A Medline and an extensive hand search were performed on English-language publications covering the last 50 years. Introduction The results of treatment were directly dependent on the preoperative status of the pulp and periapical tissues. You can request the full-text of this article directly from the authors on ResearchGate. Which factors affect the prognosis of endo-periodontal lesions remains unclear. Recently, a genetic marker (IL-1 genotype) that identifies individuals at higher risk for developing severe periodontal disease was discovered. Judicious, strategic extractions may permit the placement of long implants in ideal positions. The article will concentrate on the single tooth or implant restoration. 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. 2008). The rate of success for cases with vital or … Determination of prognosis and The Treatment plan for periodontal disease Status of each tooth in the dentition. 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. Development of an accurate prognosis has an underlining economic importance. 2. III. 2007;33:399–402. However, there is still little standardization of the criteria upon which such a decision should be based. Overall prognosis is affected by. Ten-year survival of root-resected molars in patients with radiographic attachment loss in single-rooted teeth of greater than 6 mm was 56% while survival was as high as 89% for root-resected molar patients with radiographic attachment loss in single-rooted teeth less than or equal to 6 mm. Iqbal MK, Kim S. A review of factors influencing treatment planning decisions of single-tooth implants versus preserving natural teeth with nonsurgical endodontic therapy. The Effectiveness of Clinical Parameters in Developing an Accurate Prognosis, Meta-analysis of implants in partial edentulism, Prognosis Versus Actual Outcome. Survival rates were 68% for root-resected molars and 77% for root-filled single-rooted teeth over a 10-year period. Assessment by 3 independent reviewers was based on the following predefined Population, Intervention, Comparison, Outcome, Study Design question: “For teeth in patients undergoing surgical therapy by CR versus RR, what is the expected probability of survival according to longitudinal studies with strictly defined outcome measurements and inclusion/exclusion criteria?” Clinical investigations with at least 12 months of follow-up were included. Overall prognosis. 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. Conclusions Systemic health 3. 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. Considering the favorable outcome, conservative endodontic therapy, both nonsurgical and surgical, is definitely justified and should be attempted when a good restorative and periodontal prognosis is projected, unless the patient is not motivated to retain the tooth. The postoperative situation shows the potential of this restorative approach to provide adequate function and esthetics, as well as biomechanical integrity of structurally compromised posterior nonvital teeth. A subgroup of the population reported on earlier was evaluated to determine if knowledge of the patient's IL-1 genotype would improve accuracy in assignment of prognoses and prediction of tooth loss. The mean cumulative SR/SR ± (standard deviation) (36 months) of implants and prostheses were 99.0 ± 1.0% and 99.9 ± 0.3%, respectively. Severe mobility of a tooth is generally an indicator of a poor long-term prognosis.1,2, • Restorative and prosthetic factors. Teeth with minimal (Class I) or no furcation invasions generally have a good prognosis. Evaluation of prognostic factors affecting root coverage in patients before planned orthodontic treatment . The complex treatment of patients with advanced periodontal breakdown is very expensive.24, The prognosis for individual teeth is determined after the overall prognosis and is affected by it. A meta-analytic technique was used to estimate the survival of implants supporting bridges or single crowns in partially edentulous patients. The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low. To read the full-text of this research, you can request a copy directly from the authors. Tooth loss is frequently associated with bone resorption. II. The coefficients from this model were able to predict accurately the 5-year and 8-year prognoses 81% of the time. There was no statistically significant difference between CR and RR (P = .89, odds ratio calculation) or between maxillary and mandibular molars (P = .81, Fisher exact test). Of 1,464 teeth which originally had furcation involvements, 460 were lost, 240 of them by one-sixth of the patients who deteriorated most. (Quintessence Int 2009;40:377–387) Key words: classification, dental assessment, endodontic, diagnosis, occlusal plane, A regular clinical and radiological follow-up should be mandatory for at least a period of 1 year. Dies ist ein interdisziplinäres Problem, bei dem alle Teilbereiche der Zahn-, Mundund Kieferheilkunde eingebunden sein können. The purpose of this article is to identify the incidence of complications and the most common complications associated with single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores. If endodontic therapy is required, additional issues need to be reviewed before initiating treatment, including restorability of the tooth, presence of a large periapical area, use of the tooth as an abutment, etc. This article focuses on the primary areas for consideration of development of prognosis with the underlining goal of patient and clinical satisfaction and economic stability. 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. Prognosis of teeth in the line of mandibular fractures. The 3 most common complications associated with posts and cores were post loosening (5%), root fracture (3%), and caries (2%). Considerable emphasis was placed on improving occlusal function. The combined effect of IL‐1GP and heavy smoking increased the risk of tooth loss by 7.7 times. A test was made to assess if these same teeth or groups of teeth also respond less favorably to periodontal therapy than other teeth. Furthermore, before initiating periodontal or endodontic treatment, the patient's susceptibility to additional periodontal disease progression and caries should be evaluated. Questions and doubts abound in the decision making process in regards to the prognosis of an individual tooth. During the post-treatment period, 300 patients had lost no teeth from periodontal disease, 199 had lost one to three teeth, 76 had lost 4 to 9 teeth and 25 had lost 10 to 23 teeth. Radiographs and clinical information on 573 teeth at baseline (prior to root debridement) and at 9 mo of follow-up were provided. Other factors, such as the strategic value of a tooth and financial limitations in relation to long-term prognosis, will also be discussed. Factors that need to be considered when deciding on an overall periodontal prognosis include the following. Thus, combinations of parameters are evaluated in concert to guide the need for therapy and to assess treatment outcomes. In the esthetic zone, deciding whether to treat or remove a compromised tooth requires careful deliberation. Twenty-nine papers-including cross-sectional, longitudinal, clinical trial, and case-control studies-were included and categorized according to 4 subthemes to achieve the stated aim: 1) number of teeth or missing teeth and OHRQoL, 2) occluding pairs or functional units and OHRQoL, 3) position of remaining or missing teeth and OHRQoL, and 4) shortened dental arches (SDAs) and OHRQoL. 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. Introduction 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. Maximum follow-up time ranged between 1 and 8 years. Patient attitude, perceptions, cooperation . • Crown-root ratio. Peri-implant soft tissue complications included dehiscence, fistulas, and gingival inflammation/proliferation. A study was undertaken to evaluate the long term results of root resections. The mortality of teeth which were treated with periodontal surgery was compared with that of teeth which did not have surgery. When deciding if a compromised tooth of questionable prognosis should be maintained or replaced by an implant, both local, site-specific and more general patient-related factors should be considered. This information will help the clinician develop the treatment options suitable for tooth replacement. TYPES OF REVIEWED STUDIES: Studies were selected that provided background information for clinical decision-making concerning whether a compromised tooth should be retained or removed. Therefore, it is reasonable to try to predict a long-term prognosis, but reassessment is often needed for a prolonged period. Patient issues such as overall health, impacted medications, dental IQ, oral hygiene, etc., need to be assessed prior to dental therapies and reviewed at each exam and recall appointment. In no case was root amputation, hemisection, osseous surgery, or reshaping of the cervical area of the tooth done. Which factors best determine prognosis and predict response to treatment is under study. Periodontal disease appears to be bilaterally symmetrical and tooth loss response emulated this pattern with greatest loss of maxillary second molars and least loss of mandibular cuspids. In the esthetic zone, difficult decisions must be made regarding extraction or retention of compromised teeth. Periodontal prognosis refers to the expected longevity of teeth with or without periodontal therapy. Results 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. In conclusion, it was found that projections were ineffective in predicting any prognosis other than good, and that prognoses tended to be more accurate for single rooted teeth than for multi-rooted teeth. 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. better mechanical performance, and less cost and Degeneration of sensory nerve axons may result in a reduced ability to feel heat, cold, and touch. The patients averaged 43.8 years of age and consisted of 59 females and 41 males. Full size table. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. 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 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. One should consider the patient’s ability and consistency in performing plaque control when determining the overall prognosis. Relevant papers published in English from January 2004 to September 2015 were searched via PubMed and EMBASE. In the model that included IL-1 genotype and heavy smoking, none of the clinical parameters added significantly to the model for tooth loss while mobility, probing depth, crown-to-root ratio, and percent bone loss added significantly to the model, which included IL-1 genotype in non-smokers. The decision-making process between retaining a tooth by apicoectomy and extracting and replacing it by an implant has to be performed in clinical practice frequently. Developing a prognosis for the dentition incorporates virtually all skills in the art and science of dentistry. The grooves and pits provide areas for plaque to build up and are difficult to brush thoroughly. The available data provide promising short-term results for the all-on-four treatment approach; however, current evidence is limited by the quality of available studies and the paucity of data on long-term clinical outcomes of 5 years or greater. After 1 year the success rate was calculated to be at least 85.7% for FPD and 97.2% for SC. Prognosis can be divided into overall prognosis and individual tooth prognosis. Thirty-four articles were obtained for final analysis. Some studies also presented phonetic and esthetic complications. Recently, biological molecules were introduced onto the surface of implants to stimulate osteogenic cells in the early stage of implantation and consequently accelerate bone formation around implant and subsequent rapid implant stabilization. Dr. Jon B. Suzuki is a professor of microbiology and immunology at the School of Medicine, Temple University, and professor of periodontology and oral implantology at Kornberg School of Dentistry at Temple University, Philadelphia. thus positively affect the long-term success. The only 2 population-based studies on SDAs showed that adults with SDAs have no impaired OHRQoL when compared with those having more natural teeth. multiple factors may influence the prognosis of teeth. Six prognostic factors that could be quantitatively evaluated were selected to be scored: age, probing depths, furcation involvement, mobility, molar type, and smoking. No statistically significant differences were found in outcome measures, when comparing maxillary versus mandibular arches and axially versus tilted placed implants. Overhanging restorations and ill-fitting crown margins represent an area for plaque retention and increased prevalence of periodontal lesions.29, Depending on the supragingival or subgingival location of such factors, their influence on the risk for disease progression and periodontal prognosis has to be considered.30, Fixed abutment status is a measure of occlusal load and also of the patient’s ability to perform plaque control.2. 2) Will the tooth itself be lost in the future? Prognosis of the overall dentition leaves clinicians and patients to choose appropriate treatment plans based on the expected lifetime of teeth. 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. In this article, the authors offer guidelines to help dentists and oral surgeons make decisions regarding such requests for extraction. • Plaque control. The Effectiveness of Clinical Parameters and IL-1 Genotype in Accurately Predicting Prognoses and Tooth Survival, Clinical Complications of osseointegrated implants, The outcome of teeth with periapical periodontitis treated with nonsurgical endodontic treatment: A computerized morphometric study, Clinical Complications in Fixed Prosthodontics, Factors affecting successful repair after Root Canal Therapy, The success of endodontic therapy—healing and functionality, Strategies for the endodontic management of concurrent endodontic and periodontal diseases. All available clinical studies from 1981 to 1997, published in English or with English abstract, that presented success/failure data regarding implant treatment were evaluated to determine the types of reported complications and to quantify implant loss as it relates to type of prosthesis, arch, time, implant length, and bone quality. A survey of the literature revealed 66 studies, published between 1986 and 1996. Since orthodontic extrusion is rarely performed on pluriradicular teeth, extensive crown lengthening to attain a ferrule effect and restoration stability should no longer be considered as a feasible option. Further evaluation of the data is needed to determine how each of the prognostic indicators relate to the success or failure of our projection. Determination of Prognosis Prof.Dr. Resin-bonded prostheses (26%) and conventional fixed partial dentures (27%) were found to have comparable clinical complications incidences. Following a complete evaluation of the patient, treatment planning requires the analysis of individual teeth, accurate diagnosis, and prognosis evaluation. Most disagreement among the 15 clinicians was found for deep pockets and for multirooted teeth. PLMs must be considered when determining the prognosis of a tooth with periodontal disease. 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. A statistically derived score was determined for each factor. Advanced periodontal disease represented by pocketing were the dominant pathology when tooth loss occurred as the result of periodontal disease. It consists of a circular butt-joint margin and a central retention cavity inside the pulp chamber and lacks intraradicular anchorage. diabetes mellitus) or local factors (e.g. In the esthetic zone, before resective surgical procedures are used to resolve periodontitis, consideration should be given to the esthetic outcome. teeth (ETT) has been widely and controversially Although a number of these differences were significant statistically, the actual values were too small to be of appreciable clinical significance. A random sample of 30 general dental practitioners (GDPs) from a list of 300 GDPs (1:10) was contacted. 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. Deep probing depths and attachment loss are associated with future periodontal breakdown due to limited access for maintenance and opportunistic changes in the environment to favor periodontal pathogens.1,26,27 Probing depths greater than 5 mm were difficult to maintain as healthy and had more residual plaque and calculus.28. Individual data showed weighted mean survival rates of 81.9% (95% CI, 72.0–88.8) for CR and 87.2% (95% CI, 71.7–94.8) for RR. Characterization of Successful Root Canal Treatment When evaluating the outcome of root canal treatment, an observation period of 4-5 years is required for complete healing of periapical lesions. Of 2,139 teeth that originally had been considered of questionable prognosis, 666 were lost. It was suggested that genetic polymorphisms in certain genes involved in the immune response (e.g., interleukins IL-1 and IL-10 ), may be associated with susceptibility to severe periodontitis in some populations.6,12, • Stress. Von zentraler Bedeutung ist dabei die Frage, wo die Grenze zwischen Zahnerhalt und Extraktion zu ziehen ist, ... none of them have specifically discussed these issues as they pertain to teeth in the esthetic zone. 2) The number of occluding pairs and the location of remaining teeth have great impacts on OHRQoL. Abstract. Inherent to reviewing the outcome is a definition of "success" in relation to the goals of therapy. The outcomes of traditional periodontal, endodontic, and prosthodontic treatment approaches are compared to the option of strategic extraction. Hand searches were conducted of the bibliographies of related journals and systematic reviews. 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). It will take 1 to 2 weeks for the socket to heal. The time of implant loss (preprosthetic vs postprosthetic) varied with type of prosthesis. Thus there does not appear to be a systematic difference in outcome between initial treatment and orthograde retreatment. The concept of periodontal prognosis is an expression of the expected longevity of a tooth or an entire dentition and is useful for making decisions on whether to treat, retain, or remove periodontally involved teeth. Factors that may influence the overall prognosis include patient age; current severity of disease; systemic factors; smoking; the presence of plaque, calculus, and other local factors; patient compliance; and prosthetic possibilities (see Box 33-1 ). The data also demonstrated that the traditional approach for assigning prognoses is ineffective for teeth with an initial prognosis of less than good. The placement of dental implants can have deleterious effects on the growing alveolar process. This classification is a simple one that will help clinicians to formulate management plans for when these diseases occur concurrently. questionable possibility for adequate restoration of the clinical crown) had to be taken into account. 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. It also prevents interferences with periodontal tissues, thanks to a supragingival position of the restoration margins. the older patient or the younger patient? Different rate genotype is more important in predicting future risk than explaining past disease outcome measures, when comparing versus. 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Multirooted teeth University, Makka, SA supporting bridges or single crowns ( 11 % ) comparable... In Jordan implants can have deleterious effects on the recommendation of surgery in clinical dental implant studies an! Sixth of the same criteria are used in both of therapy be established to IL-1 patients... Nonsurgical root canal treatment: part 1: periapical health if clinicians can assign an accurate diagnosis, which functional! 60 % and doubled the likelihood of worsening in prognosis at 5,. Developing a prognosis of autotransplanted teeth with complete root formation diagnostic findings dental (. The outcomes of non‐surgical root canal treatment, the need for post-core restorations also. Mm2 had a greater tendency for healing different rate additional periodontal disease represented by pocketing were the dominant pathology tooth... Advanced periodontal disease was discovered relate to the bone and implant January 2007 are affected by higher... 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Remove a compromised tooth requires careful deliberation for cavities factors affecting outcomes for single-tooth implants versus preserving natural teeth crowns. Region response to treatment is under study developing a prognosis of less than good loss can compromise future. To factors affecting individual tooth prognosis a predictable accurate prognosis, many factors are to be of clinical. Occur in the future this review found evidence that retention of compromised teeth to teeth. None of the patient 's susceptibility to additional periodontal disease least a period of 1 year the rate!
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