Seattle Study Club Treatment Planning Template

Patient Name Date of presentation

Treating Clinicians: (Enter name(s) of clinicians here) Age at initial presentation: (Enter age & gender here) Initial presentation date: (Enter date here)

Introduction & Background  Enter case description here.

Medical History  Enter patient information here.

Diagnostic Findings

Full Face Smile Full Face Repose Extraoral/Facial Findings  Enter patient data here.

Full Face Profile Smile Full Face Profile Repose Extraoral Findings, cont.  Enter patient findings here.

Smile Close-Up Repose Close-Up Smile Analysis  Enter data here.

Retracted Closed Retracted Open Dental Findings  Enter dental findings here.

Left Lateral Right Lateral Occlusal Notes  Enter occlusal findings here.

Maxillary Occlusal Mandibular Occlusal Occlusal Notes  Enter occlusal findings here.

Additional Image Additional Notes  Enter any additional findings or concerns here.

TMJ & Mandibular Range of Motion  Enter TMJ findings here.

Periodontal Findings  Enter periodontal findings here.

Periodontal Probing

Panorex or FMX Insert Date Here Radiographic Findings  Enter radiographic findings here.

Diagnosis & Prognosis  Diagnosis  Type in here.  Prognosis  Periodontal:  Biomechanical/Structural:  Functional:  Esthetic:

Summary of Concerns  Enter summary of concerns here.

Proposed Treatment Plan  Enter proposed treatment plan here.

Proposed Treatment Plan, cont.  Continue proposed treatment plan.

Group Treatment Planning

Review of Treatment Goals  Enter the goals here.

Active Treatment

Active Treatment - Phase I  Enter Phase I treatment here.

Phase II  Enter Phase II treatment here.

Phase III  Enter Phase III treatment here.

Phase IV  Enter Phase IV treatment here.

Phase V  Enter Phase V treatment here.

Phase VI  Enter Phase VI treatment here.

Phase VII  Enter Phase VII treatment here.

Commentary  Enter commentary here.

Post-Treatment Follow-up  Enter post-treatment information and/or commentary here.