牙周病的治疗优秀PPT.ppt

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1、QUESTIONQUESTION？Is my disease Is my disease fatalfatal?Will I Will I loselose my teeth?my teeth?Will your treatment Will your treatment helphelp me?me?What can you doWhat can you do to help me?to help me?第第第第 11 11 章章章章 PROGNOSTIC JUDGMENT PROGNOSTIC JUDGMENT TREATMENT PLANNINGTREATMENT PLANNING牙周病

2、的预后和支配牙周病的预后和支配牙周病的预后和支配牙周病的预后和支配PROGNOSISPROGNOSISPrognosisPrognosisForecastForecast预后预后预后预后预料预料预料预料预预预预 后后后后 类类类类 型型型型骨吸收骨吸收 病病 因因 依从性依从性 全身病变全身病变极佳极佳无无可消除可消除良好良好无无良好良好轻轻较差较差中中难消除难消除差差明显明显/未控制未控制极差极差重重整整体体预预后后依依据据病史、年龄病史、年龄疾病类型疾病类型 发展速度发展速度全身因素全身因素 环境因素环境因素患者意愿、依从性患者意愿、依从性菌斑菌斑 牙石量牙石量 解剖解剖牙周破坏程度牙周破

3、坏程度有全身因素的牙龈炎有全身因素的牙龈炎有全身因素的牙龈炎有全身因素的牙龈炎全身因素限制后可以痊全身因素限制后可以痊全身因素限制后可以痊全身因素限制后可以痊愈愈愈愈龈炎的预后龈炎的预后龈炎的预后龈炎的预后单纯性龈炎：良好单纯性龈炎：良好单纯性龈炎：良好单纯性龈炎：良好牙周炎的预后牙周炎的预后牙周炎的预后牙周炎的预后总预后总预后总预后总预后个别牙预后个别牙预后个别牙预后个别牙预后牙周炎总预后牙周炎总预后牙周炎总预后牙周炎总预后对整个牙列预后的评估，内容包括对整个牙列预后的评估，内容包括对整个牙列预后的评估，内容包括对整个牙列预后的评估，内容包括1.1.牙周炎的类型牙周炎的类型牙周炎的类型牙周炎

4、的类型2.2.单因素轻中度单因素轻中度单因素轻中度单因素轻中度CPCP，疗效易，疗效易，疗效易，疗效易巩固巩固巩固巩固3.3.有全身因素的牙周炎，变有全身因素的牙周炎，变有全身因素的牙周炎，变有全身因素的牙周炎，变更多样更多样更多样更多样2.2.骨破坏的速度、程度、类型骨破坏的速度、程度、类型骨破坏的速度、程度、类型骨破坏的速度、程度、类型 3.3.局部因素消退状况局部因素消退状况局部因素消退状况局部因素消退状况:4.4.菌斑、根分叉问题、咬菌斑、根分叉问题、咬菌斑、根分叉问题、咬菌斑、根分叉问题、咬合合合合5.5.牙松动牙松动牙松动牙松动6.6.余留牙的数目、分布；余留牙的数目、分布；余留牙

5、的数目、分布；余留牙的数目、分布；7.7.患者依从性患者依从性患者依从性患者依从性8.8.环境与行为因素环境与行为因素环境与行为因素环境与行为因素9.9.全身、遗传、年龄因素全身、遗传、年龄因素全身、遗传、年龄因素全身、遗传、年龄因素牙周炎个别牙预后牙周炎个别牙预后牙周炎个别牙预后牙周炎个别牙预后1.1.探诊深度、附着水平：探诊深度、附着水平：探诊深度、附着水平：探诊深度、附着水平：2.2.部位？程度？部位？程度？部位？程度？部位？程度？3.3.袋深浅不是确定的因素。袋深浅不是确定的因素。袋深浅不是确定的因素。袋深浅不是确定的因素。4.4.牙槽骨：牙槽骨：牙槽骨：牙槽骨：5.5.破坏部位、程度

6、、根分叉病变；破坏部位、程度、根分叉病变；破坏部位、程度、根分叉病变；破坏部位、程度、根分叉病变；6.6.牙松动度：牙松动度：牙松动度：牙松动度：7.7.自限性？进行性牙松动？自限性？进行性牙松动？自限性？进行性牙松动？自限性？进行性牙松动？8.8.牙解剖：牙解剖：牙解剖：牙解剖：牙周病治疗支配牙周病治疗支配牙周病治疗支配牙周病治疗支配总体目标总体目标总体目标总体目标1.1.限制菌斑、炎症限制菌斑、炎症限制菌斑、炎症限制菌斑、炎症2.2.合理的牙周组织形态合理的牙周组织形态合理的牙周组织形态合理的牙周组织形态3.3.订正：牙周袋订正：牙周袋订正：牙周袋订正：牙周袋 龈退缩龈退缩龈退缩龈退缩4.

7、4.骨缺损骨缺损骨缺损骨缺损 牙松动牙松动牙松动牙松动5.5.牙齿及邻接关系牙齿及邻接关系牙齿及邻接关系牙齿及邻接关系3.3.复原牙周组织功能复原牙周组织功能复原牙周组织功能复原牙周组织功能合理的咬合关系合理的咬合关系合理的咬合关系合理的咬合关系修复失牙修复失牙修复失牙修复失牙戒除不良习惯戒除不良习惯戒除不良习惯戒除不良习惯4.4.维持长期疗效防复发维持长期疗效防复发维持长期疗效防复发维持长期疗效防复发5.5.口腔卫生指导与菌斑限口腔卫生指导与菌斑限口腔卫生指导与菌斑限口腔卫生指导与菌斑限制制制制6.6.定期检查定期检查定期检查定期检查治疗程序治疗程序治疗程序治疗程序主要分为四个阶段主要分为四

8、个阶段主要分为四个阶段主要分为四个阶段第一阶段第一阶段第一阶段第一阶段病因治疗病因治疗病因治疗病因治疗基础治疗基础治疗基础治疗基础治疗INITIAL INITIAL THERAPYTHERAPY消退、限制：致消退、限制：致消退、限制：致消退、限制：致病因素病因素病因素病因素临床炎症临床炎症临床炎症临床炎症包括下列方法：包括下列方法：包括下列方法：包括下列方法：1.1.自我限制菌斑的方法：自我限制菌斑的方法：自我限制菌斑的方法：自我限制菌斑的方法：2.2.刷牙方法和习惯；刷牙方法和习惯；刷牙方法和习惯；刷牙方法和习惯；3.3.牙线和牙签；牙线和牙签；牙线和牙签；牙线和牙签；4.4.菌斑显示剂检查

9、菌斑显示剂检查菌斑显示剂检查菌斑显示剂检查5.5.漱口剂漱口剂漱口剂漱口剂2.2.拔除病牙拔除病牙拔除病牙拔除病牙3.3.洁治、刮治、根面平洁治、刮治、根面平洁治、刮治、根面平洁治、刮治、根面平整术整术整术整术4.4.药物限制感染药物限制感染药物限制感染药物限制感染5.5.咬合调整咬合调整咬合调整咬合调整6.6.治疗龋齿，矫正不良治疗龋齿，矫正不良治疗龋齿，矫正不良治疗龋齿，矫正不良修复体和食物嵌塞修复体和食物嵌塞修复体和食物嵌塞修复体和食物嵌塞7.7.处理牙周处理牙周处理牙周处理牙周-牙髓病变牙髓病变牙髓病变牙髓病变1 1stst阶段结束后阶段结束后阶段结束后阶段结束后4646周再评估，确认

10、周再评估，确认周再评估，确认周再评估，确认疗效、依从性、治疗方案疗效、依从性、治疗方案疗效、依从性、治疗方案疗效、依从性、治疗方案其次个阶段其次个阶段其次个阶段其次个阶段牙周手术治疗牙周手术治疗牙周手术治疗牙周手术治疗并非每个患者都要进行并非每个患者都要进行并非每个患者都要进行并非每个患者都要进行牙周手术目的牙周手术目的牙周手术目的牙周手术目的清除袋内感染物清除袋内感染物清除袋内感染物清除袋内感染物根面平整根面平整根面平整根面平整治疗牙槽骨缺损治疗牙槽骨缺损治疗牙槽骨缺损治疗牙槽骨缺损订正龈及膜龈畸形订正龈及膜龈畸形订正龈及膜龈畸形订正龈及膜龈畸形基础治疗后基础治疗后基础治疗后基础治疗后131

11、3月全面评估月全面评估月全面评估月全面评估手术的种类手术的种类手术的种类手术的种类1.1.牙龈切除术牙龈切除术牙龈切除术牙龈切除术切除肥大增生的牙龈切除肥大增生的牙龈病理性牙周袋病理性牙周袋2.2.翻瓣术翻瓣术翻瓣术翻瓣术3.3.牙周骨手术牙周骨手术牙周骨手术牙周骨手术骨修整术、植骨骨修整术、植骨4.4.GTRGTR5.5.膜龈手术膜龈手术膜龈手术膜龈手术6.6.牙种植术牙种植术牙种植术牙种植术第三阶段第三阶段第三阶段第三阶段修复治疗阶段修复治疗阶段修复治疗阶段修复治疗阶段并非每个患者都要进行并非每个患者都要进行2 2stst阶段后阶段后阶段后阶段后2323月进行月进行月进行月进行松牙固定松牙

12、固定松牙固定松牙固定义齿修复、正畸义齿修复、正畸义齿修复、正畸义齿修复、正畸第四阶段第四阶段第四阶段第四阶段疗效维护期疗效维护期疗效维护期疗效维护期1st1st阶段后无论是否须要进行阶段后无论是否须要进行阶段后无论是否须要进行阶段后无论是否须要进行2 2、3 3阶段治疗即应当起先，内容包括：阶段治疗即应当起先，内容包括：阶段治疗即应当起先，内容包括：阶段治疗即应当起先，内容包括：1.1.定期复查定期复查定期复查定期复查1.1.时间：一般时间：一般时间：一般时间：一般3636个月个月个月个月1 1次。次。次。次。2.2.内容：内容：内容：内容：3.3.PLIPLI、CICI、DIDI、GIGI、

13、BOPBOP、PDPD、4.4.附着水平、牙松动度、附着水平、牙松动度、附着水平、牙松动度、附着水平、牙松动度、5.5.咬合状况、骨高度、密度、咬合状况、骨高度、密度、咬合状况、骨高度、密度、咬合状况、骨高度、密度、6.6.危急因素：吸烟、全身疾病危急因素：吸烟、全身疾病危急因素：吸烟、全身疾病危急因素：吸烟、全身疾病2.2.复治复治复治复治依据发觉的问题进行新依据发觉的问题进行新依据发觉的问题进行新依据发觉的问题进行新一轮的治疗与疗效维护一轮的治疗与疗效维护一轮的治疗与疗效维护一轮的治疗与疗效维护牙周治疗与院内感染牙周治疗与院内感染牙周治疗与院内感染牙周治疗与院内感染P P163-16416

14、3-164自学自学自学自学OVEROVERTHANKSTHANKS牙周治疗与院内感染牙周治疗与院内感染牙周治疗与院内感染牙周治疗与院内感染交叉感染交叉感染交叉感染交叉感染 是医院内感染是医院内感染是医院内感染是医院内感染(NOSOCOMIAL(NOSOCOMIAL INFECTION)INFECTION)中的重要内容之一。中的重要内容之一。中的重要内容之一。中的重要内容之一。医院感染的传播途径有：医院感染的传播途径有：医院感染的传播途径有：医院感染的传播途径有：干脆接触病损、血液、体液、龈沟液、菌斑等；干脆接触病损、血液、体液、龈沟液、菌斑等；干脆接触病损、血液、体液、龈沟液、菌斑等；干脆接触

15、病损、血液、体液、龈沟液、菌斑等；吸人含致病菌的气雾或飞溅物吸人含致病菌的气雾或飞溅物吸人含致病菌的气雾或飞溅物吸人含致病菌的气雾或飞溅物(如血液、唾液等如血液、唾液等如血液、唾液等如血液、唾液等)；间接接触间接接触间接接触间接接触(污染器械、手、治疗台等传染媒体污染器械、手、治疗台等传染媒体污染器械、手、治疗台等传染媒体污染器械、手、治疗台等传染媒体)；手机供水管道中的存水返流人口中。手机供水管道中的存水返流人口中。手机供水管道中的存水返流人口中。手机供水管道中的存水返流人口中。我国人群中我国人群中我国人群中我国人群中HBVHBV携带者约占携带者约占携带者约占携带者约占10%10%，艾滋病、

16、梅毒等也有增多的趋势。艾滋病、梅毒等也有增多的趋势。艾滋病、梅毒等也有增多的趋势。艾滋病、梅毒等也有增多的趋势。牙周诊室限制感染牙周诊室限制感染牙周诊室限制感染牙周诊室限制感染特点及原则特点及原则特点及原则特点及原则病史采集及必要的检查病史采集及必要的检查病史采集及必要的检查病史采集及必要的检查重视询问全身疾病、传重视询问全身疾病、传重视询问全身疾病、传重视询问全身疾病、传染性疾病。染性疾病。染性疾病。染性疾病。“一样对待一样对待一样对待一样对待”原则原则原则原则universal precautionuniversal precaution即假定每位患者均有血即假定每位患者均有血即假定每位患

17、者均有血即假定每位患者均有血源性传播的感染性疾病，源性传播的感染性疾病，源性传播的感染性疾病，源性传播的感染性疾病，诊治中一律严格防交叉诊治中一律严格防交叉诊治中一律严格防交叉诊治中一律严格防交叉感染，必要时作有关的感染，必要时作有关的感染，必要时作有关的感染，必要时作有关的化验检查。化验检查。化验检查。化验检查。治疗器械的消毒治疗器械的消毒治疗器械的消毒治疗器械的消毒 按器械分类、分别用按器械分类、分别用按器械分类、分别用按器械分类、分别用不同的方法消毒。不同的方法消毒。不同的方法消毒。不同的方法消毒。“双消毒双消毒双消毒双消毒”：对运用过：对运用过：对运用过：对运用过的器械应实行消毒液浸的

18、器械应实行消毒液浸的器械应实行消毒液浸的器械应实行消毒液浸泡、超声波或手工清洗、泡、超声波或手工清洗、泡、超声波或手工清洗、泡、超声波或手工清洗、清水冲净干燥、高压灭清水冲净干燥、高压灭清水冲净干燥、高压灭清水冲净干燥、高压灭菌或其他消毒方法。菌或其他消毒方法。菌或其他消毒方法。菌或其他消毒方法。大型设备如综合治疗台大型设备如综合治疗台大型设备如综合治疗台大型设备如综合治疗台表面等，表面等，表面等，表面等，可用牢靠的消毒剂进行可用牢靠的消毒剂进行可用牢靠的消毒剂进行可用牢靠的消毒剂进行表面擦拭等。表面擦拭等。表面擦拭等。表面擦拭等。应尽量运用已消毒的一次性用品应尽量运用已消毒的一次性用品应尽量

19、运用已消毒的一次性用品应尽量运用已消毒的一次性用品(如检查器、吸唾器、注射器等如检查器、吸唾器、注射器等如检查器、吸唾器、注射器等如检查器、吸唾器、注射器等)。一人一机。一人一机。一人一机。一人一机。也可也可也可也可2%2%碘酊擦拭手机的各部位，酒精碘酊擦拭手机的各部位，酒精碘酊擦拭手机的各部位，酒精碘酊擦拭手机的各部位，酒精脱碘脱碘脱碘脱碘2 2次，次，次，次，也可用也可用也可用也可用1%1%碘附消毒。碘附消毒。碘附消毒。碘附消毒。爱护性屏障爱护性屏障爱护性屏障爱护性屏障口罩、帽子、防护眼镜、口罩、帽子、防护眼镜、口罩、帽子、防护眼镜、口罩、帽子、防护眼镜、面罩、手套、工作服等面罩、手套、工

20、作服等面罩、手套、工作服等面罩、手套、工作服等治疗过程中，治疗过程中，治疗过程中，治疗过程中，污染的手套不得随意触摸污染的手套不得随意触摸污染的手套不得随意触摸污染的手套不得随意触摸四周的物品，四周的物品，四周的物品，四周的物品，治疗结束后治疗结束后治疗结束后治疗结束后应清洗手套上的血污后再应清洗手套上的血污后再应清洗手套上的血污后再应清洗手套上的血污后再摘除手套，书写病历等。摘除手套，书写病历等。摘除手套，书写病历等。摘除手套，书写病历等。尽量运用脚控开关来调整治疗椅尽量运用脚控开关来调整治疗椅尽量运用脚控开关来调整治疗椅尽量运用脚控开关来调整治疗椅照明灯扶手、开关等可用一次性照明灯扶手、开

21、关等可用一次性照明灯扶手、开关等可用一次性照明灯扶手、开关等可用一次性覆盖物覆盖。一次性器械及覆盖覆盖物覆盖。一次性器械及覆盖覆盖物覆盖。一次性器械及覆盖覆盖物覆盖。一次性器械及覆盖物在用毕后应妥当、单独回收，物在用毕后应妥当、单独回收，物在用毕后应妥当、单独回收，物在用毕后应妥当、单独回收，作必要的销毁。作必要的销毁。作必要的销毁。作必要的销毁。削减治疗椅四周空气中的细菌量削减治疗椅四周空气中的细菌量削减治疗椅四周空气中的细菌量削减治疗椅四周空气中的细菌量治疗前治疗前治疗前治疗前1%1%过氧化氢或过氧化氢或过氧化氢或过氧化氢或0.12%0.12%氯己氯己氯己氯己定液鼓漱一分钟，削减患者口中定

22、液鼓漱一分钟，削减患者口中定液鼓漱一分钟，削减患者口中定液鼓漱一分钟，削减患者口中的细菌数量、治疗时的气雾污染。的细菌数量、治疗时的气雾污染。的细菌数量、治疗时的气雾污染。的细菌数量、治疗时的气雾污染。诊室内应有良好的通风。诊室内应有良好的通风。诊室内应有良好的通风。诊室内应有良好的通风。不在诊室内饮水和进食。不在诊室内饮水和进食。不在诊室内饮水和进食。不在诊室内饮水和进食。治疗台水管系统的消毒、治疗台水管系统的消毒、治疗台水管系统的消毒、治疗台水管系统的消毒、阻挡水回流的装置；阻挡水回流的装置；阻挡水回流的装置；阻挡水回流的装置；在每位患者治疗结束后，再空放水在每位患者治疗结束后，再空放水在

23、每位患者治疗结束后，再空放水在每位患者治疗结束后，再空放水3030秒；秒；秒；秒；每天起先工作前再冲水一至数分钟。每天起先工作前再冲水一至数分钟。每天起先工作前再冲水一至数分钟。每天起先工作前再冲水一至数分钟。国外建议超声波洁牙机运用单独的净水储国外建议超声波洁牙机运用单独的净水储国外建议超声波洁牙机运用单独的净水储国外建议超声波洁牙机运用单独的净水储水器，并每周用水器，并每周用水器，并每周用水器，并每周用1:101:10的次氯酸钠液冲储水的次氯酸钠液冲储水的次氯酸钠液冲储水的次氯酸钠液冲储水系统，随后马上用蒸馏水冲洗。系统，随后马上用蒸馏水冲洗。系统，随后马上用蒸馏水冲洗。系统，随后马上用蒸

24、馏水冲洗。严格遵守限制医院感染的原则，严格遵守限制医院感染的原则，严格遵守限制医院感染的原则，严格遵守限制医院感染的原则，使病原微生物的扩散和环境的污染使病原微生物的扩散和环境的污染使病原微生物的扩散和环境的污染使病原微生物的扩散和环境的污染降低到最小的程度。降低到最小的程度。降低到最小的程度。降低到最小的程度。爱护患者和医务人员的利益平安。爱护患者和医务人员的利益平安。爱护患者和医务人员的利益平安。爱护患者和医务人员的利益平安。Treatment can alter Treatment can alter prognosis.prognosis.Prognosis has different

25、 Prognosis has different connotations and nuances.connotations and nuances.The The patient has every rightpatient has every right to to know the answers to these know the answers to these questions.questions.QuestionQuestion？Is my disease Is my disease fatalfatal?Will I Will I loselose my teeth?my t

26、eeth?Will your treatment Will your treatment helphelp me?me?What can you doWhat can you do to help me?to help me?What are the What are the therapeutictherapeutic odds?odds?What are the What are the financialfinancial risks?risks?What are the What are the chanceschances that the that the treatment wi

27、ll be of treatment will be of benefitbenefit?Prognosis has Prognosis has three meaningsthree meanings in dentistry.in dentistry.Diagnostic prognosis.Diagnostic prognosis.What are evaluations of the course What are evaluations of the course of the disease of the disease without treatmentwithout treat

28、ment?What is the What is the status of the teeth nowstatus of the teeth nowWhat is the anticipated What is the anticipated future of future of these these teethteeth?Therapeutic prognosis.Therapeutic prognosis.Given Given the state of the artthe state of the art and and science of periodontics and t

29、he science of periodontics and the knowledge and skillknowledge and skill of the of the practitioner,what practitioner,what effecteffect will will periodontal treatment have on the periodontal treatment have on the course of the disease?course of the disease?Prosthetic prognosis.Prosthetic prognosis

30、.What is the What is the forecastforecast for the for the success of the prosthetic success of the prosthetic restoration?restoration?Will the prosthesis be Will the prosthesis be therapeutic therapeutic or detrimentalor detrimental?What What specific needs dictatespecific needs dictate that it that

31、 it be prescribed?be prescribed?Judgement of the severity Judgement of the severity depends on depends on：1.pocket depth,1.pocket depth,2.degree of bone loss,2.degree of bone loss,3.tooth mobility,3.tooth mobility,4.crown-root ratio.4.crown-root ratio.generalized or localizedgeneralized or localized

32、The distribution of diseaseThe distribution of disease：Inflammatory factors Inflammatory factors：Traumatic factorsTraumatic factors：Individual tooth Individual tooth therapeutic prognosistherapeutic prognosisincludes such factors as includes such factors as：PercentagePercentage of bone loss;of bone

33、loss;Probing Probing depthdepth;Distribution and typeDistribution and type of of bone lossbone lossPresence and severity ofPresence and severity of furcation involvementsfurcation involvementsMobilityMobilityCrown-root ratioCrown-root ratioPulpal involvementPulpal involvementTooth position and occlu

34、salTooth position and occlusalStrategic valueStrategic valueFollowing areFollowing are factors factors included in included in overall prognosis:overall prognosis:AgeAgeMedical statusMedical statusIndividual tooth prognosesIndividual tooth prognoses (distribution and severity)(distribution and sever

35、ity)Degree of involvementDegree of involvement,duration,duration,andand history history of the of the disease(rate of progression)disease(rate of progression)Patient cooperationPatient cooperationEconomic considerationsEconomic considerationsKnowledge and ability Knowledge and ability of the of the

36、dentistdentistEtiologic factorsEtiologic factorsAccuracy and completeness Accuracy and completeness of the of the information gatheredinformation gathered at the examinationat the examinationDentists abilityDentists ability to recognize to recognize and eliminate or control the and eliminate or cont

37、rol the factors causing the diseasefactors causing the diseasethe the patients abilitypatients ability and and determination in determination in maintaining the health of maintaining the health of the periodontium and teeth.the periodontium and teeth.The overall prognosis The overall prognosis depen

38、ds on the prognoses depends on the prognoses of the individual teeth.of the individual teeth.PAST HISTORYPAST HISTORY (RATE OF DESTRUCTION)(RATE OF DESTRUCTION)Probably the most Probably the most important factor in important factor in forecasting the future health forecasting the future health stat

39、us of a dentition is status of a dentition is knowledge of its past health knowledge of its past health status.status.SpeedSpeed of breakdown under of breakdown under controls or uncontrols controls or uncontrols The The locationlocation,shapeshape and and depthsdepths of the pockets of the pocketsT

40、ooth mobility can be Tooth mobility can be controlled or eliminated,the controlled or eliminated,the prognosis is better.prognosis is better.The greater the bone loss,The greater the bone loss,the poorer the prognosis.the poorer the prognosis.As bone loss exceeds 50%,As bone loss exceeds 50%,the pro

41、gnosis worsens the prognosis worsens rapidly.rapidly.The more irregular the The more irregular the bone loss,the poorer the bone loss,the poorer the prognosis.prognosis.the pattern of bone lossthe pattern of bone loss:horizontal,vertical or horizontal,vertical or infrabony defects.infrabony defects.

42、the age of the patient and the age of the patient and the etiologic factors involved the etiologic factors involved in the patients disease.in the patients disease.poorer prognosis:poorer prognosis:tilted,drifted,or rotated,tilted,drifted,or rotated,hygiene difficult,elimination hygiene difficult,el

43、imination of pockets impairedof pockets impairedperiodontal disease is periodontal disease is complicated by active complicated by active systemic factors systemic factors and traumatismand traumatismmorphologicmorphologic in nature and in nature and include the include the numbernumber and and dist

44、ributiondistribution of teeth,tooth of teeth,tooth morphology,morphology,furcationfurcation involvement.involvement.Extent of involvement.Extent of involvement.Is the furcation partially or Is the furcation partially or totally involved?totally involved?Status of bone support.Status of bone support.

45、If the bone levels are If the bone levels are relatively sound,the effort to relatively sound,the effort to save may be justifiable.save may be justifiable.Root length and crown-root Root length and crown-root ratio must be consideredratio must be consideredAngulation of root Angulation of root spre

46、ad.spread.Health of Health of neighboring teeth.neighboring teeth.The number and distribution The number and distribution of teeth presentof teeth presentcrown-root ratio,crown-root ratio,shape and number of the shape and number of the root root the height of the alveolar the height of the alveolar

47、crestcrestpersonal psychologic personal psychologic and sociologic,and sociologic,financial considerations.financial considerations.OTHER OTHER CONSIDERATIONS IN CONSIDERATIONS IN ESTABLISHING ESTABLISHING PROGNOSISPROGNOSISThe performance of The performance of home home carecare is acceptable and t

48、he is acceptable and the cariescaries incidence is low,incidence is low,the prognosis is betterthe prognosis is better The prime consideration is The prime consideration is the the preservation of the preservation of the dentitiondentition as a functioning as a functioning unit.unit.In some instance

49、sIn some instancesthe extraction of a single tooth the extraction of a single tooth will make the whole situation will make the whole situation untenable.untenable.In other situationsIn other situations isolated extractions will simplify isolated extractions will simplify the problem.the problem.wha

50、t is considered to be a what is considered to be a hopeless tooth.hopeless tooth.This will make treatment This will make treatment planning simpler.planning simpler.the the characteristics characteristics of hopelessof hopeless periodontally involved teeth:periodontally involved teeth:Associated wit