Quality Resource Guide –

Treatment Planning 4th Edition

www.metdental.com

Page 6

References

Stefanic SJ and Nesbit SP. Treatment planning in dentistry, St Louis, 2016, Mosby.

revision of diagnoses, identification of new

problems, modification of prognoses and whether

the problems addressed by the course of therapy

have been resolved. The clinician should determine

whether the problems addressed by the initial

course of treatment have been resolved and the

reasons for failure if problems persist.

Phase II Therapy

The broad objectives of Phase II are to replace lost

structures and/or restore function and appearance.

While attaining this objective in the short term does

not depend on a successful conclusion of Phase I,

long-term success without control of caries and

inflammatory periodontal disease is unlikely. This

unpleasant reality is well known to dentists but not

always appreciated by patients.

Phase II therapy is specifically directed to correction

of developmental defects or sequelae of diseases,

such as major loss of coronal tooth structure,

pockets and other periodontal defects, and missing,

impacted or malposed teeth. As such, it includes

a wide array of procedures, including definitive

restoration of individual teeth, surgical correction

of periodontal defects, orthodontic treatment

and replacement of missing teeth with fixed or

removable prostheses or implants.

Although the focus of Phase II is restoration

of structure and function, disease control and

preventive strategies implemented in Phase I,

whether performed by patient or dentist, must be

sustained. This effort together with the outcome of

procedures should be evaluated during and at the

completion the Phase II plan.

If a treatment plan is based on a comprehensive

problem list, the list can be used to judge the

success of therapy. Such a plan, if well designed

and executed, should result in a patient free of all

original problems when examined at the end of

Phase II.

Alternately, some problems may persist

or new problems may arise. This would obviously

trigger an analysis of the reasons for this outcome

and development of a new treatment plan.

Phase III Therapy

Phase III consists of those strategies necessary

to maintain the health and stability achieved in

Phase II. In a very real sense, Phase III is no

longer “treatment” but rather “health maintenance.” It

entails continuation of patient-performed preventive

regimens; periodic assessment of oral, dental

and periodontal status to ensure early detection

of new or recurrent diseases; and the delivery of

appropriate supportive therapy.

Should disease or

other problems arise during the maintenance period,

appropriate active treatment would be prescribed

and delivered, and maintenance would continue.

Although treatment plans may be complicated, the

development of a good treatment plan need not be

a difficult task if the practitioner heeds the following:

Examine extra- and intraoral structures thoroughly

and comprehensively.

2. Document examination findings in a manner that

would meet rigorous peer-review.

3. Understand

your

patient:

make

accurate

diagnoses; develop a defined problem list;

make reasonable prognoses with and without

treatment; be aware of the patient’s expectations

and fears; and appreciate systemic conditions

that may impact on or be impacted by proposed

dental treatment.

4. Construct an individualized treatment plan that

addresses all of the patient’s defined problems

as well as possible.

5. Base treatment strategies on current evidence.

6. Sequence the treatment plan based on need and

priority: relieve pain and infection and address

other emergent or urgent problems; arrest

active diseases with strategies aimed at causes

and contributing factors; implement preventive

measures; correct structural defects or other

sequelae of disease or injury; and maintain health

once achieved by preventive and supportive

therapy to minimize disease risk.

7. Record the treatment plan. Written documents

remember what patients and practitioners forget.

8. Present and discuss the treatment plan. This

is necessary to ensure that the patient fully

understands both procedures and goals.

This discussion is also the basis for obtaining

informed consent to treat.