Do we really know how to evaluate tooth prognosis? A systematic review and suggested approach

Periodontal treatment is based on tooth prognosis evaluation. Different approaches for determining tooth prognosis have been described in the literature. The vast majority are based on clinical and radiographic findings, as well as patient-related factors. The availability of various systems for assigning tooth prognosis complicates both the assignment process and the communication between clinicians regarding patient status and treatment plan. In addition, performance evaluation of several systems reveals that the accuracy of prediction differs between teeth of various conditions in most methods, as well as the factors providing significant predictive power. As a standardized prognostic classification system is still lacking, an overall evaluation based on a uniform dataset could provide an objective comparison of all methods, and help progress towards developing novel approaches. The main features of such approaches should include the selection of predictive factors, their assigned weights in accordance with different tooth conditions, and the estimated period of time applicable for reevaluation of prognosis. In this paper, we propose a different approach for prognosis evaluation, suggesting reevaluating tooth prognosis at several time points during the treatment plan, and taking into consideration some of the most important issues of patient compliance, oral hygiene, and plaque control. The suggested approach attempts to address prognosis from a different perspective, viewing the process as a dynamic and recurring evaluation embedded within each step of the treatment plan. Due to the fact that accurate tooth prognosis evaluation is still (and might forever be) unavailable, a more humble and less aggressive approach should be adopted, trying to preserve more and extract less. Keywords: hopeless teeth, periodontal disease, periodontitis, tooth extraction, tooth loss