30 November 2023

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How to classify structurally compromised teeth? A novel classification proposal

Lorenzo Breschi

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Introduction: Natural teeth can undergo structural compromissions as a result of caries, fractures and severe wear. In a recent clinical article, Fichera G. et al. introduced a comprehensive, clinically relevant novel classification of structurally compromised teeth (SCT) based on the status of the residual coronal structure and the most apical location of the residual cervical structure, with respect to periodontal tissues. 

Materials and methods: To classify the SCT, standardize the overall preoperative evaluations and determine the biological and mechanical features, authors analyzed various aspects regarding the structure of the tooth and soft tissues. A classification of the coronal and cervical tooth defects, an attentive analysis of the biomechanical and biological characteristics of SCT was presented.

Results/discussion: According to the position of the most apical part of the cervical structure with respect to the gingival margin, gingival sulcus, supracrestal tissue attachment and bone crest, five major different clinical scenarios can be individuated. Within this classification, the authors intend to draw the attention to those challenging clinical situations that can pose clinicians in front of the decision on whether to intervene with direct restorative approaches or refer to more aggressive or time-consuming interventions.

Conclusions: The SCT classification is intended to enhance the existing and offer new standardized operative guidelines, enlarge the spectrum of strategical clinical options for the maintenance of the natural tooth and perform a risk-benefit analysis during diagnostic phases. 

Keywords: bone crest, cervical structure, classification, ferrule, resistance form, structurally compromised teeth, supracrestal tissue attachment 

For more information: Fichera G, Mazzitelli C, Picciariello V, Maravic T, Josic U, Mazzoni A, Breschi L. Structurally compromised teeth. Part I: Clinical considerations and novel classification proposal. J Esthet Restor Dent. 2023 Aug 24. doi: 10.1111/jerd.13117. Epub ahead of print. PMID: 37615505.

Source: https://doi.org/10.1111/jerd.13117