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DT U.S. Edition, Nov./Dec. 2010, Vol. 5, No. 23

By Belinda Brown-Joseph, DMD, MS; Samia Hardan, DDS, MS; David L. Hoexter, DMD, FACD; Sebastien Dujardin, DDS, MS; and Jon B. Suzuki, DDS, PhD, MBA Systemic and dental factors affecting the prognosis of teeth The greatest challenge in treat- ment planning is to assign a pre- dictable accurate prognosis. In the era of evidence-based dentistry, out- come studies have forced us to re- examine our treatment approaches. Periodontal prognosis refers to the expected longevity of teeth. Determination of periodontal prognosis is an integral part of peri- odontal practice and it influences treatment planning directly whether to treat, retain or remove periodon- tally involved teeth.1,2 The prognosis of whole dentitions or individual teeth is “dynamic” and may require alteration of projections as health status or dental initiatives (e.g., oral hygiene) change. While many considerations from the periodontal literature apply, new information and techniques should be considered to retain teeth or not.2 This article focuses on the prima- ry areas for consideration of devel- opment of prognosis with the under- lining goal of patient and clinical satisfaction and economic stability. Periodontal prognostication systems Historically, the prognosis of a tooth was defined based on tooth loss.3,4 Several authors have formulated and investigated their own prog- nostication systems with variable results, but showed that systems based on tooth loss were unpredict- able over the long term.1 The accepted, and generally used, classification of prognosis was sug- gested by McGuire and Nunn.5 This system contains a detailed stratifica- tion for individual teeth as seen in Table 1. Another system was introduced by Kwok and Caton, which deter- mines prognosis on future periodon- tal stability.1,6 Prognosis is consid- ered “favorable” for teeth when the local or systemic factors can be con- trolled and the periodontal status of the tooth can be stabilized with comprehensive periodontal treat- ment and maintenance. When the local or systemic fac- tors may or may not be controlled, teeth are determined to have a “questionable” prognosis, although the periodontium can be stabilized with comprehensive periodontal treatment and periodontal mainte- nance if these factors are controlled. For teeth with an “unfavorable” prognosis, the local or systemic factors cannot be controlled, and periodontal breakdown is likely to occur even with comprehensive Clinical DENTAL TRIBUNE | Nov./Dec. 201014A AD g DT page 16A Good prognosis Control of the etiologic factors and adequate periodontal support maintainable with good compliance Fair prognosis 25 percent attachment loss, Class I furcations maintain- able with good compliance Poor prognosis 50 percent attachment loss, Class II furcations, Class I furcations Questionable prognosis >50 percent attachment loss, poor root form, Class II fur- cations, 2+ mobility, siginificant root proximity Hopeless prognosis Inadequate attachment, extraction Table 1: McGuire and Nunn Prognostication System