Treatment Planning in Dentistry – An Overview

Ahmad El-Ma’aita

BDS, MSc, PhD, MEndo RCSEd

Formulating a logical sequence of treatments designed to restore

the patient’s dentition to good health together with optimal

function and appearance, with the minimum necessary

intervention.

A treatment plan is not a static list of services. Rather, it is a

multiphase and dynamic series of events.

Its success is determined by its suitableness to meet the patient's

initial and long-term needs.

Treatment planning should allow for re-evaluation and be

adaptable to meet the changing needs, preferences, and health

conditions of the patient

Definition:

Development of treatment plan consists of four steps:

Problem(s) identification

Decision to recommend intervention

Identification of treatment alternatives

Selection of the treatment with patient's involvement

I- Problem Identification:

Patient’s complaint (s)

History

Examination

Special investigation

Diagnosis

a) History:

1- Chief complaint and its history

2- Medical history

3- Dental history

4- Social history

I- Problem Identification:

I- Problem Identification:

b) Examination:

1- Extra-oral exam: facial symmetry, TMJ, LN, MOM, lips

2- Intra-oral exam:

Soft tissue

Teeth charting

Inspection, palpation, percussion

Mobility

Saliva

Periodontal examination

I- Problem Identification:

c) Special investigation:

Sensibility (vitality) testing

Biopsies

Radiography

I- Problem Identification:

d) Occlusion registration:

Study casts

Bite registration

Face-bow registration

Study casts:

Diagnostic wax-up

Patient’s complaint (s)

History

Examination

Special investigation

Diagnosis

Treatment options Treatment plan

Treatment plan sequencing:

I- Management of the emergency situation

II- Dealing with incidental findings

III- Stabilization and prevention (control) phase

IV- Re-evaluation phase

V- Definitive treatment phase

VI- Maintenance phase

I- Management of the emergency situation:

Relief of symptoms (pain, swelling… etc.)

Management of trauma

Temporary management of appearance

II- Management of incidental findings:

Potentially malignant lesions

Potential systemic disease

Potential infectious disease

Treatment plan sequencing:

I- Management of the emergency situation

II- Dealing with incidental findings

III- Stabilization and prevention (control) phase

IV- Re-evaluation phase

V- Definitive treatment phase

VI- Maintenance phase

III- Stabilization and prevention (control) phase:

Oral hygiene instructions/ reinforcement

Diet analysis and advice

Fluoride supplement

Extraction of teeth with poor prognosis

Periodontal debridement

Caries control

Replacement/repair of defective restorations

Occlusal adjustment- correction of occlusal trauma

Treatment plan sequencing:

I- Management of the emergency situation

II- Dealing with incidental findings

III- Stabilization and prevention (control) phase

IV- Re-evaluation phase

V- Definitive treatment phase

VI- Maintenance phase

IV- Re-evaluation phase:

The holding phase - the time between the control

and definitive phases.

Allows for resolution of inflammation and time for

healing

To re-assess and reinforce the following:

Home care habits.

Motivation for further treatment.

Initial treatment and pulpal responses.

Treatment plan sequencing:

I- Management of the emergency situation

II- Dealing with incidental findings

III- Stabilization and prevention (control) phase

IV- Re-evaluation phase

V- Definitive treatment phase

VI- Maintenance phase

V- Definitive treatment phase:

Multi-disciplinary approach following stabilization of the

patient’s condition.

Approval and design of the final prosthesis

Periodontics: Crown lengthening, implant placement.. etc.

Endodontics: RCTs and apical surgery.

Orthodontics: teeth alignment, intrusion/ extrusion.. etc.

Oral surgery

Occlusal management: RCP/ ICP, new OVD?

Prosthodontics: definitive direct and indirect restorations

Treatment plan sequencing:

I- Management of the emergency situation

II- Dealing with incidental findings

III- Stabilization and prevention (control) phase

IV- Re-evaluation phase

V- Definitive treatment phase

VI- Maintenance phase

VI- Maintenance phase:

Oral hygiene reinforcement

Regular review appointments

Regular periodontal debridement

Radiographic follow-up

Factors affecting treatment plan:

Treatment plan approval:

Informed consent has become an integral part of

modern day dental practice

Provides the patient with the necessary information

about the alternative therapies available to manage

their oral conditions

Protects the dentist from mal-practice allegations

Treatment plan approval:

Must include the following:

1- Diagnosis of the condition

2- Treatment options available

3- Pros and cons of each treatment option (Advantages/

disadvantages + associated risks)

4- The proposed procedure (s)

5- Cost

Thank you