1. Laboratory Investigations, Prognosis and Treatment Plan

2. Laboratory Investigations

3. Laboratory Investigations
Laboratory Aids to Clinical Diagnosis:
Radiographs
Blood tests

4. The Periodontal Screening and Recording System (PSR):
Designed for easier and faster screening and recording of the periodontal status of a patient
Instrument:
Specially designed probe that has a 0.5mm ball tip and is color coded from 3.5 – 5.5 mm

5. Procedure: Patient’s mouth is divided into 6 sextants
Each tooth is probed on 6 surfaces – mesiofacial, midfacial, distofacial, mesiopalatal, mid palatal, distopalatal
Deepest finding is recorded
Maxillary right
Maxillary anteriors
Maxillary left
Mandibular
right
Mandibular
anteriors
Mandibular
left

6. Criteria Code Probe’s colored band is completely visible
Gingival tissue is healthy
No BOP
No calculus or defective margins
Patient’s require only preventive care
Code 0
BOP present
Patient’s require subgingival plaque removal & oral hygiene instruction
Code 1
Calculus or defective margins are found
Patient’s require calculus removal correction of plaque retentive margins of restorations & oral hygiene instruction
Code 2

7. Criteria Code Probe’s colored band is partially submerged BOP present
Calculus or defective margins are found
Patient’s require a comprehensive full – mouth periodontal examination, charting is indicated
Code 3
Probe’s colored band is completely submerged (> 5.5mm)
Patient’s require a comprehensive full – mouth periodontal examination, charting & treatment planning is indicated
Code 4
The code number in addition to -
Abnormalities like - furcation involvement, mobility, mucogingival problem, gingival recession
Code *

8. The code finding for each sextant & the date are entered on a sticker, which is placed on the patient’s record

9. Prognosis

10. Prognosis
Prognosis is a prediction of the probable course, duration and outcome of a disease based on the knowledge of the pathogenesis of the disease and presence of risk factors.
It is established after a diagnosis is made
Based on information about disease , physicians knowledge , previous experience

11. Types of Prognosis
Excellent
Good
Fair
Poor
Questionable
Hopeless

12. Criteria
Type of Prognosis
No bone loss
Excellent gingival condition
Good patient cooperation
No systemic or environmental factors
Excellent
Adequate bone remaining
Adequate possibility to control etiologic factors
Adequate patient cooperation
( if present well controlled)
Good
Less than adequate bone remaining
Some tooth mobility
Grade 1 furcation involvement
Adequate maintenance possible
Acceptable patient cooperation
Presence of limited systemic or environmental factors
Fair

13. Criteria
Type of Prognosis
Moderate to advanced bone loss Tooth mobility Grade 1 &2 furcation involvement Difficult to maintain areas Doubtful patient cooperation Presence of systemic or environmental factors
Poor
Advanced bone loss
Tooth mobility
Grade 2 & 3 furcation involvement
Inaccessible areas
Presence of systemic or environmental factors
Questionable
Severe tooth mobility
Non maintainable areas
Extractions indicated
Presence of uncontrolled systemic or environmental factors
Hopeless

14. Types of Prognosis
Overall Prognosis - concerned with the dentition as a whole
Individual Prognosis - concerned with the individual teeth

15. Factors in Determining Prognosis

16. Relationship between Diagnosis and Prognosis
Factors such as –
patient age
severity of disease
genetic susceptibility
presence of systemic disease
Important criteria in the diagnosis of the condition
These are important in developing a prognosis

17. Prognosis for patients with Gingival Disease
Dental plaque induced Gingival Disease
Non plaque induced Gingival Disease
Gingivitis associated with Dental plaque only:
- Reversible
- Plaque removal
Prognosis:
Good

18. Plaque induced Gingival Disease modified by Systemic factors:
- Inflammatory response to bacterial plaque
- Influenced by systemic factors
Prognosis:
Long term prognosis depends not only on control of bacterial plaque but also on control of the systemic factors

19. Prognosis: Plaque induced Gingival Disease modified by Medication:
Drug induced gingival enlargement
Oral contraceptive associated gingivitis
Plaque control alone is not sufficient
Surgical intervention required
Prognosis:
Long term prognosis depends on whether the patient’s systemic problem can be treated with an alternative medication that does not cause gingival enlargement

20. Gingival Disease modified by Malnutrition:
- Vitamin C deficiency
Prognosis:
The prognosis depends on the severity and duration of the deficiency and on the likelihood of reversing the deficiency through dietary supplementation

21. Non plaque induced Gingival Disease:
- Seen in bacterial , fungal, and viral infections
Prognosis:
Prognosis for these patients depends on the elimination of the causative agent

22. Prognosis for patients with Periodontal Disease
Chronic Periodontitis:
- slow progressing
Prognosis:
Slight to moderate periodontitis – Good
Severe disease – Fair to poor prognosis

23. Aggressive Periodontitis:
- Rapid attachment loss & bone destruction
- Familial aggregation
- Use of systemic antibiotics is a must
Prognosis:
Early – Good
Advanced – Fair, Poor, Questionable

24. Periodontal Disease as a manifestation of Systemic condition:
- These disorders manifest early in life
- The impact on the periodontium is similar to AgP
Prognosis:
Fair to Poor

25. Necrotizing Periodontal Disease –
- ANUG
- NUP
Prognosis:
ANUG – Fair
NUP – depends on the systemic condition of patient

26. Revaluation of Prognosis after Phase 1 Therapy
Reduction in pocket depth & inflammation – Favorable prognosis
Inflammation uncontrolled – Unfavorable prognosis
Progression of periodontitis occurs in episodic manner
Advanced ,active lesions - progress rapidly to hopeless stage

27. Treatment Plan

28. Treatment Plan After the diagnosis and prognosis have been established
The treatment is planned
The treatment plan is the blueprint for case management
It includes all procedures required for the establishment & maintenance of Oral Hygiene

29. It includes procedures like -
Decisions to teeth to be retained or extracted
Decisions on techniques to be used for pocket therapy
The need for Mucogingival Surgery / Reconstructive surgery
The need for occlusal correction
The need for temporary or final restorations
The need for orthodontic consultation
Endodontic therapy

30. The Master Plan for Total Treatment
The primary goal is elimination of gingival inflammation and correction of the conditions that cause or perpetuate it
It is important to establish and maintain the health of the periodntium throughout the mouth rather than to tighten loose teeth
The periodontal condition of the teeth to be retained is more important than the number of such loose teeth

31. Sequence of Treatment Plan
Preliminary phase ( Emergency Phase)
Phase I therapy ( Etiotropic Phase)
- Scaling and root planing
Phase II therapy ( Surgical Phase)
- Periodontal surgery
- R.C.T.
Phase III therapy ( Restorative Phase )
- Final restorations
- Fixed prosthesis
Phase IV therapy ( Maintenance Phase )
- Periodic recalls

33. Preferred Sequence of Periodontal Therapy

34. Thank You