Protocols for Predictable Aesthetic Dental Restorations

4 Protocols for Predictable Aesthetic Dental Restorations
inaccuracies.  This  usually  results  in  underesti-
mating  disease  severity,  and  necessitates  more
complex and  costly  treatment  later. The aim of
risk  assessment  is  to  tailor  treatment  plans
individually  according  to  a  patient’s  dental
profile,  thereby  moving  away  from  a  ‘repair
model’  to a  ‘wellness model’. This will discour-
age disease recurrence and encourage  long-term
oral health.
Many  studies  have  cited  that  the  two major
dental  diseases,  caries  and  periodontal  disease,
are preventable. This assertion is based on iden-
tifying  and  reducing  risk,  and  implementing
appropriate preventive measures.
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For example,
the diagnosis of severe periodontal disease does
not  imply  a  high  risk  of  periodontal  disease.
Diagnosis assesses current clinical findings, while
risk assesses or predicts  future disease patterns.
This  is  because  traditional  diagnosis  is  two-
dimensional (2D) (clinical examination and radi-
ographs),  which  indicate  disease  severity.  The
third  dimension,  risk  assessment,  is  omitted. A
three-dimensional (3D) diagnosis for periodontal
disease incorporates the following (Fig. 1.7):
! Clinical examination and findings
! Radiographic assessment
! Risk prediction
Using a 2D diagnosis, all patients will be pre-
scribed  the  same  treatment,  irrespective of  risk.
However,  when  individual  patient  risks  are
incorporated  in  a  3D  diagnosis,  the  treatment
plan differs for each patient, even though the 2D
diagnosis is identical. Periodontal risk factors are
crucial  when  considering  implants  or  aesthetic
prostheses.  For  low-risk  patients,  simple
Figure 1.4 CT scan showing insufficient bone for endosseous implant placement (image courtesy of Dr Alan Sidi, UK).