1. Clinical Treatment Planning
Treating Clinician:
Dr’s.

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

3. Treatment Planning Case Presentation.
Introduction and Background.
Patient Name:
Gender:
Date of Birth:
Age:
Marital Status:
Race:
Date of Initial Examination:
Occupation: Personality Type:

4. Introduction-Background
Chief Dental Complaint:
Reason for Initial Visit:
Oral Image and Expectation:.

5. Medical History ASA: Medications: Allergies: Smoker:
Systemic Diseases:

6. Dental History Previous Dental Treatment History:
What does the patient desire?

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

8. Extra-Oral - Face/Profile/Symmetry

9. Extra-Oral : Lips/Smiles

10. Combination Charting

11. Status of Dentition - Occlusal Views

12. Periodontal Chart
GI – PI –
Gingival Status:
Recession:
Inflammation:

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

14. Intra-oral, Anterior – (Soft Tissue)

15. Intra-oral - Occlusal Views

16. L
Radiographs - FMX R

17. L R
Radiographs

18. Radiographs - AnteriorL R
Radiographs - Anterior

19. Radiographs - PanoramicL R
Radiographs - Panoramic

20. L
Radiographs – Misc. R

21. Casts - Facial R R L

22. Casts - Lingual R R L

23. Composite – Images, Casts, RadiographsL R

24. Composite – Images, Casts, RadiographsL R

25. Composite – Images, Casts, RadiographsL R

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

27. R L
Occlusal Images

28. Abrahamson – Tooth Wear

29. Esthetic Analysis (Chiche)
Incisal Plane Incisal Profile Incisal Length Smile Line Tooth Proportion

30. Esthetic Analysis (Chiche)
Gingival Outline Tooth Shades Intrinsic Characteristics Buccal Corridors Lip support

31. Treatment Planning Kois

33. Risk Factor - KOIS Periodontal Biomechanical: (Tooth structure)
Functional: (Joint, Bite Chewing)
Dento-Facial: (Esthetic)

34. Diagnostic Opinion - Kois
RISK PROFILE
PERIODONTAL
BIOMECHANICAL
FUNCTIONAL
DENTOFACIAL
MEDICAL PRECAUTIONS
Low Moderate High

35. Diagnostic Opinion: Perio - Kois
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:
Individual
Teeth
Excellent
Good
Fair
Poor
Hopeless
Please List

36. Diagnostic Opinion: 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:
Individual
Teeth
Excellent
Good
Fair
Poor
Hopeless
Please List

37. Diagnostic Opinion: Functional - Kois
Risk Assessment
__Low __Moderate __High
General Prognosis
__Excellent __Good __Fair
__Poor __Hopeless
Based on the specific prognosis: most teeth are in this category
Specific:
Individual
Teeth
Excellent
Good
Fair
Poor
Hopeless
Please List

38. Diagnostic Opinion: 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:
Individual
Teeth
Excellent
Good
Fair
Poor
Hopeless
Please List

39. Risk Profile Summary - Kois
PERIODONTAL
BIOMECHANICAL
FUNCTIONAL
DENTOFACIAL
MEDICAL PRECAUTIONS
Low Moderate High

40. Guidelines - Kokich Creating Overjet/Overbite

41. Kokich Guidelines Creating 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

42. Guidelines - Spear Vertical wear (Rat) Constricted envelope of function. Need greater Overjet. Horizontal and incisal wear – (Cow) Need greater Centric Freedom

43. 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.

44. Spear – Worn Dentition-Contd.
Set 8UAS; check for wear, gingival margins, vertical uprightedness.
Should it be proclined, retruded, intruded,
APF or combination.
For vertical check anterior facial angulation
relative to occlusal plane.
Usually a space problem so ortho is valuable.
Apply same parameter to LAS

45. The Gummy Smile - Robbins Five 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 – VME
Tx: Orthognathic surgery.

46. The Gummy Smile – Robbins Five questions
2 Lip length: Repose from base of nose to inferior border of the maxillary lip
In young adult: Females mm
In young adult: Males mm
Dx: Short or hyperactive upper lip
Tx: Behavior modification / Botox.
LIP Mobility 6-8mm

47. The Gummy Smile - Robbins Five questions.
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.

48. The Gummy Smile – Robbins Five questions
4 Length of the maxillary central incisor:
10-11mm
Dx 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.

49. Bill Robbins DDS The Gummy Smile. Five questions
5 Feel the CEJ in the sulcus:
DX: Cannot feel CEJ – APE
Tx: Esthetic Crown lengthening Surgery.

51. Bill Robbins DDS-Esthetic Evaluation
Face Height _______________________
Lip Length _______________________ mm Lip Mobility _____mm
Dental / Facial Midline _____________ R/L
Central Exposed in Repose _________ mm
Gingival Line to Upper Lip in Full Smile _______________ +/- mm
Distal Extent of Smile (Tooth#) ___________ R _________ L
Incisal 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

52. Problem list

53. Summary of Concerns
Interesting 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

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

55. Comprehensive Dental Care includes
Disease control
Caries, Endodontic
Periodontal and gingival infection
Reconstructive Dentistry
Tooth/Teeth, Bridges, partials, crowns, implants
Periodontal: pocket reduction, regeneration, normal periodontal architectural configuration
Esthetic enhancement
Maintenance
Professional and patient

56. Facilitating a Patient’s Choice for Better Dentistry
Determine 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.

57. 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.

58. 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.

59. Function and Esthetics.
Comprehensive Care
Periodontics
Periodontics
Restorative
Dentistry
Predictability
Function and Esthetics.

60. Delivering a Successful Outcome includes:
Comprehensive Exam
Diagnosis
Comprehensive Ts Planning
Case Presentation
Team Tx planning
Long-term predictable Tx and Results.

61. Treatment Planning Work Sheet.
Additional consultations requested:
Disease control, aka. Initial Therapy, Phase 1 Therapy,
Restorative:
Periodontal:
Endodontic:
Oral Surgical:
Other:
Reconstructive Dentistry
Orthodontic:
Prosthodontic:
Esthetic enhancement:
Functional:
Maintenance
Professional:
Patient:

62. 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

63. Doctors Proposed Treatment Plan

64. Phase I:
Disease control.
Includes:
Periodontal: HCI;
PROPOSED

65. Phase II
PROPOSED

66. Phase III
PROPOSED

67. Phase IV
Definitive treatment

68. Phase IV
PROPOSED

69. Phase V
PROPOSED

70. Phase VI:

71. Maintenance q 3 months, alternating
Phase VII
Maintenance q 3 months, alternating
with the Periodontist.
PROPOSED

72. Actual
treatment
provided

73. Actual treatment provided Disease Control: Caries/SRP/Endo/Etc

74. Actual treatment provided Orthodontic/Oral surgery/Orthognathics

75. Actual treatment provided
Restorative

76. Actual treatment provided
Reconstructive

77. Actual treatment provided
Maintenance

78. Actual treatment provided Supplemental over time/

80. Discard garbage
Cell
Phone
Time
Name Tags and
CE sheets
Drive safely