Clinical Treatment Planning Treating Clinician:

Dr’s.

The plans where useless, but the planning was indispensable. Dwight Eisenhower, WW2

Patient Name:Gender:Date of Birth:Age:Marital Status:Race:Date of Initial Examination:Occupation: Personality Type:

Treatment Planning Case Presentation.

Introduction and Background.

Introduction-Background

Chief Dental Complaint:

Reason for Initial Visit:

Oral Image and Expectation:.

Medical History

ASA:Medications: Allergies:Smoker:Systemic Diseases:

Dental History

Previous Dental Treatment History: What does the patient desire?

Diagnostic Findings ( Head and Neck) Nodes: TMJ/Mandibular: Range of Motion: Functional: Joint sounds: Tenderness to musculature palpation: Myofacial pain: Headaches:

Extra-Oral - Face/Profile/Symmetry

Extra-Oral : Lips/Smiles

Combination Charting

Status of Dentition - Occlusal Views

Periodontal Chart

GI – PI – Gingival Status: Recession: Inflammation:

LR Intra-oral Images: (Periodontal)Recession – Gingivitis – Periodontitis – MG aberrations.

Intra-oral, Anterior – (Soft Tissue)

LR

Intra-oral - Occlusal Views LR

Radiographs - FMX RL

RadiographsL R

RL Radiographs - Anterior

Radiographs - Panoramic RL

Radiographs – Misc. RL

Casts - Facial

L

R

R

Casts - Lingual

LR

R

Composite – Images, Casts, RadiographsLR

Composite – Images, Casts, RadiographsLR

Composite – Images, Casts, RadiographsLR

Occlusal Notes Class occlusion: Class: IG/CG: NW interferences. CO/CR/MIP:

Slide/s:

Occlusal Images LR

Abrahamson – Tooth Wear

Esthetic Analysis (Chiche)

Incisal PlaneIncisal ProfileIncisal LengthSmile LineTooth Proportion

Esthetic Analysis (Chiche)

Gingival OutlineTooth ShadesIntrinsic CharacteristicsBuccal CorridorsLip support

Treatment Planning

Kois

Risk Factor - KOIS

PeriodontalBiomechanical: (Tooth structure)Functional: (Joint, Bite Chewing)Dento-Facial: (Esthetic)

Diagnostic Opinion - Kois

RISK PROFILE

PERIODONTAL

BIOMECHANICAL

FUNCTIONAL

DENTOFACIAL

MEDICAL PRECAUTIONS

Low Moderate High

PERIODONTAL (Gum and Bone)  

Risk Assessment __Low __Moderate __High  

General Prognosis __Excellent __Good __Fair

__Poor __Hopeless

Based on the specific prognosis:most teeth are in this category

Specific:IndividualTeeth

Excellent

Good

Fair

Poor

Hopeless

Please List  

Diagnostic Opinion: Perio - Kois

Diagnostic Opinion: Biomechanical

BIOMECHANICAL  

Risk Assessment __Low __Moderate __High  

General Prognosis __Excellent __Good __Fair

__Poor __Hopeless

Based on the specific prognosis:most teeth are in this category

Specific:IndividualTeeth

Excellent

Good

Fair

Poor

Hopeless

Please List  

Diagnostic Opinion: Functional - Kois

FUNCTIONAL  

Risk Assessment __Low __Moderate __High  

General Prognosis __Excellent __Good __Fair

__Poor __Hopeless

Based on the specific prognosis:most teeth are in this category

Specific:IndividualTeeth

Excellent

Good

Fair

Poor

Hopeless

Please List  

Diagnostic Opinion: DentoFacial.

DENTOFACIAL  

Risk Assessment __Low __Moderate __High  

General Prognosis __Excellent __Good __Fair

__Poor __Hopeless

Based on the specific prognosis:most teeth are in this category

Specific:IndividualTeeth

Excellent

Good

Fair

Poor

Hopeless

Please List  

Risk Profile Summary - Kois

PERIODONTAL

BIOMECHANICAL

FUNCTIONAL

DENTOFACIAL

MEDICAL PRECAUTIONS

Low Moderate High

Guidelines - KokichCreating Overjet/Overbite

Kokich GuidelinesCreating Overjet/Overbite

Procline/Retrude Maxillary Incisors Intrude Maxillary/Mandibular Anterior Teeth Retract Mandibular Incisors: (Facial of mandibular

incisors should be over chin – see Ceph.)

Uneven gingival margins, intrude or extrude. Maxillary Incisors should be parallel relative to

lower lip – see Ceph) Maxillary Facial Incisal Inclination should be

vertical to the Incisal plan for good light reflection – See Ceph

Guidelines - Spear

Vertical wear (Rat)Constricted envelope of function. Need greater Overjet.

Horizontal and incisal wear – (Cow)Need greater Centric Freedom

Frank Spear Worn Dentition

Most cases do not require VDO opening.

Check if posterior teeth are worn or missing; if no, need to get space in the anterior with modest opening prn.

Spear – Worn Dentition-Contd.

Set 8UAS; check for wear, gingival margins, vertical uprightedness.

1 Should it be proclined, retruded, intruded, 2 APF or combination.3 For vertical check anterior facial angulation 4 relative to occlusal plane.5 Usually a space problem so ortho is valuable.6 Apply same parameter to LAS

The Gummy Smile - RobbinsFive questions.

1 Face height: Repose, from Glabella (mid-brow) to base of nose = Base of nose to inferior border of chin. (Middle third of face should equal the lower third of face.

DX: Lower third of face longer – VMETx: Orthognathic surgery.

The Gummy Smile – RobbinsFive questions

2 Lip length: Repose from base of nose to inferior border of the maxillary lip

In young adult: Females 20-22 mm In young adult: Males 22-24mm

Dx: Short or hyperactive upper lip Tx: Behavior modification / Botox.

LIP Mobility 6-8mm

3 Gingival Line: Draw from Canine to Canine. Should engage centrals and cuspids.

Dx Concave – Dentoalveolar Extrusion.

Tx. Orthodontic, intrusion, Esthetic Crown Lengthening, Segmental osteotomy.

The Gummy Smile - RobbinsFive questions.

The Gummy Smile – RobbinsFive questions

4 Length of the maxillary central incisor:

10-11mmDx Less than 10mm Microdontia, Wear, APE

In repose “Emma” 3-4mm of incisal edge of maxillary centrals in young female and 2mm in young males.

Bill Robbins DDSThe Gummy Smile. Five questions

5 Feel the CEJ in the sulcus:

DX: Cannot feel CEJ – APETx: Esthetic Crown lengthening Surgery.

Bill Robbins DDS-Esthetic EvaluationFace Height _______________________ Lip Length _______________________ mm Lip Mobility _____mmDental / Facial Midline _____________ R/LCentral Exposed in Repose _________ mmGingival Line to Upper Lip in Full Smile _______________ +/- mmDistal Extent of Smile (Tooth#) ___________ R _________ LIncisal Edges to Lower Lip (Follows Smile Line, Covered by Lip)___Buccal Corridors – Negative Spaces Y/N _Length of Maxillary Anteriors – (Chart) Tissue Levels – (Chart) Angle of Incisal Plane – (Chart)Incisal Wear – Y/N Tooth #’s _____________________________CEJ Located Y/N ______________________________________Posterior Occlusal Plane (OK, Step Up, or Step Down) _________Tooth Color ___________________________________________Tooth Alignment (Spacing, Overlap) ________________________DR. NOTES

Problem list

Summary of ConcernsInteresting issues related to this case that warrant discussion prior to treatment? •Wear•Expectation•Are there phasing issues? • Depending on treatment plan chosen, see treatment outline below.Are there conflicts between what is best and what the patient wants or will tolerate?•Possible cost, depending on treatment plan chosen

Diagnosis and Prognosis

AAP Type: AAP Hopeless: #’sGuarded: #’s See risk factors.Good: The rest, assuming homecare improvement, and patient pursues prescribed treatment.

Comprehensive Dental Care includes

Disease controlCaries, EndodonticPeriodontal and gingival infection

Reconstructive DentistryTooth/Teeth, Bridges, partials, crowns, implantsPeriodontal: pocket reduction, regeneration,

normal periodontal architectural configurationEsthetic enhancement

MaintenanceProfessional and patient

Facilitating a Patient’s Choice for Better DentistryDetermine patient’s desired expectation

Complete a comprehensive exam to delineate risk factors

Educate patient – how their risk factors affect their desired expectations (communication)

Discuss means to reduce risk factors – treatment needed and alternatives, plus timing and staging

Determine if patient can accept the price of treatment and work with them in this regard.

A comprehensive result includes:Class 1 Occlusion No Pockets

Normal skeletal relationship No recession

No missing teeth Adequate KT

Good tooth position Normal positive soft tissue architecture

Normal occlusal landmarks CRO – No occlusal interferences

No caries Stable anterior guidance

Normal dental anatomy No mobile teeth

Good sealed margins Stable healthy TMJ’s

Good crown form Adequate bone support.

A Comprehensively Treated Case Should be:

The easiest to Maintain

The easiest to restore

The most esthetic

And produce the most predictable long term result.

Comprehensive CareComprehensive Care

PeriodonticsPeriodonticsPeriodontics

Restorative Dentistry

PredictabilityFunction and

Esthetics.

Delivering a Successful Outcome includes:Comprehensive Exam

Diagnosis

Comprehensive Ts Planning

Case Presentation

Team Tx planning

Long-term predictable Tx and Results.

Treatment Planning Work Sheet.Additional consultations requested:Disease control, aka. Initial Therapy, Phase 1 Therapy,

Restorative: Periodontal: Endodontic: Oral Surgical: Other:

Reconstructive DentistryPeriodontal:Orthodontic:Oral Surgical:Restorative:Prosthodontic:Esthetic enhancement:Functional:Other:

MaintenanceProfessional:Patient:

•Treatment Plan•Break out time - 30 min

•Group A Ideal, costs are not a factor•Group B Ideal, costs are a factor•Group C The best you can do,

costs and time are major factors.

•Outline Goals/Objectives of Treatment

Doctors Proposed

Treatment Plan

Phase I: Disease control. Includes:

Periodontal: HCI;

PROPOSED

Phase II

PROPOSED

Phase III

PROPOSED

Phase IVDefinitive treatment

Phase IV

PROPOSED

Phase V

PROPOSED

Phase VI:

Phase VII Maintenance q 3 months, alternating

with the Periodontist.

PROPOSED

Actual treatment provided

Actual treatment providedDisease Control: Caries/SRP/Endo/Etc

Actual treatment providedOrthodontic/Oral surgery/Orthognathics

Actual treatment providedRestorative

Actual treatment providedReconstructive

Actual treatment providedMaintenance

Actual treatment providedSupplemental over time/

Discard garbage

Name Tags and CE sheets

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