28/01/1440
Treatment Planning
for Comprehensive
Care Cases
Prof. Faten Salah
Treatment Planning Purpose
Formulating a logical sequence of
treatment designed to restore the
patient’s dentition to good health,
with optimal function and
appearance .
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The key of a successful dental case
is the planning of the treatment at
the beginning to sequence the
necessary procedures to diagnose
and develop a treatment plan for
complex prosthodontic cases in the
Primary Care Clinics
What is an Ideal Treatment plan?
Treatment plan that achieves the best
possible long-term outcomes for the
patient, while addressing all patient
concerns and active problems, with the
minimum necessary intervention*
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Complex Prosthodontic Cases
Factors to be considered:
Four or more fixed restorations (crowns, FPD)
CD/RPD, RPD/RPD with or without crowns
Immediate dentures
Cases requiring a change in VDO
Implant cases (Optional)
Cases deemed complex by screening or clinic
faculty
Developing Treatment Options
Factors to be considered:
Longevity
Cost
Patient’s expectations
Success rate
Possible complications
Time involved, both total treatment time and
number of visits
Influence on quality of life
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Treatment Plan by Phases
Dental & medical history
Phase I Clinical examination, Radiographic films
Diagnosis , Dx photographs
& Dx Casts , mounting &occlusal analysis
Emergency
Dx Wax-up, Aesthetic evaluation
Treatment Plan by Phases
Immediate treatment to control pain or
infection
Phase I
Diagnosis Extraction of hopeless teeth
&
Emergency intial oral hygiene instructions
Intial scaling
Initiation of education and motivation
of patient
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Treatment Plan by Phases
Periodontal Therapy & deep scaling
Endodontic Therapy (RCT)
Phase II
Removal of existing restorations ,
Disease
Control Caries control
Crownlengthening & occlusal
adjustment
Long-term provisional restorations
Definitive Periodontal treatment
Definitive mouth preprations
Phase III
Restorative Definitive fixed cast restorations
procedures,
& Final
Definitive cast RPD’s procedures
Insertion
Definitive RPD & fixed
prosthodontic restoration
insertion
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Recall every 6 months
Phase IV
Maintenance
Fluoride supplements
Reinforce oral hygiene
Diagnostic Phase (I)
A series of diagnostic appointments should be
scheduled to complete a thorough evaluation
of the patient dental condition:
Diagnostic Impressions
Diagnostic casts (duplicated twice for RPD
cases and one for other treatments)
Two sets of casts oriented identically on
articulator in CR (Face-bow required)
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Diagnostic Casts*
Mount Dx casts on articulator using
face bow/CRR
Each set is mounted identically
(cross-mounted technique)
One set of Dx cast is used for Dx
wax-up
One set of Dx casts is left unaltered
(original)
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Diagnostic Wax-up:
Casts/waxing/set-ups (denture teeth)
must be completed prior to beginning
any reconstructive treatment
(castings/prostheses or
definitive Periodontal
therapy)
Diagnostic Wax-up
* Useful to show proposed treatment to the
patient
*Used for fabrication of provisional
restorations
*Fabrication of final restorations against the
diagnostically waxed cast allows establishing
optimum contour and occlusion
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Diagnostic Wax-up
*Provides specific information about
desired tooth length and form or
occlusal arrangement: dentist-lab
technician communication
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Treatment options
There are many challenges in
choosing the dental prosthesis
from being fixed dental
prosthesis or removable one.
There are many points put in
mind in choosing the dental
prosthesis like:
•Patients that will not permit cutting
of tooth structure.
•Patients having bad habits
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*Professional fees ( must be adequate).
*Favorable occlusion (inter maxillary
relationship favorable for dental
prosthesis).
*General health of the patient
* Oral health
* Ridge conditions
Thank You!
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