Article: Volume 45 Number 6 Page 496 - June 2018

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  Dent Update 2018; 45: 496-505

Periodontics:  Prognostication in Periodontics – Science or Art?

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Abstract: It has long been assumed that clinicians are able to predict the course of periodontal disease and advise patients about the longevity of individual teeth; the evidence challenges this concept and suggests that clinicians are unable to do this with any certainty. Periodontal therapy can be highly effective in the long term and questionable teeth can be retained for long periods. These facts have important implications when deciding whether or not to remove a tooth and consider some form of tooth replacement. The advent of dental implants has further complicated this decision-making process. In addition, the fate of dental implants in periodontally susceptible patients is not as predictable as it is in the periodontally healthy.

Clinical relevance: This paper highlights the difficulties clinicians face when determining the prognosis of periodontally involved teeth in terms of whether to extract or retain such teeth. It also examines the survival of implants in periodontally susceptible patients. ‘Let’s see what happens’ is actually very sensible….time is a powerful diagnostic tool, though many patients are unimpressed by it’ (Raymond Tallis, Hippocratic Oaths 2004).

Author notes: Philip Ower, MSc, BDS, MGDS RCS, Specialist in Periodontics, Briars Dental Centre, 8 St Johns Road, Newbury RG14 7LJ; Past President, British Society of Periodontology; Director, Periocourses Ltd (

Objective: To understand the unpredictability in determining tooth prognosis in the periodontal patient and be aware of the higher risks faced by implants in such patients.