Dr Mark-Steven Howe BDS DGDP MGDS RCS MSc(Oxon) FCGDent
Abstract
Objectives:
This study introduces a novel, evidence-based restorative risk assessment tool designed to help dental practitioners optimise long-term treatment options for individual patients.
Methods:
The tool is grounded in two core concepts. First, patients are viewed as complex adaptive systems, composed of interacting components that behave in non-linear and often unpredictable ways. Second, given the uncertainty in both the evidence base and patient-specific data, plausible inference is used to interpret risk in a meaningful manner.
Using pooled 10-year survival data, the tool estimates the plausible probability of a complication-free outcome, defined as no significant repair, replacement, or removal of a tooth, implant, or prosthesis over a decade. Each restoration is assigned a prognostic value of 1 (poor), 7 (average), or 9 (excellent). An overall risk multiplier is then applied, taking into account systemic health, periodontal condition, and occlusal stability. The output produces a probability value that reflects the patient’s likely 10-year complication-free status.
Results:
The tool provides a straightforward yet structured method for clinicians to evaluate a patient’s current restorative stability and predict the likelihood of future complications.
Conclusions:
By incorporating principles of complexity science and plausible inference, this new risk index helps clinicians provide more objective, evidence-informed guidance during treatment planning and consent discussions. It also enables practitioners to model and compare future treatment scenarios and estimate related cost benefits. While conceptually robust, further research is needed to validate its clinical effectiveness in diverse settings.
Keywords: restorative dentistry; indices; plausible inference; complex adaptive systems, clinical risk
Clinical Significance: The design of this novel risk assessment tool accepts the existence of complexity and missing data when estimating a patient’s 10-year complication-free dental restorative status. By using probabilities, it supports clinicians in delivering clearer, evidence-informed treatment planning and consent, while enabling comparison of future scenarios and potential cost benefits.
Link:
Thoughts on Life and Dentistry 