Phases of treatment planing

2. CONTENT
 Introduction
 Basic principles
 Phases
 Comprehensive treatment plan
 Modification
 Treatment planning in our context
 Merits of treatment planning
 Summary.

3. TREATMENT PLAN
Development of a
treatment plan is the
most critical step in
the successful future
management of the
patient
DIAGNOSIS----Provisional diagnosis
Final Diagnosis

4. Formulate Treatment Options
Treatment Plan
The golden rule of treatment planning is that a diagnosis should
be made before treatment begins.
Caries Risk
Assessment
Patient’s
Preferences/factors
(Subjective Findings)
Problem Lists
(Objective findings from oral
and radiograph exam)
Patient’s Preferences
Informed Consent

5. “ The sequential guide for the patient’s care as
determined by the dentist’s diagnosis and is used by
the dentist for the restoration to and/or maintenance of
optimal oral health”
-American Dental Association

6. Treatment plan is their
required treatment that our
plan is based upon
BASIC PRINCIPLES INVOLVED…
Afford patient opportunity to make well
informed decisions
Educate and advise patients
Medical risk assessment should be done

7. PHASES OF TREATMENT PLAN
Preliminary phase/
Emergency phase
Nonsurgical phase
(phase 1 )
Surgical phase (phase 2)
Restorative phase (phase 3)
Maintenance phase/
Recall Phase(phase 4)

8. ACUTE PHASE :PRELIMINARY PHASE
Emergency Treatments
Maxillofacial trauma
Swelling
Systemic infection
Severe pain

9. PRELIMINARY PHASE
Emergency phase
 includes the chief complain along with those
dental problems producing acute symptoms
and their potential sources.

10. .
Soft tissue lesion
Painful , infected and
hopeless teeth
Bad oral habits like,
chewing paan tobacco
Stoppage of
bleeding

11. NON-SURGICAL PHASE
Plaque control and
patient education
Oral prophylaxis (scaling and polishing )
Removal of calculus and root planning
Correction of restorative and irritating factors
Occlusal therapy
Minor orthodontic movement
Anti microbial therapy
(systemic or local)

12. PATIENT EDUCATION
 In patient with rampant caries advices such as diet
controlling can be a preventive measure.
 Awareness regarding oral hygiene –practices like type of
brush, materials used, techniques and frequency of
brushing.

13.  Dietary instruction: Balanced diet with exclusion of
cariogenic and retentive food.
 Use of topical fluorides.
 Use of anti plaque agent (chlorhexidine, delmopinol
etc).
 Pit and fissure sealants.

14. EVALUATION TO NON-SURGICAL PHASE
Rechecking
 Pocket depth and Gingival inflammation.
 Plaque , Calculus , Caries.

15. The most popular traditional indication is the
presence of pockets of ≥5mm.
 Irregular bony contours
 Degree II and III furcation involvements.
 Distal areas of last molars with expected
mucogingival problems.
 Persistent inflammation.
 Root coverage.
 Removal of gingival enlargements.

16.  Includes extraction of teeth which cannot be
restored / which do not have adequate bone
support.
 It includes periodontal surgeries , including
placements of implants.
 Endodontic procedures.
SURGICAL PHASE

17.  Final restoration
 Periodontal examination
 Space maintainers for children
 Fixed and removable prosthodontic
appliances
 Single crowns, inlays or onlays
RESTORATIVE PHASE

18. MAINTENANCE PHASE
 Recall
 Periodic rechecking
 Evaluation of procedure after treatment is done
 Usually after 6 month of interval

19. EMERGENCY PHASE
NONSURGICAL PHASE
MAINTENANCE PHASE
SURGICAL PHASE RESTORATIVE PHASE

20. COMPREHENSIVE TREATMENT PLAN
(BASED ON LEVELS OF PREVENTION)
1. Emergency phase
2. Promotive phase: Based on health
promotion. Eg: oral hygiene instructions,
diet counseling, habit counseling.
3. Preventive phase: Sealants, fluoride
application, oral prophylaxis if
preventive.

21. 4. Curative phase: based on early diagnosis
and prompt treatment and disability
limitation.
Eg: Oral prophylaxis if curative, restorations,
extractions, periodontal treatment.
5. Rehabilitative phase: dentures- CD, RPD,
FPD
6. Maintenance phase: periodic recall

23. MODIFIED TREATMENT PLAN FOR MEDICALLY
COMPROMISED PATIENT
Based on medical complexity status
classification and protocol ,patients are
categorized and treatment planning is
done accordingly.

24.  It is helpful to focus on the following three
questions.
 What is the likelihood that the patient will
experience an adverse event due to dental
treatment ?
 What is the nature and severity of the potential
adverse event ?
 What is the most appropriate setting in which a
patient can be treated ?

25.  The four major concerns that must be addressed
when assessing the likelihood of the patient
experiencing an adverse event are :
 Possible impaired hemostasis
 Possible susceptibility to infections
 Drug action and drug interaction
 The patient’s ability to withstand the stress and
trauma of dental procedure

26.  Finally based on the type and severity of the
medical condition the patient can be treated
as one of the following:
 Outpatient in general dental office
 Outpatient in dental office with more extended
resources for resuscitation
 Patient in a short procedure unit in a hospital
 Inpatient in a operating room

27. TREATMENT PLANNING IN OUR CONTEXT
Based on the patient’s economic condition, treatment plan
can be either ideal or economical.
 Ideal
 for patient with high economic status , In addition
to reconstructive works, cosmetic and implant
procedure (veneers, laminates, braces) are the
expected outcomes.

28.  Economical
 Patient with low economy and require basic dental work in
order to have functional mouth.
 E.g. Replacement of fixed partial denture with removable
partial denture and Fixed appliance with removable appliances

30. MERITS OF TREATMENT PLANNING
 Chair time can be saved and begin immediately.
 Diagnostic decisions are made at once avoiding
rediagnosing at each time.
 Permits the dental assistants to prepare the required
instrument.

31.  Hence, treatment plan is a blue print for a case
management that includes all procedures required for
the establishment and maintenance of oral health .

32. REFERENCES
 Burkett's Oral Medicine
 Carranza’s clinical Periodontology
 Public Health Dentistry 5th edition Soben Peter
 Wikipedia

35.  Soft-tissue injuries.
Injuries to the soft tissues, which include the
tongue, cheeks, gums, and lips, result in bleeding.
To control the bleeding,
Rinse your mouth with a mild salt-water solution.
 Use a moistened piece of gauze or tea bag to apply
pressure to the bleeding site. Hold in place for 15 to
20 minutes.
 To both control bleeding and relieve pain, hold a
cold compress to the outside of the mouth or cheek
in the affected area for 5 to 10 minutes.
 If the bleeding doesn't stop, see your dentist right
away or go to a hospital emergency room. Continue
to apply pressure on the bleeding site with the
gauze until you can be seen and treated.

37. MCQ

38. 1. Occlusal therapy and minor orthodontic
movement comes under which phase of
treatment plan?
a) Surgical Phase
b) Non Surgical phase
c) Restorative phase
d) Emergency phase

39. 2. An ideal treatment plan should be?
a) Rational
b) Scientific
c) Definitive
d) All of the above

40. 3. Based on history, clinical and radiographical
examination ,clinical diagnosis of ameloblastoma was
made. Treatment plan was formulated to manage the
case. what is the phase of treatment.
(a) Preliminary phase
(b) Surgical phase
(c) Phase 1
(d) Phase 2
(e) Both b & d

41. 4. Which of the following is correctly matched
for treatment planning?
1. Phase 1--- emergency phase
2. Phase 4--- surgical phase
3. Phase 3--- restorative
4. Phase 4--- oral prophylaxis