Treatment Planning in Conservative Dentistry
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Dental Science - Review Article Treatment planning in conservative dentistry Andamuthu Sivakumar, Vinod Thangaswamy1, Vaiyapuri Ravi Department of ABSTRACT Conservative Dentistry A patient attending for treatment of a restorative nature may present for a variety of reasons. The success is and Endodontics, built upon careful history taking coupled with a logical progression to diagnosis of the problem that has been Vivekanandha Dental College for Women, presented. Each stage follows on from the preceding one. A fitting treatment plan should be formulated and Tiruchengodu, 1Oral and should involve a holistic approach to what is required. Maxillofacial Surgery, JKKN Dental College and Hospital, Kumarapal Ayam, India Address for correspondence: Dr. Andamuthu Sivakumar, E-mail: tirupurdental@gmail. com Received : 01-12-11 Review completed : 02-01-12 Accepted : 26-01-12 KEY WORDS: Diagnosis, history, holistic, restorative, treatment plan he purpose of dental treatment is to respond to a patient’s understanding of the disease processes and their relationship T needs. Each patient, however, is as unique as a fingerprint. to each other. Fundamental is that the diagnosed lesion be Treatment therefore should be highly individualized for the considered in context with its host, the patient, and the total patient as well as the disease.[1] environment to which it is subjected. Careful weighing of all information will lead to an authoritative opinion regarding Treatment Planning treatment. So, a sound treatment plan [Table 1] depends on thorough patient evaluation, dentist expertise, understanding 1. It is a carefully sequenced series of services designed to the indications and contraindications, and prediction of eliminate or control etiologic factor.[2] patient’s response to treatment. An accurate prognosis for 2. It is the schedule and sequence of the treatment, which each tooth and the patient’s overall dental health is central to [3] have been outlined. a successful treatment plan. 3. It is created as a response to the problem list.[4] 4. It means developing a course of action that encompasses the Development of treatment plan for a patient consists of four ramifications and sequeale of treatment to serve patients’ steps: needs.[5] 1. Examination and problem identification 5. It is the blueprint for case management.[6] 2. Decision to recommend intervention 3. Identification of treatment alternatives The order of the general treatment plan has as its basis an 4. Selection of the treatment with patient’s involvement.[2] Access this article online Quick Response Code: When the database (information) is gathered, three stages Website: must be established: www.jpbsonline.org 1. Generation of the problem list (ranking the order of problems) DOI: 2. Tentative treatment plan for each of the problems 10.4103/0975-7406.100305 3. Synthesis of the tentative treatment plan into a unified detailed treatment plan.[7] How to cite this article: Sivakumar A, Thangaswamy V, Ravi V. Treatment planning in conservative dentistry. J Pharm Bioall Sci 2012;4:406-9. S406 Journal of Pharmacy and Bioallied Sciences Vol 4 August 2012 Supplement 2 - Part 4 Sivakumar, et al.: Conservative dentistry-treatment planning Table 1: Factors affecting treatment plan Urgent phase Patient factors Dentist factors Patient preferences Dentists knowledge The urgent phase of care begins with a thorough review of the Motivation Experience and training patient’s medical condition and history. So, a patient presenting Systemic health Laboratory support with swelling, pain, bleeding, or infection should have these Emotional status Dentist–patient compatibility problems managed as soon as possible and certainly before Financial capabilities Availability of specialists initiation of subsequent phases. Functional, esthetic, and technical demands Control phase Problem List It is meant to The problem list is a summary listing of the patient’s 1. eliminate active disease such as caries and inflammation; complaints, lesions, and conditions that warrant additional 2. remove conditions preventing maintenance; diagnostic evaluation or treatment. The problem list is organized 3. eliminate potential causes of disease, and by the priority of the problems in the judgment of the clinician. 4. begin preventive dentistry activities.[2] This is usually in the sequence of the chief complaint, current medical conditions, general dental problems, and specific This includes extractions, endodontics, periodontal debridement dental lesions. [8] and scaling, occlusal adjustment as needed, caries removal, replacement/repair of defective restorations such as those with Even when modification is necessary, the dentist is ethically gingival overhangs, and use of caries control measures.[11] The and professionally responsible for providing the best level of goals of this phase are to remove etiologic factors and stabilize care possible. A treatment plan is not a static list of services. the patient’s dental health. Rather, it is a multiphase and dynamic series of events. Its success is determined by its suitableness to meet the patient’s Re-Evaluation phase initial and long-term needs. Treatment planning should allow for re-evaluation and be adaptable to meet the changing needs, The holding phase is the time between the control and preferences, and health conditions of the patient.[2] definitive phases that allows for resolution of inflammation and time for healing. Home care habits are reinforced, Order of treatment motivation for further treatment is assessed, and initial treatment and pulpal responses are re-evaluated before Operative treatment generally proceeds from the most to the definitive care is begun. least involved teeth. • Treatment of the chief complaint of dental pain will of Definitive phase course take precedence. • Certain functional and esthetic considerations may be After the dentist reassesses initial treatment and determines dealt with early in the treatment plan when indicated the need for further care, the patient enters the corrective (broken teeth, even though not painful, will call for some or definitive phase of treatment. Sequencing operative care treatment to relieve the patient of the discomfort of sharp with endodontic, periodontal, orthodontic, oral surgical, and margins). prosthodontic treatment is essential. Sensitive teeth and areas of food impaction may also be treated Maintenance phase early. Stability of the occlusion should be assured before proceeding with cast and esthetic crowns. This includes regular recall examinations that: 1. may reveal the need for adjustments to prevent future Factors like operator’s schedule and his experience will alter the breakdown, and [9] planned order of procedure. 2. provide an opportunity to reinforce home care. Treatment plan sequencing The frequency of re-evaluation examinations during the maintenance phase depends in large part on the patient’s risk It is the process of scheduling the needed procedures into for dental disease: a time frame. Proper sequencing is a critical component 1. A patient who has stable periodontal health and a recent of a successful treatment plan. Complex treatment plans history of no caries should have longer intervals (e.g. often should be sequenced in phases, including an urgent 9–12 months or longer) between recall visits. phase, control phase, re-evaluation phase, definitive phase, 2. Those at high risk for dental caries and/or periodontal and maintenance phase.[10] For most patients, the first three breakdown should be examined much more frequently (e.g. phases are accomplished as a single phase. Generally, the 3–4 months). concept of greatest need guides the order in which treatment is sequenced. This concept dictates that what the patient Actual caries risk is the extent to which a person at a particular needs is performed first. time runs the risk of developing carious leision.[12] Journal of Pharmacy and Bioallied Sciences Vol 4 August 2012 Supplement 2 - Part 4 S407 Sivakumar, et al.: Conservative dentistry-treatment planning Quadrant Dentistry This approach should be included in the treatment plan. It reduces the number of times local analgesics is used, makes maximum use of the time available, and is economically beneficial.[13] 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 Figure 1: This chart does not represent the size of the lesion or 3. Should be comprehensive restoration 4. Should be brief 5. Should be clear have endodontic treatment before restoration is complete. For 6. Should be made to use the data conveniently the endodontically inadequate filled tooth, oral fluids exposed 7. Should be easily expandable to the fill should be evaluated before restorative therapy is 8. Should be versatile initated.[16] 9. Should be efficient by quickly conveying complex information Periodontics 10. Should be economical 11. Should be educational by reinforcing diagnostic, treatment Generally, periodontal treatment should precede operative care, planning, and patient management principles.[8] since it creates a more desirable environment for performing operative treatment. Any teeth requiring restorations that may Charting encroach on the biologic width of periodontium should have appropriate crown-lengthening surgical procedures