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Published byMaude Gibson Modified over 9 years ago
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Seattle Study Club Treatment Planning Template
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Patient Name Date of presentation
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Treating Clinicians: (Enter name(s) of clinicians here) Age at initial presentation: (Enter age & gender here) Initial presentation date: (Enter date here)
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Introduction & Background Enter case description here.
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Medical History Enter patient information here.
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Diagnostic Findings
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Full Face Smile Full Face Repose Extraoral/Facial Findings Enter patient data here.
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Full Face Profile Smile Full Face Profile Repose Extraoral Findings, cont. Enter patient findings here.
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Smile Close-Up Repose Close-Up Smile Analysis Enter data here.
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Retracted Closed Retracted Open Dental Findings Enter dental findings here.
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Left Lateral Right Lateral Occlusal Notes Enter occlusal findings here.
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Maxillary Occlusal Mandibular Occlusal Occlusal Notes Enter occlusal findings here.
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Additional Image Additional Notes Enter any additional findings or concerns here.
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TMJ & Mandibular Range of Motion Enter TMJ findings here.
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Periodontal Findings Enter periodontal findings here.
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Periodontal Probing
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Panorex or FMX Insert Date Here Radiographic Findings Enter radiographic findings here.
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Diagnosis & Prognosis Diagnosis Type in here. Prognosis Periodontal: Biomechanical/Structural: Functional: Esthetic:
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Summary of Concerns Enter summary of concerns here.
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Proposed Treatment Plan Enter proposed treatment plan here.
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Proposed Treatment Plan, cont. Continue proposed treatment plan.
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Group Treatment Planning
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Review of Treatment Goals Enter the goals here.
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Active Treatment
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Active Treatment - Phase I Enter Phase I treatment here.
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Phase II Enter Phase II treatment here.
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Phase III Enter Phase III treatment here.
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Phase IV Enter Phase IV treatment here.
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Phase V Enter Phase V treatment here.
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Phase VI Enter Phase VI treatment here.
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Phase VII Enter Phase VII treatment here.
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Commentary Enter commentary here.
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Post-Treatment Follow-up Enter post-treatment information and/or commentary here.
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