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Diagnosis & Prognosis
Periodontal Diagnosis:
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Recognizing a departure from normal in the
periodontium and distinguishing one disease
from another.
Based on information obtained from the
medical and dental histories, clinical and
radiographic examination of the patient and
laboratory findings.
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Proper diagnosis is essential to intelligent
treatment
Periodontal diagnosis should first determine
whether disease is present; then identify its
type, extent, distribution, and severity; and
finally provide an understanding of the
underlying pathologic processes and its
cause
CLINICAL DIAGNOSIS
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Medical history
Dental history
extra-oral exam
intra-oral exam
– soft tissue
– hard tissue
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Radiographic Assessment
Periodontal Survey
Medical History
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antibiotic prophylaxis
systemic disease
pregnancy
drug habit
Dental History
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chief complaint
oral habits
history
Extra-oral Exam
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lymph nodes
Intra-oral Exam
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Soft Tissue
– evaluate for an atypical or abnormal
appearances
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Hard Tissue
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malpositioned teeth
caries
restorations
habits
Abfractions
Examination of the
Periodontium
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plaque and calculus
clinical attachment loss
– periodontal pockets
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amount of attached gingiva
furcation
– Class I, II, III
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mobility
– Grade I, II, III
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periodontal abscess
– suppuration
Radiographic Assessment
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Radiographs do not
1. Show periodontal pockets
2. Distinguish between successfully treated
and untreated cases
3. Show structures on buccal, lingual, and
labial aspect of tooth
4. Record tooth mobilty
Radiographic Assessment
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full mouth series
Look At:
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lamina dura
crown:root ratio
interproximal bone
hypercementosis
furcation
involvement
– periapical
pathology
– overhangs
– calculus
– resoption
Predisposing Conditions
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Tipping of teeth
Open contacts
Poor contours of restorations and
overhang margins
Prognosis
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Prognosis:
A prediction as to the progress,
course and outcome of a disease.
Based on:
- current established criteria
- therapeutic judgment and
experience
- documented successes and failures
of the past
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Over all Prognosis:
Concerned with the dentition as a
whole.
Individual Prognosis:
Concerned with individual tooth.
Prognosis
Nature of disease process
a. Rapid (-) vs. chronic (+)
b. Juvenile (-) vs. Adult onset (+)
Systemic Factors (-)
a. Diabetes,
b. Smoking
c. Stress
d. Nutrition
e. Others
Prognosis
Patient age/degree of disease
a. Young (-)
b. Older (+)
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Excellent Prognosis:
No bone loss, excellent gingival condition,
adequate patient cooperation.
Good Prognosis:
One or more of the following:
- adequate remaining bone support.
- adequate possibilities to control etiologic
factors and establish a maintainable
dentition.
- adequate patient cooperation
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Fair Prognosis:
One or more of the following:
- less than adequate remaining bone
support
- some tooth mobility
- grade I furcation involvement
- adequate maintenance possible
- acceptable patient cooperation
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Poor Prognosis:
One or more of the following:
- moderate to advanced bone loss
- tooth mobility
- grade I and II furcation involvement
- difficult to maintain areas
- doubtful patient compliance
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Questionable Prognosis:
One or more of the following:
- advanced bone loss
- grade II and III furcation involvement
- tooth mobility
- inaccessible areas
Hopeless Prognosis:
One or more of the following:
- advanced bone loss
- non maintainable areas