2. Dr Asmaa Faden

3. Treatment Planning Concepts The Dentist’s goal is to provide the best dental treatment for each patient individually - Gathering of Information- Diagnosis

4. Treatment Planning Concepts Treatment Plan is a strategy that may be changed OR adjusted according to the patients needs. Time is needed for a successful treatment Prognosis

5. Format of Treatment Plans Treatment Plans General Format Flexible Format

6. Format of Treatment Plans I -General Format Phase I (Priority Tx) Phase II (Disease Control) Phase III (Restoring Function & Aesthetic) Phase IV (Re-evaluation & Re-Call)

7. Format of Treatment Plans II - Flexible Format - A rigid Tx. Plan is not suitable for All Patients - New information during Tx. -Tx. Plan needs modification or changes

8. Format of Treatment Plans Phase I (Priority Care) - Eliminate Pain and manage acute infections. - If possible manage C.C. 1- Tx. of pulpally involved teeth (extraction or ER Endo). 2- Placement of Temp. restorations in teeth that have Caries near to the Pulp. 3- Tx. of painful periodontal conditions (ANUG or Pericoronitis). 4- Diagnosis and management of suspicious bony or mucosal lesions. 5- Temp. restorations for rampant caries or caries approaching the pulp.

9. Format of Treatment Plans Phase II (Disease Control) - To control all disease processes BUT not to eradicate All diseases. 1- Management of the C.C (if not completed in Phase I). 2- Oral hygiene instructions. 3- Most Oral Surgery. 4- Periodontics. 5- Endodontics. 6- Orthodontics. 7. Occlusal analysis.

10. Format of Treatment Plans Phase III (Restoration of Function & Aesthetics) - Eliminate the remaining areas of decay. - Restore the mouth to full function and aesthetics through restorative & prosthodontics procedures. 1- Placement of amalgam or tooth-colored restorations. 2- Accomplishing all procedures necessary prior to prosthodontics. 3- Placement of crowns and fixed bridges. 4- Delivery of complete or removable partial dentures.

11. Format of Treatment Plans Phase IV (Re-evaluation & Re-call) * On completion of treatment, the patient should be re-evaluated to: - Determine that all procedures have been completed. - No additional treatment is indicated. * Follow-up appointments to re-evaluate - Endo. or perio. Treatment * Routine re-call examinations (Check-ups).

12. Factors that influence treatment plans: 1- The patient’s Health2- The patient’s Age3- The patient’s expectations4- Psychological Factors5- Existing Dental Conditions6- The Operator’s philosophy7- The Prognosis8- Emergency Treatment9- Financial Considerations

13. Factors that influence treatment plans The medical health status of a patient may necessitate modifications, e.g., prophylactic antibiotics. Precautions may include necessary medications prior to the dental treatment, e.g., diabetic patient or patient with heart problem. Modifications of treatment planned, e.g., one quadrant per appointment. 1- The patient’s Health

14. Factors that influence treatment plans Chronologic age is a rough indicator of physiologic age, considering the physical & emotional maturity of the patient. Age can indicate the relative size of the pulp chamber. 2- The patient’s Age

15. Factors that influence treatment plans Many factors influence the patient's expectations regarding the dental care (Attitudes, past experiences, financial concerns). Sometimes, the patients desires may be attainable or unrealistic As the patient ages, list of priorities may differ. 3- The patient’s expectations

16. Factors that influence treatment plans Modifications to the treatment plans according to the patients personality may be needed. Treatment plan must be designed and presented to motivate the patient to accept optimal care. The Chief Complaint should be managed first, to help establish that the dentist is listening and cares. 4- Psychological Factors

17. Factors that influence treatment plans The dentist should first determine a diagnosis, which includes factors such as, the presence and absence of caries and periodontal diseases, the location and numbers of missing teeth. The dentist should consider what possible treatment for the existing condition. Finally, the dentist decides which treatment option will provide the best long-term prognosis. 5- Existing Dental Conditions

18. Factors that influence treatment plans In a situation when the dentist is given the choice between 2 treatment alternatives, he/she is most likely to choose the option that is consistent with her/his philosophy of dental care with which he/she has the most successful outcomes. In other cases, when treatment is beyond the ability of the dentist the case is usually referred to a dental specialty practice (Ortho, Endo…….) 6- The Operator’s philosophy

19. Factors that influence treatment plans The dental treatment plan should be designed with a definitive goal concerning the longevity of the care (Timing). The amount of time needed to provide comprehensive care for one patient may not be acceptable to another. Generally, the prognosis for any dental reconstruction should be at least 5 years (with the exception of transitional dental appliances). 7- The Prognosis of Proposed Dental Treatment

20. Factors that influence treatment plans * Four levels of prognosis can be identified to make an accurate predictions concerning the longevity of treatment plans 1- Teeth with Stable Prognosis 1- Teeth with Stable Prognosis: have no major problems, can be maintained by Pt. indefinitely 2- Teeth with Guarded Prognosis 2- Teeth with Guarded Prognosis : have problems that may render them poor candidates for indefinite retention, but can rely on them for an adequate length of time. 7- The Prognosis of Proposed Dental Treatment, cont’d

21. Factors that influence treatment plans * Four levels of prognosis can be identified to make an accurate predictions concerning the longevity of treatment plans 3- Teeth with Diminished Prognosis 3- Teeth with Diminished Prognosis: have predictive longevities of approximately 1 to 5 years or they are incapable of contributing a dependable amount of support for dental appliances. 4- Teeth with Hopeless Prognosis 4- Teeth with Hopeless Prognosis : are defined as teeth that cannot be maintained and are indicated for removal. 7- The Prognosis of Proposed Dental Treatment, cont’d

22. Factors that influence treatment plans Emergency patients may have severe pain and may insist on extraction of teeth rather than other alternatives such as RCT, which may result in loss of useful tooth. To avoid this, many dentists recommended conservative treatment to relieve pain and to delay definitive care. Decisions can then be decided by the patient after a thorough diagnosis and formulation of treatment alternatives 8- Emergency Treatment

23. Factors that influence treatment plans Financial factors should not affect the dentist’s formulation of the best dental treatment plan. Modifications may be made to the plan to make it less expensive, or to deliver only the initial phase of care and to postponed other phases. 9- Financial Considerations

24. Alternative & Tentative Treatment Plans OPINION Treatment plan for the patient is an OPINION of what the dentist thinks is best for the patient. This is because: The formulation of a professional opinion is the “service“ dentists provider patients. The dentist should not be offended if patients seek a second opinion. More than one way exists to plan treatment for a patient, many of them are acceptable.

25. Alternative Treatment Plans - Alternative treatment plans are developed mainly to provide the patient with options when finances are a concern. - Alternatives to treatment may be limited to elimination of diseases, or use of different types of treatment. - The dentist should present the plan that is in the patients best interest regardless to financial cost.

26. Alternative Treatment Plans - Alternative treatment plans are sometimes a necessity, but the dentist should develop other treatment options that provide the patient with the highest level of possible care and the best long-term dental health potential.

27. Tentative Treatment Plans - Some dental diagnosis are so complex that no definitive treatment can be planned until the result of intermediate therapy is determined. -These require a tentative treatment plan, which are vague but crucial in situations since they determine whether the patient chooses sophisticated or expensive treatment.

28. Tentative Treatment Plans -Simple tentative plans that involve only one or two areas of questionable treatment are much like definitive plans and are easily explained to the patient. -Complex tentative plans require a great deal of explanation (advanced periodontitis with questionable prognosis on several potential abutment teeth) fixed, partial or complete dentures????

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