Periodontal Prognosis Assessment

Patient Information

Evaluation Form

Score 1 Score 1 Score 2 Score 2 Score 3 Score 3 Score 4 Score 4
Patient age Patient age
Gingival phenotype Gingival phenotype
Bleeding on Probing (Bop) Bleeding on Probing (Bop)
Clinical attachment loss(CAL) Clinical attachment loss(CAL)
Probing pocket depth Probing pocket depth
Tooth loss Tooth loss
Tooth Mobility(TM) Tooth Mobility(TM)
Furcation Involvement(FI) Furcation Involvement(FI)
Radiographic bone loss Radiographic bone loss
Tobacco Usage Tobacco Usage
Co-morbidities (CM) Co-morbidities (CM)
Patient compliance Patient compliance

Periodontal Prognosis Assessment

Patient age Diagnosis
Patient gender Existing Periodontal Prognosis Overall Individual
Score 1 Score 2 Score 3 Score 4