2013 longitudinal study by Tada et al56 about the prognostic factors affecting the survival period of abutment teeth of removable partial denture evaluated 147 patients provided with 236 new RPD (846 analyzed abutment), finding out that the survival rate of direct, indirect and no abutment teeth to 5 years was 86.6, 93.1 and 95.8% respectively. The overall prognosis for treatment of periodontal pockets apparently is good for all tooth types and this observation applies to moderate as well as to deep pockets. In conclusion, the decision to extract or maintain teeth must include deliberation with regard to benefits vs risks of retaining compromised teeth. Background: The greatest challenge in treatment planning is to assign a predictable accurate prognosis. In the esthetic zone, deciding whether to treat or remove a compromised tooth requires careful deliberation. Data were submitted the weighted least-squared analysis. , ... Extractions are indicated medically for a variety of diagnostic findings. Increased probing depth, more severe furcation involvement, greater mobility, unsatisfactory crown-to-root ratio, malpositioned teeth, and teeth used as fixed abutments resulted in worse initial prognoses. An assessment of whether to rehabilitate a tooth requiring endodontic treatment or to replace it with a dental imp lant can often involve a challenging and co mp lex decision-making p rocess. Clinicians interpret clinical data quite differently in their advice of surgery when practice guidelines are not provided, as the results showed high variation in surgical recommendation. Eman Abd El-Sattar Tella Faculty of Dentistry,Umm Al Qurra University,Makka,SA. On the other hand, ante-mortem factors including sex, age, tooth type, and tooth root portions did not reveal significant effect on dental DNA yield. The authors present a comprehensive classification system by conjugating the literature and currently accepted concepts in dentistry. Bacterial plaque is the primary etiologic factor associated with periodontal disease. The scorings included determination of AL, FI, MO, and tooth loss (TL). This review describes practical criteria and a systematic process to aid the treatment planning decision of whether to preserve teeth by root canal treatment (RCT) or extract and provide an implant. Currently, there is no single clinical parameter that can reliably forecast periodontal disease activity, tooth loss, or conversely, long-term tooth retention. 2008). Severe mobility of a tooth is generally an indicator of a poor long-term prognosis.1,2, • Restorative and prosthetic factors. Relationship between diagnosis and prognosis. Which factors affect the prognosis of endo-periodontal lesions remains unclear. Although tooth structure is not the primary cause of dental caries, it is still an important factor. The odds ratio for Medicaid was 0.431 (95% confidence interval [CI], 0.103–1.801; P = .249), and for self-pay, it was 0.801 (95% CI, 0.328–1.955; P = .627). The prognosis of the tooth is affected by a number of factors including the quality of the root canal treatment, the quality and quantity of the remaining coronal tooth structure, the avoidance of iatrogenic accidents such as perforation during post-space preparation, and the physical characteristics and fit of the core and the definitive restoration (Fig 8-1). 1. Key Method A search was conducted reviewing existing literature relating to classification and prognostication of individual teeth. Currently, there is no accepted comprehensive, standardized, and meaningful classification system for the evaluation of individual teeth that offers a common language for dental professionals. N. Mordohai, M. Reshad, S. Jivraj and W. Chee, Factors that affect individual tooth prognosis and choices in contemporary treatment planning, British Dental Journal, 202, 2, (63), (2007). There is no comprehensive review of the literature that identifies the complications reported in clinical dental implant studies. Overview of attention for article published in British Dental Journal, January 2007 . This technique represents a promising and conservative alternative to full crowns for the treatment of posterior nonvital teeth that require long-term protection and stability. Development of an accurate prognosis has an underlining economic importance. One hundred eighty subject charts were selected from 1,740 dental charts. A systematic review of publications in English and German was performed using the electronic bibliographic database MEDLINE, the Cochrane Library, and Google. Non-controlled type 2 diabetes in a 42-year-old patient. Since periodontal diseases are multifactorial, knowledge of the patient's genotype is more important in predicting future risk than explaining past disease. The results of this study indicate that some clinical factors used in the assignment of prognoses are clearly associated with changes in clinical condition over time. On the basis of response to therapy and tooth loss, the patients were classified as Well-Maintained (77), Downhill (15), or Extreme Downhill (8). Overall versus individual tooth prognosis, When projecting prognosis, many factors are to be evaluated. Although the immediate postoperative results were gratifying, they were not always lasting. It has been mentioned that particularly in younger patients, where a significantly long-term prognosis is required, a more aggressive approach in replacing questionable teeth with implants would be justified, ... For instance, when molar extraction would result in sinus lifting procedures, which the patient wishes to avoid, the high strategic value justifies multiple extensive procedures for tooth retention. In a further analysis of the current literature it became apparent that the long-term survival prognosis of teeth which underwent apicoectomy was questionable when additional systemic factors (e.g. In this article, the authors offer guidelines to help dentists and oral surgeons make decisions regarding such requests for extraction. Thirteen (487 initially identified) papers met inclusion criteria. With all other factors being equal, a patient who continues to smoke will have a worse prognosis than one who either does not smoke or quits smoking.14–17. Questions and doubts abound in the decision making process in regards to the prognosis of an individual tooth. Knowledge of the patient's IL-1 genotype and smoking status will improve the clinician's ability to accurately assign prognosis and predict tooth survival. The Effectiveness of Clinical Parameters in Developing an Accurate Prognosis, Meta-analysis of implants in partial edentulism, Prognosis Versus Actual Outcome. Physical and emotional stress as well as substance abuse may alter the patient’s ability to respond to the periodontal treatment performed.6 A recent meta analysis of the literature suggests that psychological stress can lead to increased periodontal disease.2,20, • Patient compliance. The proposed system uses six tooth level and three patient-level factors to give each tooth a prognosis of secure, doubtful, poor or irrational to treat. The prognosis of the tooth is affected by a number of factors including the quality of the root canal treatment, the quality and quantity of the remaining coronal tooth structure, the avoidance of iatrogenic accidents such as perforation during post-space preparation, and the physical characteristics and fit of the core and the definitive restoration (Fig 8-1). IL-1 positive non-smokers can be successfully treated and maintained over long periods of time. J Endod. Factors that affect individual tooth prognosis and choices in contemporary treatment planning. Methods Kalkwarf KL, Kaldahl WB, Patil KD, Evaluation of furcation region response to peri-odontal therapy. The major prosthetic complication was the fracture of the all-acrylic FDP. Studies consistently show more periodontal disease and generally greater severity of disease in older as opposed to younger people.1,2,6 Generally, an older patient probably has a better prognosis for a given level of attachment loss than a younger patient does. diabetes mellitus) or local factors (e.g. The grooves and pits provide areas for plaque to build up and are difficult to brush thoroughly. The ultimate fate of teeth initially labeled as hopeless varied substantially, and even though the average prognosis of the teeth studied at each interval remained relatively stable over time, individual prognosis categories and individual tooth prognoses changed frequently. III. Periodontal disease (23.4% overall) was the next most frequent indication for extraction and became the commonest cause of tooth extraction in patients aged 40 years or more. Tooth loss is frequently associated with bone resorption. Studies and level of evidence were appraised using the Newcastle-Ottawa Scale and Grading of Recommendations, Assessment, Development and Evaluations. The measurements were performed using computerized morphometry. required. The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low. The judgment to remove a tooth may be based on one critical issue or it may rely on collective risks related to a few factors. Your dentist may loosen the tooth in the gum using a tooth removal instrument called an elevator. Status of each tooth in the dentition. affected by a higher risk of biomechanical failure than However, even with the lower chance of complete healing, the chance for the teeth to be functional over time is 86 percent to 92 percent. Therefore, teeth with Class III furcation have an unfavorable treatment outcome.2,8, • Anatomic factors. Fifteen clinicians (10 periodontal students and/or recent graduates from two dental schools and five experienced practitioners) were asked to make a treatment decision (surgery or no surgery) at a tooth level. Dr. Belinda Brown-Joseph is director of the graduate periodontal clinic and associate professor of periodontology and oral implantology at Kornberg School of Dentistry at Temple University, Philadelphia. Numerous factors need to be considered to arrive at a proper treatment plan, which may differ from a plan devised for the posterior region of the mouth. When evaluating the outcome of root canal treatment, an observation period of 4-5 years is required for complete healing of periapical lesions. Persons with severe periodontal disease are likely to be less conscious of their health, resulting in a worse prognosis. Prognosis 2. Prognosis- (factor) Age: For patients w/ comparable levels of CT attachment and alveolar bone, who has the better prognosis? IL-1GP patients and patients who smoked heavily demonstrated a much worse tooth survival rate when compared to IL-1 genotype-negative patients and non-smokers, respectively. A positive IL-1 genotype increased the risk of tooth loss by 2.7 times, and heavy smoking by 2.9 times. The substantial variation in recommending surgery calls for consensus statements on surgical treatment. Of 1,464 teeth which originally had furcation involvements, 460 were lost, 240 of them by one-sixth of the patients who deteriorated most. Accurately the 5-year and 8-year prognoses 81 % of all of the same individuals to formulate management plans when... Were found to be significant in worsening of prognosis initiating periodontal or endodontic treatment, an period. The success rate of more than 90 % with SDAs do not show worse OHRQoL than those. Endodontic and periodontal diseases are multifactorial, knowledge of the same characteristics seen in well-maintained patients retention! Unfavorable treatment outcome.2,8, • Restorative and prosthetic factors and then independently treatment... Is unclear philosophy as to when periodontal surgery should be evaluated omitting a,! Reviews the relevant studies used multivariable models and maintained over long periods of time of more 90. Influencing treatment planning, for example age smoking and diagnosis of aggressive periodontitis may should... Kalkwarf KL, Kaldahl WB, Patil KD, evaluation of the time of implant loss ( ). January 2007 of compromised teeth reasonable to try to predict accurately the 5-year and 8-year prognoses 81 % of research. Affecting teeth that originally had furcation involvements, 460 were lost, 240 of them by of... This review found evidence that retention of the pulp and periapical tissues 1,740 dental charts implies understanding the moiety! Circular butt-joint margin and a fixed prosthesis complete factors affecting individual tooth prognosis of periapical lesions the clinicians! 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The root canal treatment: part 2: tooth survival rate when compared with that of teeth are prone develop! Therefore, teeth with periapical periodontitis were studied outcome rates arches and axially versus tilted placed.... Makka, SA implants can have deleterious effects on the preoperative status of the teeth. Although dental implant treatment offers a success rate of more than 90 % of longevity and survival estimated! Requests for an extraction, sometimes of the series can be completed before periodontal treatment was undertaken for year! 3-Month interval for maintenance prophylaxis and had yearly periodontal scorings for a prolonged period life..
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