Top tips for treatment planning: tooth-by-tooth prognosis - Part 1: restorative prognosis

Assessing the likelihood of a tooth's long-term stability within a patient's oral cavity, thereby determining its suitability for inclusion in comprehensive rehabilitation, poses a formidable challenge in the field of dentistry. 1As treatment complexity increases, designing a well-structured and achievable treatment plan becomes increasingly important.Whilst the treatment plan often needs adaptation as treatment progresses, it serves as a useful road map for the stages of treatment.The foundation of robust treatment planning hinges upon accurate diagnosis and prognosis evaluations, particularly when exploring various treatment options. 1 Prognosis, in this context, refers to the predictive estimation of the probable course and outcome of a dental condition, as well as the likelihood of recovery. 2This prognostic assessment operates on two distinct levels: the patient level and the individual tooth level. 1 In the evaluation of patient-level prognosis, factors such as biologic risks, environmental influences, financial, behavioural, and personal considerations must be taken into account.Once relevant clinical information has been gathered along with necessary investigations (eg, radiographs) the phase prior to developing the treatment plan involves considering individual tooth by tooth prognosis.This is a key stage and allows an open discussion in the consent process as to what teeth can and cannot be saved so that the patient enters the treatment pathway with sufficient information to provide informed consent. 3,4ooth-specific prognosis examines three critical areas: Restorative, Periodontic, Endodontic, assessments for each tooth (Fig. 1).In part 1 of this series, we focus on the restorative prognostic factors. Classification system for assessing prognosisVarious classifications have been suggested in the literature 5 for toothby-tooth prognosis, encompassing terminology such as 'favourable' and 'questionable ' , 6 or employing prognostic categories of 'good' , 'questionable' , and 'hopeless' . 7Some systems utilise descriptors like 'good ' , 'fair' , 'poor' , 'questionable' and 'hopeless' . 8 In order to enhance accessibility and reader comprehension, the present article adopts a simplified approach, utilising the terms 'good' , 'questionable' and 'poor' to characterise prognosis.