Defining Structural Threshold

Threshold defines the boundary between preservation and escalation.

Threshold is not a radiographic measurement.

Threshold is not a percentage of remaining dentin.

Threshold is not determined by symptom alone.

Threshold is defined when projected force across projected time exceeds remaining structural capacity and reduces long-term stability below acceptable predictability.

The Structural Decision Framework™ is a threshold-based clinical decision model in dentistry that evaluates irreversible treatment using four variables: structure, force, time, and long-term stability.

Threshold exists only when these four variables are evaluated together.

Structure establishes capacity.

Force establishes demand.

Time establishes cumulative exposure.

Long-term stability establishes projected outcome.

Structural threshold is reached when remaining structure cannot reliably tolerate projected force across projected time without unacceptable risk of instability.

Threshold is relational.

It is not defined by structure alone.

It is not defined by force alone.

It is not defined by time alone.

Threshold is defined by convergence across structure, force, time, and long-term stability.

Two teeth with similar structural loss may occupy different threshold positions because force differs.

Two patients with similar occlusion may occupy different threshold positions because structural reserve differs.

Time progression may accelerate convergence in one case and remain stable in another.

Threshold must therefore be individualized.

Preservation is indicated when projected long-term stability remains acceptable under projected force across projected time.

Escalation is indicated when projected long-term stability under preservation falls below acceptable predictability and intervention improves projected stability.

Threshold does not represent failure.

Threshold represents structural inevitability under current trajectory.

Acting before threshold convergence produces premature escalation.

Acting after threshold convergence allows instability to compound and increases severity of structural loss.

Accurate threshold identification requires disciplined evaluation of:

Structure.

Force.

Time.

Long-term stability.

The Structural Decision Framework™ positions threshold as the central mechanism of irreversible decision-making.

Threshold defines when preservation ends.

The next chapter defines acting too soon.