Bacteria / viral associated with periodontal disease

• 700 different microbial species > 100–200 species commonly colonise an individual’s mouth, reflecting great diversity

pathways for the oral bacteria to exert their effects

• tooth surfaces (either crown or root)• periodontal tissues (either sulcular, junctional

or pocket epithelium lining), • connective tissues (if access is gained via

ulcerated pocket• epithelium) or other bacteria already attached

to these surfaces.

Designated periodontal pathogens: Suspected periodontal pathogensinclude:

• Aggregatibacter actinomycetemcomitans• Porphyromonas gingivalis• Tannerella forsythia

Prevotella intermedia– Split into two distinct speciesPrevotella intermedia andPrevotella nigrescens in 1992• Fusobacterium nucleatum• Campylobacter rectus• Eikenella corrodens• Peptostreptococcus micros• Selenomonas species• Eubacterium species• Spirochaetes– Only 10 cultivated so far

Prognosis of tooth

• Prediction of probable course, duration, and outcome of a disease based on a general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease.

Prognosis of tooth

1. % of bone loss-CAL2. Probing depth3. Distribution and type of bone loss4. (anatomy of intrabony defects)5. Furcation : presence & severity6. Mobility7. Crown to root ratio

8. Bleeding upon probing9. Root morphology10. Pulpal involvement/Caries11. Tooth position and occlusal12. relationship / strategic value/ cost13. Patient risk factor

Recession

PDCAL

How do you use PD and CAL?

• CAL is often used to monitor disease progression- determine prognosis

• PD is commonly used to develop type of treatment- grafting

Glickman’s Furcations

Miller Index Classification:

• 1- First sign of movement greater than normal

• 2 - Up to 1 mm in any direction• 3 - More than 1 mm in any direction and/or

vertical depression

Radiographic exam

• Full-mouth series• Vertical Bite wings• Panorex– developmental anomalies– Pathology– fractures

• Previous radiographs

Classification of PrognosisModified McGuire’s

• Good• Fair• Poor• Questionable• Hopeless

• *Note: the textbook uses the orginial McQuire’s classification. In the Modified McGuire the classification criteria remains the same but the names for questionable and poor have been switched.

Prognosis feature

Excellant No bone lossExcellent gingival conditionGood patient cooperationNo risk factors

Good Adequate remaining bone supportNo or Controlled risk factorsAdequate patient cooperation

Fair 25-40% Attachment LossGrade I furcationAdequate maintenance possibleAcceptable patient cooperation

Questionable 40-50% attachment lossGrade I or II furcationAllows proper maintenance but difficultDoubtful patient cooperationRisk factors present

Prognosis feature

Poor >50% attachment lossInaccessible Grade II furcatioGrade III furcationPoor crown to root ratio with Class 2 or 2+ mobilityRisk factors present or poorly controlled

Hopeless >75% Bone lossNon-maintainable areasGrade III FurcationClass 3 MobilityRecurrent AbscessesUncontrolled risk factors

Overall Factors thatAffect Prognosis

• Age• Medical status/systemic• background• Rate of Progression• Patient Cooperation