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Treatment Planning > L6 - risks > Flashcards

L6 - risks Flashcards

1
Q

problem solving requires?

A

requires a DIAGNOSIS and a PROGNOSIS and a calculation of risk –> leads us to a silution

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2
Q

impact of prognosis

A

understanding gives us a way to EVALUATE TREATEMTN ALTERNATIVES

we dont selct treamtnet that we know will lead to a bad outcome

prognosis determine which procedure has best probability to be successful

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3
Q

components of ‘cost’ with decisions in tx

A

financial time, discomfort, and biologic

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4
Q

providers prognosis can be broken down into

A

understanding therapeutic prognosis

understanding therapeutic potentials

knowledge of the literature

experience

operators skills

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5
Q

diagnosis definition

A

the process of identifying and understanding the nature of a PROBLEM or disease

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6
Q

prognosis defintition

A

a prediction of the course and outcome

estimate for recovery from a condition or for success of a therapy

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7
Q

risk definition

A

exposure to loss / the potential of gaining or losing something of value

intentional interaction with uncertainty/ adverse outcome

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8
Q

prognosis gives what to the patient

A

gives them a measure of the possible outcome for a treatment helping them to decide how they wish to proceed

*always a financial, time, discomfort, and biologic cost when treatment decisions are made

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9
Q

patient variables that ‘mess with prognosis’

A

perception of patient

look at their individual teeth

establish overall picture and a sense of outcomes with the patient

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10
Q

risk factors examples

A

heredity

systemic disease or condition (CA,DM)

diet

behavior

stress or environment (anxiety, smoking)

trauma or functional conditions (bruxism)

providers skills and nowledge

perception

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11
Q

list of options for periodontal therapy

A

maintenance

scaling and root planing

pocket reduction /elimination

furcation therapy

one defects and regeneration of lost bone

crown lengthening procedures

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12
Q

which factors usually outnumber

A

patient factos > factors associated with dentistry in terms of success of therapy / prgonosis / risk factors

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13
Q

scaling and root planing elieved to be preventative?

A

No - according to the insurance codes

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14
Q

definition of prophylaxis D1110 CDT-4

A

a PROPHYLAXIS refers to scaling and polishing of the teeth in order to PREVENT oral diseases

for adult patients in a HEALTHY ORAL STATE as well as ANY CONDITION OTHER THAN ACTUAL PERIODONTAL DISEASE WITH BONE LOSS

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15
Q

patient has D4910 means what?

A

they had previous diagnosis of peridontal disease and this is a perio MAINTENANCE program now

POST THERAPEUTIC PROCEUDRE
“following periodontal therapy”

“SITE SPECIFIC SCALING AND ROOT PLANING WHERE INDICATED, AND POLISHIN THE TEETH”

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16
Q

D1110?

A

intended to CONTROL LOCAL IRRITATIONAL FACTORS
– considered maintenance and is for the removal of plaque, calculus, and stains from a tooth structure in permanent and transitional dentition WITH NO SIGNS AND SYMPTOMS OF PERIO DISEASE

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17
Q

code for prophylaxis

A

D1110

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18
Q

code for perio maintenance

A

D4910

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19
Q

code for scaling and root planing

A

D4341

20
Q

root planing involves? / describe

A

scaling the tooths ROOT

removal of deposits on root surfaces / detoxifying the root surface

21
Q

risks / consequences of SRP

A

appearance changes

crown margin exposure

exposed root surfaces

pain / sensitivity

22
Q

does D04910 work?

A

if prognosis was good in beginning – tx does help / tx was successful but if INITIAL PROGNOSIS WAS LESS THAN GOOD – then success rate droped to 40%

23
Q

risk associated with perio therapy

A

risk = clinical SIGNS OF DISEASE ACTIVITY PERSITING following thorough mechanical therapy , such as increased pocket depths, loss of attachment and bleeding on probing

24
Q

pocket reduction / elimniaton/ surgical approach ?

A

removal of deposits on root surfaces / detoxify root surface and reshape the bone to aid in self healing – usually involves making a flap and recontouring

– IMPOSSIBLE TO PREDICT SURVIVAL OF PERIO COMPROMISED TOOH

25
Q

prognosis of perio compormised?

A

impossible to predict if prognosis is less than good – and those used as removable partial denture abutments had an increased risk of tooth loss

26
Q

furcation therapy treatment choices

A
  1. maintenance
  2. regeneration
  3. resection
27
Q

prognosis of maintenance on furcation invlovlemt

A

IMPOSSIBLE – presence of furcation involvment renders complete plaque and calculus removal IMPOSSIBLE

28
Q

regeneration furcation defects in decreasing predictability

A
  1. maxillary or mandibular BUCCAL class II
  2. maxillary mesial or distal class II (harder to access)
  3. maxillary or mandibular class III
29
Q

failure in posterior roots most likely one?

A

DB root

30
Q

regenerating infraabony defects and listt in decreasing predictability

A

three wall — two wall — one wall (nothing to hold graft material into place)

31
Q

can i resort to CLP to save a restorative situation of inadequate toth structure?

A

need to do RISK ANALYSIS

look at amount of tooth structure that is NOT furcated

32
Q

success / mean survival of primary endo tx and implant tx

A

primary endo – 86% and implant 90.9%

33
Q

risk does not end at the RTC procedure?

A

TRUE – need foundatinoal restorations too

  • like cores
  • cores and prefab posts
  • cast post and cores
34
Q

T/F may remove more tooth structure with pre-fab post and core?

A

true

35
Q

ferrule needs to be

A

1.5 to 2mm 360 around the tooth

36
Q

ferrule does what

A

reduces the potential for

  • root fracture
  • post fracture
  • post dislodgment
  • failure of cement seal of artificial crown
37
Q

if post length isnt correct you create?

A

leverage –

38
Q

implicatino if post is 1/4 length of crown

A

force on crown is multiplied by factor of 4

(if crown is double the length of the post – the force of the crown is doubled in the root)

if the ratio is 1:1 the force is equal

39
Q

explain anterior teeth and their need / not need for post /core

A

anterior teeth with excessive loss of coronal tooth structure usually NEED A POST b/c the pulp chamber and single canal are generally NOT ADEQUATE TO RETAIN A CORE , anterior teeth are subject to LATERAL FORCES during function

40
Q

failures of fiber reinforced usually seen where?

A

in ther periapical area

and also debonding of the posts mainly by failure in cementation or during removal of temporary restorations

41
Q

primary concern with fiber posts

A

whether they ALLOW MOVEMENT of the core during function or parafunction

42
Q

main relevant factor in longevity of post and core

A

REMAINING DENTIN AFTER PREP / FERRULE – not necessarily the type of post and core

43
Q

costs (6 categories)

A
  1. biologic
  2. therapeutic
    - like options (implant vs 3 unit bridge)
  3. esthetic
  4. financial
  5. temporal
  6. psychological
44
Q

what should you consider when look into crown lengthen to restore a tooth?

A

crown lengthen procedure will remove bone that could be kept to support an implant and the ridge and not compromise the canine

45
Q

treatment choices are bases on? ** impacted by?

A

PROGNOSIS and RISK ASSESSMENT

which are impacted by
- therapeutic 
$ and biologic cost 
-pain / degree of discomfort 
- time
- self image

Treatment Planning (9 decks)

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