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Published byDarrell Moody Modified over 9 years ago
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Clinical Treatment Planning Treating Clinician:
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Patient Name: Gender: Date of Birth: Age: Marital Status: Race: Date of Initial Examination: Occupation: Personality Type: Treatment Planning Case Presentation. Introduction and Background.
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Introduction-Background Chief Dental Complaint: Reason for Initial Visit: Oral Image and Expectation:
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Medical History ASA: Medications: Allergies: Smoker: Systemic Diseases:
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Dental History Previous Dental Treatment History: What does the patient desire?
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Diagnostic Findings Head and Neck Nodes: TMJ/Mandibular: Range of Motion: Functional: Joint sounds: Tenderness to musculature palpation: Myofacial pain: Headaches:
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Extra-Oral - Face/Profile/Symmetry
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Extra-Oral : Lips/Smiles
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Extra-Oral - Buccal Corridors
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Combination Dental-Perio. Chart
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Periodontal Chart GI – PI –
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Intra-oral Images: (Soft tissue) L R
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Intra-oral, Anterior – (Soft Tissue) L R
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Intra-oral - Occlusal Views L R
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Radiographs L R
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L R
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L R
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L R
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Images - Intra oral, Including casts L R
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L R
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L R
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Occlusal Notes Class occlusion: Class: Incisal guidance and Canine Guidance No non-working interferences. CO/CR/MIP - relationship: Slide
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Occlusal Images L R
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L R
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Problem list
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Diagnosis and Prognosis AAP Type: AAP Hopeless: #’s Guarded: #’s See risk factors. Good: The rest, assuming homecare improvement, and patient pursues prescribed treatment.
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Comprehensive Care Caries EndodonticsPeriodontics Restorative Dentistry Predictability Function and Esthetics.
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Treatment Planning Work Sheet. Additional consultations requested: Disease control, aka. Initial Therapy, Phase 1 Therapy, Restorative: Periodontal: Endodontic: Oral Surgical: Other: Reconstructive Dentistry Periodontal: Orthodontic: Oral Surgical: Restorative: Prosthodontic: Esthetic enhancement: Functional: Other: Maintenance Professional: Patient:
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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
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