P.S.
M
COLLEGE OF DENTAL
SCIENCE AND RESEARCH
THRISSUR, KERALA – 680519
(Affiliated to Kerala Health University)
DEPARTMENT OF CONSERVATIVE DENTISTRY AND
ENDODONTICS
SEMINAR ON:
TREATMENT PLANNING FOR
RESTORATIVE PROCEDURES
SUBMITTED BY:
RISMIN P SUNIL
3RD YEAR BDS
Department of
CONSERVATIVE DENTISTRY AND ENDODONTICS
CERTIFICATE
Certified that this is a Bonafide seminar RISMIN P SUNIL. She
has satisfactorily completed the seminar on the topic
“TREATMENT PLANNING FOR
RESTORATIVE PROCEDURES”
for III BDS course during the year 2020 – 2021
Head of the Department
University Reg. No.180021186
Date:
ACKNOWLEDGEMENT
Iam extremely thankful to the Almighty God, who guided me in
all aspects for preparing this successful work.
I sincerely thank Dr. Deepak Baby (Professor and Head of the
Department), Dr. Sreedevi P.V, Dr. Rajeev K.G, Dr. Derick
Joseph, Dr. Dilu Davis, Dr. Alen Pius , Dr. Varsha Joseph and
Dr.
Lauabel John for their guidance, motivation and encouragement
given throughout this work.
Special thanks to the college library for providing all the needed
facilities. Let me also convey my gratitude to my classmates
and friends for providing me all the necessary help pertaining to
this seminar and always encouraging me to bring the best.
SL no. CONTENT PAGE NO:
1. INTRODUCTION 5
2. TREATMENT PLANNING 6
3. ORDER OF TREATMENT 10
4. TREATMENT SEQUENCING 11
5. DOCUMENTATION 14
6. CHARTING 15
7. TREATMENT PLAN APPROVAL 16
8. CONCLUSION 17
9. BIBILOGRAPHY 18
INTRODUCTION
A patient attending for treatment of a restorative nature may present
for a variety of reasons.
The success is built upon careful history taking coupled with a logical
progression to diagnosis of the problem that has been presented. Each
stage follows on from the preceding one.
A fitting treatment plan should be formulated and should involve a
holistic approach to what is required.
The purpose of dental treatment is to respond to a patient's needs.
Each patient, however, is as unique as a fingerprint. Treatment
therefore should be highly individualized for the patient as well as the
disease.
TREATMENT PLANNING
1)It is a carefully sequenced series of services designed to eliminate or
control etiologic factor.
2)It is the schedule and sequence of the treatment, which have been
outlined.
3) It is created as a response to the problem list.
4) It means developing a course of action that encompasses the ramifications
and sequeale of treatment to serve patients’ needs.
5)It is the blueprint for case management.
Treatment plans are influenced by many factors, including patient
preferences, motivation, systemic health, emotional status, and financial
resources. The treatment plan is influenced by:
I.Patient’s functional, esthetic, and technical demands
II.Dentist’s knowledge, experience, and training
III.Laboratory support
IV.Dentist–patient compatibility
V.Availability of specialists
A treatment plan should allow for re-evaluation and be adaptable to meet
the changing needs, preferences, and health conditions of the patient.
DEVELOPMENT OF TREATMENT PLAN FOR A PATIENT CONSISTS OF FOUR
STEPS:
1)Examination and problem identification
2)Decision to recommend intervention
3)Identification of treatment alternatives
4)Selection of the treatment with patient's involvement.
When the database (information) is gathered, three stages must be
established:
1)Generation of the problem list (ranking the order of problems)
2)Tentative treatment plan for each of the problems
3)Synthesis of the tentative treatment plan into a unified detailed treatment
plan.
RESTORATIVE TREATMENT PLANNING OF NONVITAL TEETH
Restorative treatment decisions depend on the following:
• Amount of the remaining tooth structure
• Functional demands that will be placed on the tooth
• Need for the tooth as an abutment in a larger restoration.
Posterior teeth carry greater occlusal forces than anterior teeth, and
restorations must be planned to protect posterior teeth against
fracture.
The horizontal and torquing forces endured by abutments for fixed
or removable partial dentures dictate more extensive protective
and retentive features in the restoration.
Teeth with minimal remaining tooth structure face the following
challenges:
• They have an increased risk for fracture.
• They provide decreased retention for the restoration.
• They are in jeopardy for invasion of the periodontal attachment.
PROBLEM LIST
•The problem list is a summary listing of the patient's complaints,
lesions, and conditions that warrant additional diagnostic evaluation or
treatment.
•The problem list is organized by the priority of the problems in the
judgment of the clinician.
•This is usually in the sequence of the chief complaint, current medical
conditions, general dental problems, and specific dental lesions.
•Even when modification is necessary, the dentist is ethically and
professionally responsible for providing the best level of care possible.
•A treatment plan is not a static list of services. Rather, it is a
multiphase and dynamic series of events.
•Its success is determined by its suitableness to meet the patient's
initial and long-term needs.
ORDER OF TREATMENT
Operative treatment generally proceeds from the most to the least
involved teeth.
•Treatment of the chief complaint of dental pain will of course take
precedence.
•Certain functional and esthetic considerations may be dealt with early
in the treatment plan when indicated.
Sensitive teeth and areas of food impaction may also be treated early.
Stability of the occlusion should be assured before proceeding with cast
and esthetic crowns.
Factors like operator's schedule and his experience will alter the
planned order of procedure.
TREATMENT PLAN SEQUENCING
Proper sequencing is a crucial component of a successful treatment
plan. Certain treatments must follow others in a logical order, whereas
other treatments may or must occur concurrently and require
coordination. Complex treatment plans often are sequenced in phases,
including
I.urgent phase,
II.control phase,
III.re-evaluation phase,
IV.definitive phase, and
V.maintenance phase (that includes reassessment and recare).
Urgent phase
The urgent phase of care begins with a thorough review of the patient's
medical condition and history. So, a patient presenting with swelling,
pain, bleeding, or infection should have these problems managed as soon
as possible and certainly before initiation of subsequent phases
Control phase
It is meant to
1.eliminate active disease such as caries and inflammation;
2.remove conditions preventing maintenance;
3.eliminate potential causes of disease, and
4.begin preventive dentistry activities.
This includes extractions, endodontics, periodontal debridement and
scaling, occlusal adjustment as needed, caries removal,
replacement/repair of defective restorations such as those with
gingival overhangs, and use of caries control measures.The goals of
this phase are to remove etiologic factors and stabilize the patient's
dental health.
Re-Evaluation phase
The holding phase is the time between the control and definitive
phases that allows for resolution of inflammation and time for healing.
Home care habits are reinforced, motivation for further treatment is
assessed, and initial treatment and pulpal responses are re-evaluated
before definitive care is begun.
Definitive phase
After the dentist reassesses initial treatment and determines the need
for further care, the patient enters the corrective or definitive phase of
treatment. Sequencing operative care with endodontic, periodontal,
orthodontic, oral surgical, and prosthodontic treatment is essential.
Maintenance phase
This includes regular recall examinations that:
1)may reveal the need for adjustments to prevent future breakdown,
and
2)provide an opportunity to reinforce home care.
The frequency of re-evaluation examinations during the maintenance
phase depends in large part on the patient's risk for dental disease:
1)A patient who has stable periodontal health and a recent history of
no caries should have longer intervals (e.g. 9–12 months or longer)
between recall visits.
2)Those at high risk for dental caries and/or periodontal breakdown
should be examined much more frequently (e.g. 3–4 months).
Documentation
Documentation in the context of health care refers to the production of
a physical record that contains the pertinent information related to the
diagnosis and treatment of the patient.
Features of Ideal Patient Documentation System
1.Allow quick and easy data entry
2.Allow quick and easy data retrieval
3.Should be comprehensive
4.Should be brief
5.Should be clear
6.Should be made to use the data conveniently
7.Should be easily expandable
8.Should be versatile
9.Should be efficient by quickly conveying complex information
10.Should be economical
11.Should be educational by reinforcing diagnostic, treatment planning,
and patient management principles.
CHARTING
Though various formats are available for recording a patient's dental
condition, an acceptable charting system should conform to certain
standards. The charts should be
1)uncomplicated,
2)comprehensive,
3)accessible, and
4)current.
CONSERVATIVE CHARTING
This includes caries and existing restoration. This represents the
dentition when viewed from in front of the patient, so that the teeth
that are on the right side of the page are on the patient's left side and
vice versa.
The convention is that the horizontal line between the upper and lower
teeth represents the tongue, so that the lingual or palatal surfaces are
those nearest to this line, and the buccal or labial surfaces are those at
the top of the top row and the bottom of the bottom row.
The marks on the posterior teeth divide the tooth into occlusal, mesial,
distal, buccal, and lingual surfaces, and the same applies to the anterior
teeth except that there is no occlusal surface.
TREATMENT PLAN APPROVAL
Informed consent has become an integral part of modern day dental
practice.
One aspect of informed consent is to provide the patient with the
necessary information about the alternative therapies available to
manage their oral conditions.
Alternatives presented
↓
Advantages / disadvantages of each discussed
↓
Risk associated with each alternative therapy
↓
Cost
(Many times a reasonable alternative is not to intervene but instead to
monitor the condition.)
Once the dentist is sure about the above, then treatment can proceed.
CONCLUSION
Many problems encountered during treatment are directly traceable
to factors overlooked during the initial examination and data
collection. It is important that the patient's mouth is not seen merely
as a long list of items, each of which requires completion before the
next one can be started.
BIBILIOGRAPHY
1. STURDEVANT'S ART AND SCIENCE OF OPERATIVE DENTISTRY. 4TH
ED.
2. PRINCIPLES AND PRACTICE OF OPERATIVE DENTISTRY. 3RD ED.
3. PRINCIPLES OF ORAL DIAGNOSIS.
4. PICKARD'S MANUAL OF OPERATIVE DENTISTRY. 7TH ED.
5. GROSSMAN’S ENDODONTIC PRACTICE -14TH ED .
