牙周病的预后及治疗方案(英文)
Prognosis and Treatment Plan of Periodontal Disease,Determination of The Prognosis,The prognosis is a prediction of the duration, course, and termination of a disease and its response to treatment. It must be determined after the diagnosis is made and before treatment is planned. Temporary Final,Factors to be considered,Overall Clinical Factors Patient age Disease severity Plaque control Patient compliance,Systemic/ Environmental Factors Smoking Systemic diseasee Genetic factors stress,Local Factors Plaque/calculus Restorations Anatomic factors,Prosthetic/ Restorative Factors Abutment selection Caries Nonvital teeth Root resorption,Determination of The Prognosis,Risk Factors,Prognosis,?,Determination of The Prognosis,Excellent : NO bone loss, excellent gingival condition, good cooperation no systemic factors,Good : adequate remaining bone support, adequate possibilities to control etiologic factors and establish a maintainable dentition, adequate cooperation, no systemic factors/or well controlled,Fair: less-than-adequate remaining bone support, some teeth mobility, Fi:1 adequate maintenance possible, acceptable cooperation, limited systemic factors,Poor: moderat-to advanced bone loss,tooth mobility, Fi:1-2, difficult to- maintain areas/or doubtful cooperation, presence of systemic factors,Questionable: advanced bone loss, tooth mobility, Fi:2-3, inaccessible areas, presence of systemic factors,Hopeless: advanced bone loss, nonmaintainable areas, extraction(s) indicated, presence of uncontrolled systemic factors,P r o v I t i o n a l,Prognosis for Patients with Gingival Disease,If inflammation is the only pathologic change , the prognosis is favorable. If inflammatory changes are complicated by systemically caused tissue changes, gingival health may be improved temporarily through local therapy alone.,Prognosis for Patients with Periodontitis,Overall prognosis Prognosis for individual teeth,A 48-year-old man Generalized chronic marginal gingivitis Periodontal pocket formation Malocclusion Bone loss is slight to- moderate CP overall prognosis favorable,A 20-year-old girl Gingival inflammation Periodontal pockets Pathologic migration Severe bone destruction GAgP,Overall Clinical Factors,Disease Severity,History of previous periodontal disease,Susceptibility for future periodontal breakdown,PD,AL,Degree and type of bony defect,Overall Clinical Factors,Disease Severity,Mild: AL of 1-2mm or loss of the bone covering up to 1/3 0f the root length,Moderate: AL of 3-4mm or loss of the bone covering up to 1/2 0f the root length,Severe: AL of 5+mm or loss of the bone covering greater than 1/2 0f the root length,Overall Clinical Factors,Plaque control,Patient compliance/cooperation,Effective,Desire,Willingness,Ability,Systemic/Environmental Factors,Smoking,The severity of periodontal destruction,The healing potential of the periodontal tissue,Systemic/Environmental Factors,Stress,Prognosis for individual teeth,Tooth Mobility : the principle causes,The destructive degree of periodontal tissue,Location of remaining bone in relation to the individual tooth surfaces,Anatomic Factors,Furcation involvment Tooth morphology,Anatomic Factors,Developmental grooves,Enamel projection,Anatomic Factors,Poor crown:root ratio,Tooth adjacent to edentulous areas Relation to adjacent teeth,Extraction of severely involved tooth to preserve bone on adjacent teeth,Caries, Nonvital teeth, and Root Resorption,For teeth mutilated by extensive caries, the feasibility of adequate restoration and endodontic therapy should be considered before undertaking periodontal treatment The presence of apical disease also worsen the prognosis The periodontal prognosis of treated nonvital teeth is not different from that of vital tooth.,Determination of The Prognosis,Excellent : NO bone loss, excellent gingival condition, good cooperation no systemic factors,Good : adequate remaining bone support, adequate possibilities to control etiologic factors and establish a maintainable dentition, adequate cooperation, no systemic factors/or well controlled,Fair: less-than-adequate remaining bone support, some teeth mobility, Fi:1 adequate maintenance possible, acceptable cooperation, limited systemic factors,Poor: moderat-to advanced bone loss,tooth mobility, Fi:1-2, difficult to- maintain areas/or doubtful cooperation, presence of systemic factors,Questionable: advanced bone loss, tooth mobility, Fi:2-3, inaccessible areas, presence of systemic factors,Hopeless: advanced bone loss, nonmaintainable areas, extraction(s) indicated, presence of uncontrolled systemic factors,P r o v I t i o n a l,The Treatment Plan,After the diagnosis and prognosis have been established, the treatment is planned Unforeseen developments during treatment may necessitate modification of the initial treatment plan Periodontal treatment requires long-range planning The periodontal condition of the teeth are retained is more important than the numb