Dental Prosthetics and Restorative Factors

Prognosis of Tooth Mobility

• Tooth mobility caused by inflammation and trauma from occlusion may be correctable.
• Tooth mobility resulting from loss of alveolar bone is not likely to be corrected.

Prognosis for Patients with Gingival Disease

• Biofilm-induced gingivitis is a reversible disease that occurs when bacterial biofilm accumulates at the gingival margin.
• The prognosis is good for patients with biofilm-induced gingivitis.
• Systemic factors, such as endocrine changes, blood dyscrasias, and medications, can influence the inflammatory response and affect the prognosis.
• The long-term prognosis depends on control of bacterial biofilm and correction of systemic factors.

Biofilm-Induced Gingival Diseases Modified by Medications

• Medications, such as phenytoin, cyclosporine, and nifedipine, can cause drug-influenced gingival enlargement.
• The long-term prognosis depends on whether the etiology of the inflammation can be eliminated or the patient's systemic problem can be treated with an alternative medication.

Non–Biofilm-Induced Gingival Lesions

• Non-biofilm-induced gingivitis can be caused by bacterial, fungal, and viral infections.
• The prognosis depends on elimination of the source of the infectious agent.
• Dermatologic disorders, such as lichen planus, pemphigoid, and lupus erythematosus, can manifest in the oral cavity as atypical gingivitis.
• The prognosis is linked to management of the associated dermatologic disorder.

Prognosis for Patients with Periodontitis

• Chronic periodontitis is a slowly progressive disease associated with local environmental factors.
• The prognosis is generally favorable for patients with slight to moderate periodontitis, provided the inflammation can be controlled through good oral hygiene and removal of local biofilm-retentive factors.
• Patients with severe periodontitis, furcation invasion, and tooth mobility may have a questionable or unfavorable prognosis.
• Aggressive periodontitis can present in a localized or generalized form, and the prognosis may be poor to hopeless.
• Smoking cessation can affect the treatment outcome and improve the prognosis.

Systemic Disease or Condition

• The patient's systemic background affects overall prognosis, and the prevalence and severity of periodontitis is significantly higher in patients with diabetes.
• Well-controlled diabetics with slight-to-moderate periodontitis who comply with their recommended periodontal treatment should have a good prognosis.
• Conditions that limit the patient's performance of oral procedures, such as Parkinson's disease, can adversely affect the prognosis.

Genetic Factors

• Genetic factors may play an important role in determining the nature of the host response in periodontal diseases.

Plaque and Calculus

• The microbial challenge presented by bacterial plaque and calculus is the most important local factor in periodontal diseases.

Subgingival Restorations

• Subgingival margins may contribute to increased plaque accumulation, increased inflammation, and increased bone when compared with supragingival margins.
• Discrepancies in these margins, such as overhangs, can negatively impact the periodontium.
• Subgingival margins have a poorer prognosis than teeth with well-contoured, supragingival margins.