BRICKS PRESENTATION

putting the pieces together

Mastering Treatment Planning

Funmi Oluwajana Consultant and Specialist in Restorative Dentistry and Endodontics

Outline

What affects your treatment planning decisions

The root of the problem

Treatment Planning Process

Case Discussions

Learning objectives & outcomes

SYSTEMATIC APPROACH TO THINKING ABOUT CASES

ASSIMILATE AND COMMUNICATE INFORTMATION TO YOUR PATIENT

BE CONFIDENT THAT YOU CAN ADDRESS A PATIENT'S NEEDS APPROPRIATELY

GDC OUTCOMES: C, D

What impacts my decisions?

Risks

Time

Resources

Clinician

Patient

What is the actual problem?

Putting a plan together

Staging & Sequencing

Treatment Objectives & Options

Maintenance

Diagnosis

Problem List

Treatment Plan

Prognosis & Outcomes

Begin with the end in mind

Case 1 - UM

Case 2- KC

Case 3- JDW

Case 4 -HC

Case 5

questions?

foendodontics@gmail.com

thanks

Risks

• Informed consent
• What are the expected outcomes/prognosis for this treatment - in the literature and in my hands?
• If this all went wrong, could I justify my actions?
• Do I know the evidence to back up my decisions?
• Have I discussed all the alternatives with the patient?
• Do I know how to fix my failures and deal with potential complications?

Problem List

Diagnoses >> Problems >> Solutions

• Important summary information about a patient’s past and present conditions, that is relevant to their current care
• Brings the diagnoses to life contextually
• Helps you to think logically about how you're going to address or accept these problems within your treatment and the likley short and long term outcomes
• Helps you communicate how the diagnoses impact your treatment options and outcomes to the patient

• Strategic importance
• Restorability
• Predictability

Resources

• Equipment/Materials
• Diagnostic equipment
• IT software
• Digital workflow
• Lab support
• Specialists/Consultants
• DCPs
• Guidelines/Position Statements/Protocols

Diagnostic Terminology

Guidelines

Caries Pulpal & Periapical Periodontal Trauma Toothwear Occlusal TMJD Pain Developmental Other

• International Caries Classification & Management System
• American Association of Endodontics
• British Society of Periodontology
• International Association of Dental Traumatology
• Diagnostic Criteria for TMD

Patient factors

• Age
• Medical history
• Social history
• Past dental history
• Main complaint
• Oral health status
• Needs/Wants/Expectations
• Financial capabilities
• Willingness/Motivation for treatment
• Personality/Disposition

Clinician

• Knowledge
• Skill set/Training
• Experience
• Biases/affiliations

Treatment Plan

• Step by step plan of what is going to happen in each appointment of each phase/stage
• At this point you want to run on autopilot

Staging & Sequencing

• Acute
• Stabilisation & Disease Control
• Re-evaluation and Planning
• Rehabilitation
• Maintenance

Treatment objectives and options

• WHAT are you trying to build? - biology, function, biomechanics, aesthetics
• HOW many ways can you build it? - don't forget to consider who/what you could employ to help you
• Present ALL the options to the patient, even ones you wouldn't recommend
• Communicate WHY you might suggest one option over another with honesty

Prognosis & Outcomes

• Every action has an equal and opposite reaction
• Based on current evidence and/or prognostic tools, how long can I expect my work to last
• Survival vs success
• Should this fail/complications arise, am I capable of repairing this?
• When this fails, have I discussed future options with the patient?

Time

• Time to plan
• Time to execute
• Long term maintenance
• Failure
• Future options

Maintenance

• Always consider the maintenance implications of your treatment plan before you finalise the plan
• Inform the patient what they are commiting to e.g. composite vs porcelain, endodontics vs implants
• Who is going to carry out the maintenance and what are the biological/financial/temporal implications
• This needs to form part of the consent process