PLANNING OF COMPLEX

DENTAL SERVICE, SEQUENCE

OF URGENCY

Dr. Fazekas, Árpád PhD, DSc

 Success of operative treatment
depends on
 Appropriate pretreatment considerations
 Patient’ s reasons for seeking care
 Patient assessment #
 Examinations and diagnosis
 Treatment planning
 PATIENT ASSESSMENT
 Medical review
 Medical history form (contagious diseases,
allergies, systemic diseases etc.)
 Physical status (puls, blood pressure)
 Geriatric patients
 How to ask questions?
 Affective, sociological and
psychological rewiew
 Attitudes
 Priorities
 Expectations
 Motivations
 Educability
 Financial situation
 Dental history
 Rewiew of past dental history
 Rewiew of current problems – chief complaint
 If symptoms are present: onset and pattern,
frequency, exacerbating and relieving factors
 If pain is the main symptom: origin and
radiation, character and intensity, associations
 Available radiographs (is there a need for a new
one?) #
 Magnification aids, photography
 Pretreatment considerations
 Patient assessment
 Examinations and diagnosis
 Treatment planning
 EXAMINATION AND DIAGNOSIS
 Examination: the process of observing
both normal and abnormal conditions
 Clinical
 Extraoral – visual appraisal
 Intraoral – oral hygiene, teeth, periodontal cond,
ect #
 Radiographic
 Adjunctive diagnostic aids
 Diagnosis: determination and judgment of
variations from the normal
 Preliminary measures for clinical
examination
 In clean, dry, well illuminated mouth
 Instruments used
 Initial scaling?
 Denotation system used
 FDI,s two-digit system
 Universal (American) etc.
 Significance of charting and records
(malpractice, forensic uses, etc.)
 Features of good charting systems
(uncomlicated, comprehensive, accessible,
updated)
Caries diagnosis, clinical examintion
for caries
 Aids to diagnosis
 Visual exam. (transillumination)
 Tactile exam. (blunt or sharp probe)
 Radiographs (bitewing) #
 Knowledge of the probability of location of
caries and patterns of susceptibility
 Occurrence of caries
 Pit and fissure caries
 Smooth surface caries
 Proximal surface c. #
 Facial and lingual surfaces in gingival areas
 Root caries in geriatric patients
 Clinical examination of amalgam,
cast and tooth coloured
restorations
 Amalgam blues
 Proximal overhangs
 Marginal ditching
 Voids
 Fracture lines
 Improper anatomical contours
 Marginal ridge incompatibility
 Improper proximal contacts
 Recurrent caries
 Other examinations
 Radiographic
 Rewiew of periodontium
 Soft tissue exam.
 Occlusal exam.
 Examination of the patient in pain
 Treatment plan depends on:

 thorough patient evaluation;

 dentist expertise;
 understanding of indications,
contraindications
 prediction of patient’s response to
treatment; (prognosis!)
Steps for creating a treatment plan:

 examination and problem identification;

 decision to recommend intervention;
 identification of treatment alternatives;
 selection of the treatment (patient is
involved);
Factors influencing treatment plan:

 patient preference, motivation, systemic

health, emotional status, financial
capabilities, dentist's knowledge,
experience, training, laboratory support,
dentist-patient compatibility, functional-,
esthetic-, technical- demands.
Treatment plan sequencing:
(scheduling the needed procedures
into a time frame)
 urgent phase, „greatest need”
 control phase (extraction, endodontics,
etc.);
 holding or re-evaluation phase (time for
healing);
 definitive phase (interdisciplinary consid.);
 maintenance phase (regular recall exam.);
Interdisciplinary considerations in
operative treatment planning
 Endodontics
 Periodontics
 Orthodontics
 Oral surgery
 Occlusion
 Fixed, removable, and implant
prosthodontics
 Decision making for caries
management and operative
treatment
 Operative preventive treatment
 Restroration of incipient lesions
 Esthetic treatment
 Treatment of abrasion
 Treatment of root-surfice caries
 Treatment of root-surfice sensitivity
 Repairing and resurfacing existing restorations
 Replacement of existing restorations
 Indication for amalgam restorations
 Indication for direct composit and other tooth-colored restorations
 Ind. for indirect tooth-colored restorations
 Ind. for cast metal restorations
 Treatment plan approval

 Informed consent
 Information about the alternative
therapies
 Cost of treatment alternatives
Case selection
 Replacement of defective root calnal
filling
 Crown lengthening

 Implantation
 Hemisection
 Gingivo-, osteosurgery
 Post and core preparation
 Temporay bridgework
 Crown lengthening
 Post and core preparation
 Preparation for crowns
 Retraction of the sulcus
 Making impression
 Occlusion reconstruction
 Trial
 Fix prothesis is accomplished
 Patient’s esthetic requirements
Thank you for your
attention