However, the recognition and management of the full spectrum of complex oral and dental problems requires an approach based on deeper understanding of the problem and a higher level of engagement of cognitive, technical and clinical skills, acquired through specific advanced training. In the matter of the former problem, it has to be established whether the operator is confident of locating the canal using a conventional coronal approach (Fig. Generally, orthodontic treatment takes between six and thirty months to complete. If you don’t have an allergic reaction to metal, titanium dental implants are your best option. The decision-making now has to be aided by weighing the relative chances of success of the different endodontic options and, finally, also the restorative/aesthetic outcome. The dentist will have been trained, by necessity, to recognize only the commonly presenting tendencies in each disease. Gauge compliance in home-care and gingival health with further oral hygiene instruction as necessary, 5. 5.8a) in order to aid completion of root formation and improve the long-term restorative prognosis (Fig. 5.11 (a) Sclerosed canal in central incisor managed by apicectomy and root-end filling; (b) the treatment failed and required a further procedure when />, Only gold members can continue reading. Orthodontic Treatment Phases Orthodontic irregularities are extremely common andvary in their complexity. (888) 707-0222 (907) 276-4537. This article is intended to promote understanding of and knowledge about general oral health topics. Stabilize carious lesions in conjunction with scale and polish and reinforcement of oral hygiene instruction, 4. The Phases Of Orthodontic Treatment. On the whole, this approach probably works when preceded by active learning through assessment of personal outcomes over a lengthy period. Generally, orthodontic treatment takes between six and thirty months to complete. In simple terms, this means that the dentist should be well versed in all aspects of dentistry, understanding the role of each aspect in overall patient management, as well as being aware of potential overlaps and interactions between the subdisciplines. The reader should have a general understanding of the stages of periodontal treatment (initial, corrective and supportive) and the management of acute periodontal conditions. In simple terms, this means that the dentist should be well versed in all aspects of dentistry, understanding the role of each aspect in overall patient management, as well as being aware of potential overlaps and interactions between the subdisciplines. Further personal experience and development may lead to recognition of rarer presentations as well. 5.5). At its most complex, treatment planning is a challenging, complicated and rewarding decision-making process for both the clinician and patient that involves a two-way dialogue (interrogation and negotiation), leading preferably to short-, medium-, and long-term goals for the management of the patient’s dentition. What does a comprehensive treatment plan really mean? In the context of a healthcare profession, the “endodontist” must, therefore be a human being first, dentist second and endodontist last (, Hierarchical importance of knowledge context, Treatment option selection and treatment planning, Treatment planning, as the term implies, is the planning of the management of a patient’s dental and oral problems in a systematic and ordered way that assumes a complete knowledge of the patient’s needs, the precise nature of the problems and the prognoses of possible management options under consideration. Replacement of missing teeth with fix or removable prostheses, Fig. Diagnosis and Treatment Planning in Dentistry, 3rd Edition provides a full-color guide to creating treatment plans based on a comprehensive patient assessment.Using evidence-based research, this book shows how risk assessment, prognosis, and expected treatment outcomes factor into the planning process. Generally, orthodontic treatment takes between six and thirty months to complete. ii. Phase 3: Fixed Prosthodontics; Phase 4: Removable Prosthodontics and all procedures that should be done at treatment plan conclusion. 6. A Novel Approach to Implant Screw-Retained Restorations | Dr Giacomo Fabbri. The treatment time will largely depend on the classification of the malocclusion, the type of dental devices used to correct it and the perseverance of the patient. The treatment time will largely depend on the classification of the malocclusion, the type of dental devices used to correct it and the perseverance of the patient. Mandibular 6 anterior teeth. With several promising vaccines for the new coronavirus in various stages of testing, California is developing its own vaccination plan for the state’s population. Diagnosis and Treatment Planning in Dentistry, 3rd Edition provides a full-color guide to creating treatment plans based on a comprehensive patient assessment.Using evidence-based research, this book shows how risk assessment, prognosis, and expected treatment outcomes factor into the planning process. If, under the same circumstances, the patient was younger with an incompletely formed root, the decision may now lean towards the more conservative vital pulp therapy (Fig. A recent health economic study using a Markov model evaluating the cost-effectiveness of clinical intervention over the life-time of an adult patient revealed that root-canal treatment is highly cost-effective as a first line intervention for a maxillary central incisor. The dentist and patient will need to have a clear and open discussion (dialogue and negotiation) about concordance between the desired and the possible, at the second level. 5.7 (a) Traumatized maxillary incisor; (b) maxillary incisor following endodontic treatment. The treatment time will largely depend on the classification of the malocclusion, the type of dental devices used to correct it and the perseverance of the patient. Temporomandibular joint (TMJ) and back issues may make extensive work in a single visit uncomfortable and cause the patient t… These are: Stabilisation Reassessment 1 Preliminary Restorative Phase Reassessment 2 Definitive Restorative Phase Reassessment 3 Maintenance The need for re-assessment During treatment the effects of what has been done should be periodically reviewed. These are plaque and marginal gingival bleeding scores, which are recorded at baseline to evaluate the level of plaque control the patient has been able to achieve without instruction (Box 8-3). This treatment can benefit patients who want to address dental blemishes such as chips, cracks, gaps, or discoloration. The parent should stand behind with the child standing against the parent’s legs (Fig 8-5). Their frame of reference extends no further than the teachings at undergraduate level. A surgical approach may stand a better chance of finding the canal but may not help eradicate the major part of the infection in the root-canal system, compromising the chances of successful healing (Fig. Scheduling a Treatment Plan Phase You'll notice that to the left of each Phase in the Treatment Plan Table, there's a Schedule button. Under these circumstances, the sudden precipitation of a pulpal or periapical problem may be managed in isolation as long as there are no complex restorative implications (Fig. Scenario – a patient presents in pain with a poorly maintained mouth, several carious and periapical lesions and gingival inflammation. Here is a general overview of the three major stages of treatment: This is the first phase in the management and is critical to the success of treatment. By subtracting the percentage of sites with marginal gingival bleeding or plaque from 100% these indices can be converted into marginal gingival bleeding-free scores and plaque-free scores (see section on Motivation). Here is a general overview of the three major stages of treatment: Fig 8-3 Periodontal indices after Basic Periodontal Examination (BPE) screening. That specialist, such as an oral surgeon or periodontist, would become involved in helping to create the final treatment plan and in rendering treatment, if needed. Consider an identical scenario but where a traumatized, intact, mature, maxillary central incisor has been left untreated for years as the pulp slowly succumbs and the patient seeks attention either because of an acute infection or the discoloration caused by secondary dentine formation and/or pulp necrosis (Fig. with all aspects of dentistry, a preventive approach can be important, and in some cases, early monitoring and appropriate orthodontic treat-ment can prevent the situation. In medicine, there is a “triage” of care; dentistry is very similar. A detailed examination, using appropriate indices (see Chapple and Gilbert 2002), should be done for the following if a BPE score of 4 or * is recorded: clinical attachment levels (necessary in some cases). Therefore, the parent should be shown how to brush the child’s teeth. 5.2 Interrelationship between assessment and decision making, planning and delivery of treatment. A plan is then made of the sequence in which treatment will be executed, called the “plan of treatment” (Box 5.2). If the tooth is not restoratively compromised and the root is mature, the high prevalence of pulp necrosis in such cases may lean the decision towards root-canal treatment and the appropriate restoration as having a high chance of success (Fig. Place periodontal probe in gingival sulcus and run gently around gingival margin, Four sites for each tooth (buccal, mesial, distal, palatal), Record presence of bleeding from marginal gingival tissues, Calculate number of bleeding sites as a percentage of overall sites (four for each tooth), Record presence of plaque at gingival margin (Fig 8-4), Calculate number of sites with plaque as a percentage of overall sites (Four for each tooth). Now titled analysis and treatment making plans in Dentistry, we have added two new chapters common Diagnoses in Dentistry and Interprofessional treatment making plans. Root canal retreatment of root-filled teeth with apical periodontitis, 9. Generally, orthodontic treatment takes between six and thirty months to complete. Any dental emergency is treated first to achieve patient comfort. The first stage is we are going to address the biological issues that the patient has problems with. The major aetiological agent in periodontal diseases is plaque and therefore treatment has to be directed at its removal and preventing its re-formation. 5.10 (a) Discoloration of tooth following trauma; (b) radiographic evidence of pulp calcification and dentine sclerosis; (c) example of sclerosed canal in maxillary incisor; (d) canal successfully negotiated and obturated, Fig. Fig. This book examines the treatment process from multiple points of view in an effort to balance the very complex process of making a diagnosis, on the one hand, with the need for simplicity and coherence, on the other. The Phases of Orthodontic Treatment. It is not uncommon and perfectly valid for patients on long-term recall, to have the supervising dentist place individual teeth on probation to review their status at a subsequent time because of uncertainty about a diagnosis or the progression of a lesion (Fig. 5.10b) and only evident in the apical third of the root associated with a periapical lesion. 5.7a). ... Every large treatment plan requires extra time before the day of surgery to ensure … Obtaining images for diagnosis and treatment 4. Active engagement in CPD is mandatory in some countries but not all. The situation, however, must be clearly recognized and understood by both the patient and dentist using the so-called, (a) Symptomless 25 has been reviewed for some time and now has a sinus; (b) the same 25 has been retreated and is now under review to assess healing before making a decision about restorative options, Illustration of factors affecting treatment decision making using maxillary incisors as an example, A cost–benefit analysis should be performed to aid the decision-making process as illustrated in, Consider the not uncommon scenario of the pulp in a maxillary incisor of an otherwise intact dentition becoming compromised by a severe traumatic injury in a young, mature adult (, (a) Traumatized maxillary incisor; (b) maxillary incisor following endodontic treatment. Recognition of personal limitations in knowledge and skills, or seeking appropriate referral, is the key to finding a solution. Clear, logical organization builds your understanding with sections on comprehensive patient evaluation, key treatment planning concepts, a detailed review of the five phases of planning treatment and guidelines for selecting the appropriate plan of care, and care planning for patients with special needs. The aim of this chapter is to highlight the factors important in planning the endodontic management of pulpal and periradicular diseases and how to prioritize them in the context of the patient’s overall dental and oral needs. 1. ; In Clinical Practice boxes highlight situations that may be faced by the general dentist. In this diagnostic phase, a detailed systematic appraisal is made in the classical manner described in Chapter 4. Now other considerations come into play, including the potential for successful outcome by conventional or surgical means, as well as the desire for correcting the discoloration. Unfortunately, some dental practitioners take the receipt of their practising licence as the end of formal professional development. Otherwise, he may recommend zirconia ceramic implants. It is not unheard of that, under some circumstances, with the passage of time, the mutually agreed plan may be forgotten or fades from memory, particularly where detailed medical or dental records are not maintained. •It is also known as “Elimination of dental disease” •This includes: Oral cancer prevention and early diagnosis; prevention education and services; emergency treatment; diagnostic services and treatment planning; restorative treatment; basic 5.1 Hierarchical importance of knowledge context. Despite this, dedicated, active practice, with continuous proactive personal development may propel a dentist to the state of mastery of their field relative to contemporary knowledge. Maxillary 6 anterior teeth. Develop your skills in evaluation and dental treatment planning for all types of patients! The tooth in Figure 5.6a has been retreated (Fig. Variations inherent in dentists’ philosophy, knowledge, experience, skills and judgement can give rise to differences in treatment planning between clinicians. It may progress as follows: 1. Clear, logical organization builds your understanding with sections on comprehensive patient evaluation, key treatment planning concepts, a detailed review of the five phases of planning treatment and guidelines for selecting the appropriate plan of care, and care planning for patients with special needs. The probing pocket depth and clinical attachment level measures are described in Box 8-1. 5.6a). This implies an ongoing process of information exchange and informed consent whereby the full extent of risks and benefits are shared and acted upon. The Phases of Orthodontic Treatment. Fig 8-1 Components of initial, corrective and supportive phases of periodontal therapy. visual interpretation and reading of probe gradations by the operator (manual probes only). It includes: 2. 5.10d). A number of different solutions will be possible for management of each of the patient’s problems but the specific treatment options selected will be dictated by the particular effects of interaction of these problems on the patient’s desires, which may include their well-being, aesthetic demands, and functional requirements (eating, speaking, socializing). When planning periodontal therapy it is useful to consider the management across three phases: There may be some overlap of procedures and differences in the length of the three phases for different patients and the endpoint of a specific phase of treatment may not always be clear. In 32 years of practicing dentistry, I have learned more from the Dawson Academy courses than all the other CE courses I have taken combined! Use of interdental aids such as floss should be reserved for t/>, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), 5: Periodontal Diagnosis in Young Patients, 4: Clinical Examination and Local Risk Factors for Periodontal Diseases, 3: History and Systemic Risk Factors for Periodontal Diseases, 6: Non-plaque-induced Periodontal Diseases I: Gingival Lesions, 7: Non-plaque-induced Periodontal Diseases II: Periodontal Lesions. Phases of Treatment– Your doctor will discuss each phase in detail and address any concerns or questions you may have. In prosthetics and cosmetic dentistry, the maxillary central incisor position will dictate your treatment plan. the first relates to analysis, the bedrock from which all treatment selections are made. Show itemized procedure fees or show total amount only. The situation, however, must be clearly recognized and understood by both the patient and dentist using the so-called informed consent approach. 5.10c), which would improve the chances of success (Fig. Treatment planning encompasses the phases of: defining the problem. He discusses the surgical area and what type of implant he will use. Example of potential Bands and Patient Charges generated from phased treatment. The restorative challenges posed coupled with the desire of people to retain functional and aesthetic dentitions into later life have driven the development of the restorative subspecialities of endodontics, periodontics and prosthodontics into ever more complex scenarios. Here is a general overview of the three major stages of treatment: Their knowledge is therefore written in black and white, is clear and simple and may still serve the needs of those patients falling into the “central tendency” of disease presentation. As in life, we tend to see what we are looking for. The dentist will have been trained, by necessity, to recognize only the commonly presenting tendencies in each disease. Carry out periapical surgery, if necessary, 8. Review prognosis of treated teeth, design definitive removable or fixed prosthesis and decide on teeth requiring cast restorations (compliance should be absolute at this stage). A number of potential problems, not causing current difficulties will, therefore have been identified but a mutually agreed decision made between patient and dentist to leave the tooth/teeth alone and periodically review them. A plan of management will have been established at the first encounter at some point in the past and, in the simplest cases, requires no more than a review (recall) to evaluate a change in overall status and provide motivation for maintenance. Fig. Management of carious lesions and preventive measures, 5. Treatment planning strategies are presented to help with balancing the ideal with the practical, with emphasis placed on the central role of the patient — whose needs should drive the treatment planning process. This phase will move permanent teeth into their final position. You can also copy and paste Treatment Plans by holding down the Option Key and clicking a Treatment Plan, then dragging to a blank space in the Treatment Plan node. The intellect and skills of such practitioners may consequently be stunted from flowering into their full potential. Diagnostic Review. The treatment time will largely depend on the classification of the malocclusion, the type of dental devices used to correct it and the perseverance of the patient. Treatment planning may be categorized into a very broad spectrum of complexity from simple isolated problems to those multiple problems requiring complicated multidisciplinary management. A plan of management will have been established at the first encounter at some point in the past and, in the simplest cases, requires no more than a review (recall) to evaluate a change in overall status and provide motivation for maintenance. Conversely, the knowledge and skills of endodontics must be deployed judiciously to ensure that the patient receives appropriate care, meaning that the specialist must also understand the broader context within which their expertise is exercised. Patient Exam. Here is a general overview of the three major stages of treatment: The dentist must gauge the problems correctly, as well as the patient’s attitude, motivation and compliance. The end point of this is a series of conclusions about the general health of the patient and their current oral and dental problems; these will be juxtaposed with the patient’s own perception of their problem(s) and desires for correction of the same. ; In Clinical Practice boxes highlight situations that may be faced by the general dentist. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Overall health and oral care of patients and the role of endodontics within it, Dentistry may be viewed as a speciality of medicine, yet it is itself a diverse and broad discipline. In the ideal scenario, each option should be evaluated in an objective way taking the above factors into account, weighing the effectiveness and projected long-term prognosis (based on outcome data) with compliance, cost and time commitment. 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