Because the Ending Is Where Dentistry Gets Honest
PROLOGUE
Dentistry appears successful too early.
A restoration is placed. A procedure is completed. The record reflects resolution.
The structural outcome has not yet occurred.
Irreversible treatment is not defined by placement. It is defined by structural behavior over time under force.
A clinical decision is structurally correct only if it produces predictable long-term stability under projected force across projected time relative to remaining structure.
Dentistry becomes honest at the ending because failure exposes threshold position. When a cusp fractures, when a root splits, when a previously treated tooth becomes non-restorable, the earlier decision is reclassified by outcome.
By then, structural reserve has already been consumed.
Diagnosis identifies condition.
Decision determines irreversible intervention.
Dentistry is proficient at diagnosis. Dentistry is inconsistent at timing irreversible intervention. The recurring error is not detection. It is threshold misidentification.
Irreversible treatment alters structure.
Altered structure changes force distribution.
Force acts across time.
Time determines long-term stability.
When these variables are not evaluated in sequence, decisions default to event-based logic. Event-based logic produces short-term success and delayed instability.
Threshold defines the boundary between preservation and escalation.
Threshold is not defined by symptom alone.
Threshold is not defined by radiographic appearance alone.
Threshold is not defined by restoration size alone.
Threshold is present when structure, force, time, and long-term stability converge toward instability beyond acceptable predictability.
The Structural Decision Framework™ formalizes this model.
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.
Structure defines remaining integrity and geometry.
Force defines load magnitude and distribution.
Time defines cumulative exposure and progression velocity.
Long-term stability defines projected durability after preservation or intervention.
Irreversible treatment is justified only when threshold convergence is present.
If convergence is absent, escalation consumes structural reserve unnecessarily.
If convergence is present and escalation is delayed, instability compounds and failure severity increases.
The objective of the Structural Decision Framework™ is not to promote conservatism or aggressiveness.
It is to enforce threshold alignment.
This doctrine defines the architecture for threshold-based clinical decision-making in dentistry.
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.
Dentistry becomes structurally honest at the ending.
The purpose of this framework is to move that honesty to the moment of decision.