Dental implants are at the forefront of today’s clinical practice providing patients with answers for treatment of all forms of edentulism. Clinicians and patients alike benefit by using these implants to anchor prostheses in a variety of situations ranging from anterior to posterior tooth replacement and fully edentulous solutions. Recent publications report high long-term success and survival rates leading to a higher acceptance of the dental implant as a primary option for tooth replacement (Derks et al. 2015). With this, practitioners from all disciplines within dentistry are integrating the use of implants into their daily practice relying on esthetic, functional and durable outcomes for patient satisfaction.

In order to achieve successful outcomes, all clinical situations share a common thread; proper diagnosis, planning and execution during the restorative and surgical phases of treatment. In 2009, the International Team for Implantology (ITI) published a textbook based upon a 2007 Consensus Conference to assist in this process. Called the SAC Classification in Implant Dentistry, this volume focuses on classifying treatment difficulty in restorative and surgical phases of treatment. The aim and content of this textbook have since been adopted by clinicians, teaching institutions and dental organizations to aid in the diagnosis and planning for patients based upon clinician experience and treatment difficulty. Unfortunately, there are situations where complications in the final outcomes are realized that potentially could have been prevented during the diagnosis and planning phase. These complications are often magnified when treatment is located in the esthetic zone. 

A key diagnostic tool, the Esthetic Risk Assessment (E.R.A.) table was first published in the ITI Treatment Guide, Volume 1 (Table 1). It assists clinicians in the diagnosis and planning of treatment in the esthetic zone and identifies clinical situations that could contribute to esthetic compromise. The ease of use and comprehensive inclusion of key clinical factors that could contribute to treatment difficulty has led to the adoption of the E.R.A. by the ITI and its integration into the SAC textbook as one of the tools in determining treatment difficulty. When utilized during the consultation phase of treatment, the E.R.A. acts as a checklist and visual analog scale for the clinician and patient in determining the risk involved in achieving an esthetic outcome with treatment. It is the goal of this article to highlight the use of the E.R.A. in planning treatment for patients with esthetic demands and provide an option to minimize potential complications.