Structurally compromised teeth. Part I: Clinical considerations and novel classification proposal
Guido Fichera, Claudia Mazzitelli, Vincenzo Picciariello, Tatjana Maravic, Uros Josic, Annalisa Mazzoni, Lorenzo Breschi- General Dentistry
Abstract
Objective
A comprehensive classification of structurally compromised teeth (SCT) was introduced.
Clinical Considerations
Dental injuries or operative mismanagement undermine the structural integrity of the tooth abutment, reducing its biomechanical strength and rendering restorative procedures challenging. To standardize the overall pre‐operative evaluations and determine the biological and mechanical features, a classification of the coronal and cervical tooth defects, as well as an attentive analysis of the most apical location of the residual cervical tooth structure along the whole perimeter and the most coronal location of the bucco/lingual residual structure was presented. Considering the residual cervical structure, five possible clinical scenarios were individuated with respect to the gingival margin, gingival sulcus, supracrestal tissue attachment and bone crest (BC). The latter prevents the isolation procedures rendering the adhesive restorations unfeasible. Instead, the location of the most apical portion of residual cervical structure within subgingival/intrasulcular depth (>1.5 mm above BC) can be considered restorable.
Conclusions
This classification is threefold: to enclose all the possible clinically encountered tooth defects, to identify the apical problems of SCT to appropriately manage the perio‐restorative interfaces, and to evaluate the tooth resistance capacity of SCT, as to plan and perform the most adequate biomechanical restorative approach.
Clinical Significance
The present classification is proposed to provide a complete perspective of structurally compromised teeth to standardize the biologic and biomechanical evaluations during planning of restorative procedures.