Periodontal Treatment Planning and Prognosis

Periodontal Treatment Plan Goals

Immediate Goals

• Eliminate disease
• Restore oral cavity health state
• Arrest disease progression

Intermediate Goals

• Reconstruct healthy dentition
• Address esthetic requirements
• Endodontic, orthodontic, and periodontal therapy

Long-Term Goals

• Maintain oral health
• Professional supportive therapy

Phases of Periodontal Therapy

Preliminary Phase

Emergency treatment.

Phase I: Nonsurgical Phase

1. Preliminary scaling
2. Scaling and root planing
3. Antimicrobial therapy
4. Diet control
5. Patient motivation
6. Correction of iatrogenic factors
7. Treatment of deep caries
8. Occlusal adjustment
9. Extraction of hopeless teeth

Phase II: Surgical Phase

1. Treatment of pockets greater than 5mm
2. Class II and III furcation involvement
3. Removal of local deposits
4. Distal of last molar treatment
5. Correction of irregular bony contours
6. Removal of gingival enlargement
7. Persistent inflammation management
8. Root coverage procedures

Phase III: Maintenance Phase

Supportive Periodontal Therapy (SPT)

Goals of SPT

• Prevent recurrence and progression of disease
• Prevent tooth loss
• Increase success in treating disease

Objectives of SPT

• Monitor Clinical Attachment Level (CAL)
• Evaluate results of home care for plaque control
• Assess alveolar bone support

Sequence of SPT

1. Charting
2. Clinical data collection
3. Subgingival scaling

Sections of SPT

• Examination, Re-evaluation, and Diagnosis: 10–15 minutes
• Motivation, Re-instruction, and Instrumentation: 5–7 minutes
• Treatment of Reinfected Sites: Polishing, fluoride application, and determining future SPT (8 minutes)

Rationale for SPT

• Limit mechanical and subgingival debridement
• Monitor recolonization of pockets

Factors Affecting Periodontal Prognosis

Overall Prognosis Factors

• Medical status
• Age
• Smoking
• Genetic factors
• Patient cooperation
• Skill of the operator

Individual Tooth Prognosis Factors

Tooth-Related Factors

• Tooth position
• Restorability
• Strategic value
• Tooth morphology (Developmental grooves, root proximity, cervical enamel projections, enamel pearls, bizarre root anatomy)

Site-Related Factors

• Tooth mobility
• Periodontal pocket depth
• Type of periodontal pocket
• Percentage of alveolar bone loss
• Furcation involvement

Prognosis Classification Categories

• Excellent Prognosis: No bone loss, excellent gingival condition, good patient cooperation, no systemic factors, non-smoker.
• Good Prognosis: Less than 25% bone loss, controlled etiologic factors, adequate patient cooperation, well-controlled systemic factors, not a heavy smoker.
• Fair Prognosis: Less adequate remaining bone, 25% attachment loss, Class I furcation, location and depth allow proper maintenance, controlled predisposing factors, Stage II periodontitis.
• Poor Prognosis: 50% attachment loss, Class II furcation, maintenance is difficult, lack of patient compliance or systemic factors, Grade 1+ mobility, poor crown-to-root ratio.
• Questionable Prognosis: Advanced bone loss, 50% attachment loss, Class III furcation, Grade 2+ mobility, root proximity.
• Hopeless Prognosis: Advanced bone loss with less than 1/3 remaining, Grade 3 mobility, non-maintainable areas, uncontrolled systemic factors, cracked tooth syndrome, malposed teeth, vertical tooth fracture.

Risk Factors and Indicators

Risk Factors

• Modifiable: Smoking, poor oral hygiene, hormonal changes, stress, drugs, and Diabetes Mellitus (DM).
• Non-modifiable: Age and hereditary factors.

Risk Indicators and Markers

• Bleeding on Probing (BOP)
• Pocket depth
• History of periodontal disease
• Tooth loss
• Bone loss