giene measures). For example, a young person with periodontal disease will have a more guarded prognosis than an older person with the same disease experience. In the younger person, the disease has followed a more virulent course because of the generally less-developed systemic resistance; these facts should be reflected in treatment planning.
Fixed prostheses function in a hostile environment: the moist oral environment is subject to constant changes in temperature and acidity and considerable load fluctuation. A comprehensive clinical examination helps identify the likely prognosis. All facts and observations are first considered individually and then correlated appropriately.
General Factors. The overall caries rate of the patient's dentition indicates future risk to the patient if the condition is left untreated. Important variables include the patient's understanding and comprehension of plaque-control measures as well as the physical ability to perform those tasks. Systemic problems analyzed in the context of the patient's age and overall health provide important information. Diabetics are prone to a higher incidence of periodontal pathology, and special precautionary measures may be indicated before treatment begins. Such conditions also affect the overall prognosis.
Some patients are capable of an extremely high bite force, whereas others are not. If an elevated muscle tone of hypertrophied elevator muscles is identified during the extraoral examination and multiple intraoral wear facets are observed, loading of the teeth will be considerably higher than in the dentition of a frail 90-year-old who tires easily when asked to close. Other important factors in determining overall prognosis are the history and success of previous dental treatments. If a patient's previous dental care has been successful over a period of many years, a better prognosis can be anticipated than when apparently properly fabricated prosthe-ses fail or become dislodged within a few years of initial placement.
Local Factors. The observed vertical overlap of the anterior teeth has a direct impact on the load distribution in the dentition and thus can have an impact on the prognosis. In the presence of favorable loading, minor tooth mobility is less of a concern than in the presence of unfavorable directed or high load. Impactions adjacent to a molar that will be crowned may pose a serious threat in a younger individual in whom additional growth can be anticipated, but it may be of lesser concern in an older individual.
Individual tooth mobility, root angulation, root morphology, crown-to-root ratios, and many other variables all have an impact on the overall fixed prosthodontic prognosis. They will be addressed later in this book.
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