1-2-3-4 Risk Assessment: How We Biomimetically Assess Your Teeth
Should I have my traditional dental restoration replaced with a biomimetic restoration?
This is a common question we hear at the Alleman Center. Preventative treatment can save you time, discomfort and money down the road, and thankfully we have tools in biomimetic dentistry to help patients learn more about the risks existing restorations pose to their teeth.
When we recommend replacing an old restoration
If you are experiencing pain or sensitivity, have experienced pain or sensitivity in the past or believe part of your tooth or restoration is missing, contact us to schedule an appointment to examine your tooth. These are all signs that one or more pathologies are affecting your teeth and should be treated. Dr. Alleman will use your patient history, x-ray images and a surgical microscope to identify and treat the source of your discomfort using biomimetic restorative dentistry.
During your twice-yearly dental cleaning and exam
Your twice-yearly appointments not only ensure the health of your gums, but they are also key to early diagnosis. Some early stages of decay or cracks may not look or feel any different as you brush, floss and chew throughout the year, but during these appointments Dr. Alleman has time to carefully examine each of your teeth to look for early signs of dental pathologies. During your appointment he also inspects existing restorations for any concerns.
1-2-3-4 risk assessment for structural compromise
One of the tools for diagnosis that we use at the Alleman Center is called the 1-2-3-4 risk assessment. This diagnostic method was created by Dr. David Alleman as he was pioneering practical biomimetic treatment protocols. The hierarchical assessment determines if a tooth is structurally compromised, meaning it is at increased risk of fracture. During this assessment we look for:
Cracks into dentin: These may be visible around your existing restoration or suspected under a restoration based on symptoms you are experiencing or have experienced in the past. If a crack exists, it should be treated before it grows larger and threatens the vitality of your tooth.
Restorations wider than 2 mm: Based on the research of force distribution in traditionally restored teeth, teeth that have restorations wider than 2 mm at any point weaken a tooth’s natural structure to the point that it cannot withstand the stresses of chewing and may crack over time.
Cusps thinner than 3 mm: Cusps are the elevated portions of the top of your tooth that come together when you chew and surround a restoration. If one of these is thinner than 3 mm due to the shape and size of the restoration, it is at greater risk of cracking from chewing forces over time.
Restorations deeper than 4 mm: Your restoration depth is visible in an x-ray or, depending on the restoration shape, from the outside of the tooth. If the restoration is deeper than 4 mm, your tooth starts flexing more than it naturally should during chewing and is at risk of cracking. Think of a pair of garden shears. Short handles offer less force to cut with at the end. Longer handles provide greater force to cut larger branches. With a larger, deep restoration, stress to your tooth is being concentrated that much more forcefully at the bottom.
If your tooth is structurally compromised
If your tooth is structurally compromised, we recommend replacing the traditional restoration with a biomimetic restoration. Your tooth is at risk of cracking, which could mean losing part of the top of your tooth (a cusp) or, in severe cases, cracking through the root of your tooth and requiring extraction. Early treatment will help prevent the need for more invasive procedures, and thankfully, with biomimetic restorative dentistry, your restored tooth’s structure will function just like a natural tooth.
Quadrant dentistry
If you are having a tooth treated that is next to another tooth with a traditional restoration, we may recommend you treat both during the same visits. This is called quadrant dentistry because you treat all teeth that would benefit from treatment in the same quadrant of the mouth (e.g. upper right or lower left). Even if that tooth is asymptomatic and not structurally compromised, if you would like that tooth’s traditional restoration replaced with a biomimetic restoration, that is an ideal time for Dr. Alleman to treat that tooth.
We’re happy to talk about the work we do any time. Reach out at office@allemancenter.com or (801) 717-9860 any time, or ask Dr. Alleman at your next appointment.