An important mission statement for modern dentistry is to maintain patients' implants and teeth for a lifetime. As a corollary, a standardized dental caries risk classification should provide the basis for evidence-based specific therapies. This paper proposes that interproximal caries lesions, also termed "restorative invasion," which destroys natural anatomical tooth structure with periodontal and occlusal sequelae, is a key factor in the cascade of destruction of the dentition and periodontitis. Thus it can serve as the basis for caries risk assessment. The standardized Dental Risk Classification system proposed here can provide a basis for therapeutic modalities as well as for public health assessment and insurance reimbursement.

Introduction: The purpose of this randomized controlled clinical trial was to evaluate 2 different techniques for vertical ridge augmentation (VRA) of the posterior mandible.Materials and Methods: Sixteen subjects with 19 posterior mandibular edentulous sites requiring VRA were recruited for the study. Sites were randomly treated with either block allograft (BA; N = 9) or sandwich bone augmentation (SBA; N = 10). Clinical measurements were recorded at the time of surgery (baseline) and 6-month reentry with a custom-made acrylic surgical template.Results: The mean vertical bone gain (VBG) after mean 6.8 months was 44.5% (mean = 1.78 mm [0-5 mm]) in the BA group and 33.3% (mean = 1.0 mm [-1 to 3 mm]) in the SBA group. Significantly higher rates of incision line openings and wound dehiscences were found in the BA group (n = 7/9, 77.8%) as compared with the SBA group (n = 3/10, 30%) (P = 0.037). After adjusting for graft exposure, BA group demonstrated significantly higher VBG than SBA (difference = 2.26 mm, P < 0.001). In addition, graft exposure resulted in significantly less VBG in both groups (P < 0.001).Conclusions: A higher tendency of wound exposure during VRA was demonstrated when a BA was used compared with the SBA technique. However, if wound exposure could be prevented, higher vertical ridge gain could be achieved with a BA.Summary: The use of a BA in VRA resulted in a maximum of 2 mm more bone height gain compared with the SBA technique if the primary coverage can be achieved during the healing.