Chief complaint(s)

Burden of Personal / Social situation

Burden of Dental condition / illness

Burden of Medical condition/illness

General & Extraoral status (Diagnostic tests?)

Intraoral status (Diagnostic tests?)

Dentition status (Diagnostic tests?)

Individual tooth status (Diagnostic tests?)

Diagnose(s)

Treatment objectives formulated "Contract Part A" Consent

Strategy to achieve objectives "Contract Part B" Consent

Tx strategy A Therapy step etc. Patient explained etiology to avoid future illness

Patient explained need for maintenance & repair

Were objective(s) achieved?

yes

Happy patient

no

Revised treatment objectives?

yesHappy patient

no

Remake or alternative treatment strategy

Therapy steps

Tx strategy B

Tx strategy C

Dr. Asbjorn Jokstad University of Toronto 2008

Establish: Etiology Prognosis

Establish:

Diagnosis (etiology, prognosis & therapy)

Clinical Dentistry – Patient Management Flow Diagram

Examination - Tooth

surface Loss

Physiological Monitor

Pathological

Determine etiology

Corrosion?

Friction?

Stress?

Management

1. Explanation and patient education

2. Prevent further loss

3. Active treatment?

Diet?

Splint?

Fluoride?

Habit?

Further referral?

Monitor

Restore or Refer?

Localized loss / only anterior

teeth

Lower

Monitor

Upper Dahl appliance

Restore

Upper and lower

Dahl appliance

Restore

General loss

Decreased VDO

(Increased FWS)

No Dento-alveolar

compensation)

Establish CR. Restore to existing facial

height

VDO appropriate

(Normal FWS)

Dento-alveolar compensation

Stabilisation splint at

increased vertical height

tolerated?

Yes - restore to this increased height

No - consider crown lengthening procedures

Dr. Asbjorn Jokstad University of Toronto 2008

VDO= Vertical dimension of occlusion FWS = Free Way Space

Tooth Substance Loss – treatment decisions

Trauma - Irreparable tooth

Remove Space closure

Spontanous mesial movement of posterior teeth

Small residual spaces are accepted

Orthodontic space closure

Autogenous transplantation

Prosthetics, removable or fixed

Implants

Retain - Extraction later RISK: root resorption / ankylosis / infraocclusion)

Implants

Fixed prosthetics

Orthodontic space closure

Dr. Asbjorn Jokstad University of Toronto 2008

Dental Trauma & irreparable tooth – treatment decisions

Single tooth space

Condition of potential abutment

teeth?

Damaged coronal

structure or mobility

FPD

Implant

Intact coronal

structure, nonmobile

Parafunctional habits?

No Wear Facets

Occlusal patterns, abutment and pontic

form?

Centric contact in incisal 1/3, incisal edge

thick, optimal space for pontic

Patient understand debond risk

and need for maintenance?

Accepted

FDP

Adhesive FDP

Not accepted

FDP

Centric contact in gingival 2/3,

thin incisal edges or

inadequate or excessive

pontic space

FDP

Implant

Wear Facets

evident

FDP

Dr. Asbjorn Jokstad University of Toronto 2008

Single tooth space – treatment decisions

Identify Problem with dentition

Occlusal morphology

problems

Occlusal trauma

Lost Periodontal support

Structural

Damage

No extractions Restorative & Crowns

Strategic Extractions

Single missing

Implant

Contraindications

Immediate

Bone support

FDP

Retention & Resistance

Esthetics

Endo status

Tooth bounded space

Implant

FDP

RPDPeriodontal condition &

anatomy

No tooth distal to edentulous space

RPD

Implant

Contraindications

Immediate

Bone support

Splint vs non-splint

Fixed vz removable

Few teeth remain

RDP

Implant

Overdenture

Full extractions Immediate Denture

Reline

Denture Anatomy & Mucosa

Implants

Dr. Asbjorn Jokstad University of Toronto 2008

Structurally Damaged Dentition – treatment decisions

Dr. Asbjorn Jokstad University of Toronto 2008

Restorative Dentistry – treatment flow

1. G

ener

ell r

isik

op

rofi

l Manglende oppfølgning i recall program eller uregelmessigetannlegebesøk

Systemisk sykdom

Medisinering - bivirkninger

Sigarettrøkning

Kosthold

• Sukkerinntak, frekvens

• Tilgjengelighet av snacks

Bruk av fluorider

Lavt sosialt ressursnivå

Lavt kunnskapsnivå om tannsykdommer

Lavt forventningsnivå til tannbehandling

Historikk av gjentatte behandlinger.....

2.

Ris

iko

nø

kkel

-mar

køre

r p

å o

ral

sykd

om

Tidligere karieserfaring eller tap av støttevev i forhold til pasientens alder

Høye plaque-, og/eller blødning-score

Saliva kvantitet og kvalitet

Prevalens av dype periodontal-lommer

3. I

nd

ikat

ore

r p

å p

ato

gen

e fo

rho

ld

elle

r p

å en

pro

gres

siv

ora

l syk

do

m

Periodontalinflammasjonsparametre

Karies og karies-lokalisasjon

Tilstedeværelse av økologiske nisjermed vanskelig tilgang, eksempelvis furkasjoner

Tilstedeværelse av iatrogenefaktorer, eksempelvis fyllingsdefekter

4. T

ekn

isk

per

feks

jon

av

fylli

ng

Har fravær av en fyllings tekniske perfeksjon en betydning i forhold til din vurdering om mulig risiko for sykdomsutvikling på bestemte steder på eller rundt tannen?

Når bør en fylling revideres? 4 trinns risiko evaluering

Dr. Asbjorn Jokstad University of Toronto 2008

Comparisons of Dental Products – online resources

http://www.realityesthetics.com

Reality. No Subscription but registration necessary for website. Presents and rates products from editors’ perspectives and users.

http://www.cliniciansreport.org/

Gordon J. Christensen & CR reports. Subscription. Presents and rates products from editors’ perspectives and users.

http://www.dentalproductsreport.com/dpr

Dental Products Report. No Subscription but registration necessary. Presents products, but no rating

http://www.dentalcompare.com/index.asp

Dental compare. Presents products and allows comparisons. Contain video links for proper handling

http://www.dentaladvisor.com/

Dental Advisor. Subscription. Presents and rates products from editors’.

Links checked per March 2009.

Dr Asbjorn Jokstad

University of Toronto