Treatment Planning Dental Restorative Cases for Future Outcomes of Health Dr. Rosemary Pruneau, D.D.S.
Treatment Planning Principles ●
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“An accurate prognosis for each tooth and the patient's overall dental health is central to a successful treatment plan.” Tx Plan Formula 1. Problem identification 2. Intervention recommendation 3. Comparison of alternatives 4. Selection of treatment
Respond to Patient Problems (Functional, Esthetic, Financial) Elimination of Disease Etiology
Treatment Complications
Understanding of patient disease
Dental Treatment Knowledge
Sequence suited for Patient and Provider
Patient X - Basics
Medications
ROS ● ● ●
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HTN Depression/ anxiety Pulmonary embolism (2005) Heart murmur
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Warfarin (INR = 2) Carvedilol Lisinopril Spironolactone Aspirin 81mg
Surgical
Allergies ●
Penicillin
Social ●
Cigarettes (2 pack year history)
ID: 62yM 6’3” 203lb BMI 25.2
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Colonoscopy Knee surgery
= ASA II
Patient X - Comprehensive Exam ● ●
Patient presented to clinic in the afternoon. “Ever since I had COVID back in 2020 my health has been in decline. I used to have an amazing white smile! I was also hospitalized with pneumonia this year and have struggled with my dry mouth. My budget is 5 grand, but I am not worried about money, this is way more important. I have neglected my teeth this year and am ready to invest in getting back to where I was doc. I want to save my teeth, and am willing to pay for anything that saves them.” Armamentarium: Diagnostic Models
Radiographs (Panoramic, bitewing)
Health History
Patient Finances
Odontogram
Collaboration between resident, faculty, and staff
Patient X - Panoramic
Patient X - Odontogram and Treatment Plan Formula
1. 2. 3. 4.
Problem identification: rampant decay, difficulty chewing, loss of esthetics Intervention recommendation: extraction, composite restorations, dentures Comparison of alternatives: maxillary complete denture vs. partial, mandibular partial Selection of treatment: maxillary and mandibular partials with extractions of hopeless dentition and composite restoration of caries
Patient X - Maxillary Arch Rationale Maxillary Arch Maxi
Full Arch Extractions and Complete Denture
Pro: Complete healing and restoration with prosthetic for esthetic outcome
Con: Loss of natural esthetic teeth, adjustment to complete denture
Extractions #6,7,12,13,14,15 and Partial Denture
Pro: Keep natural teeth
Con: Future extractions and CD fabrication if caries progress
Initial Treatment Plan 1.
Extractions (hopeless prognosis)
2.
Caries Excavation and re-evaluation
3.
Composite Restorations
4.
Maxillary and Mandibular RPD
Patient X - Moving Forward Active Treatment prn
Periodic Exam
Dental Treatment and Maintenance
Hygiene At-home Care
References ●
Sivakumar, Andamuthu et al. “Treatment planning in conservative dentistry.” Journal of pharmacy & bioallied sciences vol. 4,Suppl 2 (2012): S406-9. doi:10.4103/0975-7406.100305