Download Additional Diagnostic Records Needed

Patient biographical information:
Introduction and Background
Medical History
Past Dental History
Diagnostic Findings
Extraoral
Facial: TMJ/Mandibular Range of Motion:
Intraoral
Dental
Periodontal
Supporting tissues
Occlusal Notes
Class occlusion
Excursive movements
Mobility and fremitus patterns
Other
Radiographic Review
Additional Diagnostic Records Needed:
Radiographs, Scans, Medical, Previous records, Old photographs.
Additional Consultations:
Orthodontic: Goals and Objectives
Other:
Problem list:
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Diagnosis:
Prognosis:
•
Periodontal Case type: AAP Type……..
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Hopeless: #’s
Guarded: #’s
Good: #’s
Kois Risk Factor: (See Below)
1. Periodontal:
2. Biomechanical: (Tooth Structure)
3. Functional: (Joint, Bite Chewing)
4. Dento-Facial: (Esthetic)
At this stage the attendees break out into groups to treatment plan the case.
Three alternative scenarios:
Group 1: The best treatment, no time or financial restrictions.
Group 2: Significant financial limitations, treatment plan appropriately.
Group 3: Limited finances, but wants comprehensive care phased over 2-3 years.
Each group should use the template below to facilitate the treatment planning
process.
Diagnosis and Prognosis
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AAP Type
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Hopeless: #’s
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Guarded: #’s
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Good: #’s
Problem list
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Proposed Treatment Plan
Phase I: Disease control
Medical:
Caries:
Periodontal: (OHI, SRP)
Oral surgery:
Endodontic:
Occlusal adjustment, guards:
Extractions:
Provisional partials/appliances:
Biopsies:
Other:
Phase II: Reconstructive
Periodontal: resective/regenerative/crown lengthening, muco
gingival
Orthodontic: Goals and objectives
Structural (tooth integrity):
Crown and bridge:
Occlusal:
Oral surgical: (Orthognathics)
Dental implants: (Ridge augmentations, Sinus floor
elevations
Esthetic services: (Mock up, Wax up, bleaching, bonding,
veneers,
Plastic surgical:
Other:
Phase III: Maintenance
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Treatment Planning Worksheet
Guidelines and Sequencing.
Scaling/Root Planing and OHI _________________________
Occlusal adjustment via selective grinding ____________________
___________________
Nightguard/Occlusal appliance _____________________________
___________________
Initial extractions #’s _____________________________________
Caries control #’s ________________________________________ _______________________
Provisional restoration #’s _________________________________
_______________________
Endo #’s _______________________________________________
_______________________
Transitional RPD ________________________________________ _______________________
Orthodontic Goals and Objectives:
_________________________________________________________________________
Periodontal Treatment
Osseous surgery
UR ________
UA ________
UL ________
LR ________
LA ________
LL ________
Crown Lengthening #’s
________________________________________ _________________
Root resection #’s ______________________________________________
_________________
Hemi-section without extraction #’s _________________________________
__________________
Regenerative membrane #’s ______________________________________ ___________________
Autogenous bone graft #’s ______________________________________
___________________
Allograft/alloplast #’s __________________________________________
___________________
Mucogingival Procedures
Connective tissue graft #’s _______________________________________ __________________
Free gingival graft #’s ___________________________________________
__________________
Lateral pedicle graft #’s __________________________________________ __________________
Soft tissue ridge augmentation #’s __________________________________
__________________
Gingivectomy/plasty #’s _________________________________________
__________________
Other soft tissue procedures ______________________________________ __________________
Implant Treatment
Implant sites #’s _______________________________________________
Sinus elevation ________________________________________________
Hard tissue ridge augmentation #’s ________________________________
Other implant procedures ________________________________________
__________________
__________________
__________________
__________________
Other extractions #’s ___________________________________________
Alveolectomy/plasty #’s _________________________________________
Biopsy _______________________________________________________
___________________
___________________
___________________
Oral Surgery
Orthognathic surgery
Maxillary advancement / set-back / impaction _______________________
___________________
Surgically assisted palatal expansion _______________________________
___________________
Mandibular advancement / set-back ________________________________ ___________________
Menton advancement / set-back ___________________________________ ___________________
Other orthognathic procedures ____________________________________ ___________________
Restorative Treatment
Operative dentistry #’s __________________________________________
___________________
Resin-retained bridge #’s ________________________________________
Crown and bridge #’s ___________________________________________
Removable prosthesis ___________________________________________
_______________
_____________________
_____________________
Treatment Planning Worksheet
Aesthetic services
Sequence
Composite veneers / additions #’s __________________________________ _____________________
Porcelain veneers #’s ____________________________________________
_____________________
Bleaching #’s __________________________________________________
_____________________
Odontoplasty #’s _______________________________________________
_____________________
Other aesthetic procedures ________________________________________ _____________________
Maintenance Schedule
Restorative office _______________________________________________
Periodontal office _______________________________________________
Other office ____________________________________________________
_____________________
_____________________
_____________________
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