Developing a Comprehensive Treatment Plan
This is the second in a three part series from the Chesapeake Dental Education Center (CDEC) covering the topic of treating the worn dentition. “Treating the Worn Dentition - Part I” reviewed the etiology of tooth wear and problem of aberrant tooth position that often occurs as a result of the adaptive changes with wear. In fact, the solution to most wear cases is determining the ideal tooth position. And the two factors involved in determining ideal tooth position are esthetics and function (occlusion and phonetics). In “Part II”, the systematic process for developing a comprehensive treatment plan will be covered.At the CDEC, we have developed STEP™ - a Systematic Treatment Evaluation Protocol consisting of 5 distinct sequential “STEPS” that allows for an efficient and predictable process to determine the ideal esthetic and functional tooth position for any patient.
STEP 1 is the thorough assessment of the patient that gathers all necessary history and information associated with the case. STEP 2 ensures that a comprehensive diagnosis is made and risk assessment is determined. In STEP 3.1, which is the first sub-step in Step 3 - Analyze, a two-dimensional esthetic plan is developed by applying esthetic parameters to patient photographs using PowerPoint. STEP 3.2 then converts the two-dimensional plan – the “blueprint” - into three dimensions - the diagnostic wax-up - by applying occlusal principles to the case. STEP 4 Communicates the plan to the patient and STEP 5 deals with the Implementation of the treatment plan. The discussion will now focus on developing the esthetic plan (STEP 3.1).First, In order to use patient photographs and PowerPoint to develop an esthetic plan, it should be understood that precision dental photography must be employed. Incorrect angulation of the camera will result in distorted perceptions of the patient’s true condition (See images below). It should also be understood that patient photographs will be used to demonstrate to the patient the potential treatment options to solve their problems. Clean, in-focus photographs void of retractors and mirror edges are important, as the subliminal message the patient receives is almost as important as the dental information relative to their case acceptance. Photographs can be fine-tuned – cropped, straightened and exposure adjusted. Nothing takes the place of capturing a great image with the digital camera.