A systematic scoring system to determine the long-term prognosis for severely damaged teeth

Many of the criteria commonly considered in treatment planning for severely damaged teeth are well known to clinicians. However, a systematic approach to decision-making is lacking. The purpose of this article is to introduce a quantitative systematic risk assessment scoring system (RASS) to determine the long-term prognosis for severely damaged teeth based on several important factors. Before any treatment decision is made, the dentist should take into account the role of systemic parameters such as the medical condition of the patient, smoking status, psychological factors, patient expectations with regard to the duration and overall cost of treatment, and periodontal health. In the assessment of local factors, emphasis should be placed on 5 parameters: crown to root ratio, root condition, risk of furcation involvement, complexity of the final restoration, and esthetic results. In the proposed RASS, each of these parameters is ranked using 4 color-coded levels of risk: optimal (green), favorable (blue), unfavorable (yellow), or hopeless (red). The presence of even 1 parameter in the red zone is sufficient to consider tooth extraction. If no parameter is in the red zone, the final decision should be made after the possible effects of all of the clinical conditions are weighed and the overall risk of treatment failure is determined. Clinical decision-making with regard to the preservation or extraction of severely damaged teeth is a challenging, multifactorial process. The RASS introduced in this article focuses on 5 main factors to simplify and organize the decision-making process; however, many other parameters may affect the final treatment decision. Moreover, no decision-making system can be definitively applied to all clinical scenarios, and the entire process depends on the knowledge, experience, and expertise of the clinician.