Introduction:
Failure is the state or condition of not meeting a desirable or intended objective, and may be viewed as the opposite of success.
In periodontal treatment, when we don’t achieve the desired results we term it as failure.
Treatment success:
- Bleeding (inflammation) is stopped.
- Pocket activity is eliminated.
- Probing depth is significantly reduced.
- Gain of attachment is achieved
- Tooth mobility is stabilized
Treatment failure:
- Persistent Bleeding on probing
- Symptoms of disease activity in addition to bleeding ie exudate or pus are seen in response to probing,
- Probing depth is not reduced or continues to increase.
- Attachment loss is progressive.
- Tooth mobility is increased
Failures are broadly classified into
- Dentist related failures
- Patient related failures
DENTIST RELATED FACTORS:
- Improper Case history
- Improper diagnosis
- Improper investigations
- Improper treatement sequencing
- Improper selection of technique
- Inadequate motivation
- Irregular follow-ups
Case history:
- Eliciting the signs and symptoms of the disease is very important for a successful treatment planning
- Age: affects prognosis
- Systemic health of the individual : Patient’s immune assessment helps us in deciding the need for either altering or adjusting with the patient’s medical condition/disease.
- Personal habits:
Oral hygiene : lack of maintenance of oral hygiene = failure of therapy
Case history: prime important elict signs and symptoms : reduces risk of failure. A thorough recording of case history is a must
Improper diagnosis:
- Arriving at diagnosis is important : predicting the prognosis and alters treatment plan.
- Error in detecting and recording periodontal findings such
- Soft tissue findings :
- Bleeding on probing, color ,contour consistency, exudation,Recession
- Hard tissue findings :
- Attrition/abrasion/erosion
- ‘wear facets’, occlusal findings, vertical bone defects, furcation involvement, overhangs, root exposure
- Mobility, malocclusion,loss of contacts, plunger cusp etc
Improper investigations:
- Failure to record radiological findings, microbial culture etc
Improper treatment sequencing:
- One of the most important factors governing the success of periodontal therapy.
- Factors like malocclusion, occlusal interferences, mild mobility, faulty restorations, open contacts etc. And so on and so forth, a multitude of factors must be concomitantly corrected in achieving success and overlooking these simple facts could affect the outcome of periodontal therapy.
- Treatment should aim at complete rehabilitation of the patient
Improper selection of technique:
- Improper selection of technique could be a primary trigger that leads to a cascade of events precipitating in failure
Incomplete treatment:
- If the patient fails to turn up for the procedure, it has to be considered a failure of motivation. Thus, at every step one needs to reassure the success of the previous steps to avoid complications or failure.
Inadequate motivation:
- The motivation of the patient is an important parameter as this leads to the improved acceptance and co-operation of the patient which is recognized as a critical factor in the long term success of periodontal therapy.
Irregular follow-ups:
- Regular basis and the patients have to be classified according to the maintenance care that they need.
PATIENT RELATED FACTORS:
- Maintenance
- Smoking
- Systemic diseases.
- Poor healing potential.
- Psychological component – probably the least studied and the most critical aspect in periodontics
- Maintenance
- Utmost important for successful periodontal therapy
- Regular follow-ups
- Smoking
- Smoking affects the outcome of periodontal therapy
- Less cal gain and less ppd reduction versus the smokers
- Systemic health status
- Uncontrolled diabetes
- Hormononal influences
- Hypertension
- Poor healing potential
- Aging
- Diabetic
- Nutritional deficiencies
- Psychological component
Contributor- Dr. Priyanka Jairaj Dalvi
