{"id":474,"date":"2012-03-26T00:56:41","date_gmt":"2012-03-26T05:56:41","guid":{"rendered":"http:\/\/allisonwatts.com\/blog\/?p=474"},"modified":"2020-12-24T16:01:32","modified_gmt":"2020-12-24T22:01:32","slug":"structural-biological-diagnosis-treatment-planning","status":"publish","type":"post","link":"https:\/\/allisonwatts.com\/structural-biological-diagnosis-treatment-planning\/","title":{"rendered":"Structural and Biological Diagnosis and Treatment Planning"},"content":{"rendered":"
\"\"<\/a><\/div>\n
Structural and Biological Diagnosis and Treatment Planning<\/span><\/b><\/span><\/span><\/div>\n
by Allison Watts, DDS<\/span><\/i><\/span><\/span><\/div>\n
We are walking through the steps of a  full – mouth reconstruction.<\/b>  Much of this can also be applied to other types of cases — this one especially! I enjoy learning all the parts of something and putting it all together and presenting it in an easy-to-understand and useful way. That is my goal here. My hope is that it is clear, interesting and something you can truly use. <\/span><\/span><\/div>\n
Here’s what we’ve covered so far:<\/strong><\/span><\/span><\/div>\n
\n

Phone call\/First encounter<\/b><\/a><\/span><\/span><\/p>\n

NP experience\/First appointment<\/b><\/a><\/span><\/span><\/p>\n

Data collection\/Records<\/b><\/a><\/span><\/span><\/p>\n

Treatment planning and sequencing<\/b><\/a><\/span><\/span><\/p>\n

Setting fees <\/b><\/a>– <\/b>Just a reminder that much of fee-setting is mindset—how comfortable are we with the value of what we do and do we believe that what we do is a commodity or a highly valuable service (the more training and skill we have, the more valuable).<\/span><\/span><\/p>\n

Diagnosing and treatment planning esthetics <\/b><\/a><\/span><\/span><\/p>\n

Functional diagnosis and treatment planning<\/span><\/b><\/span><\/span><\/span><\/a><\/p>\n

 <\/p>\n

Today, we will focus on Diagnosing and Treatment Planning Structure and Biology.<\/span><\/span><\/b><\/span><\/span><\/p>\n<\/div>\n

Remember, EFSB is the facially-generated model taught by Frank Spear.  Esthetics, Function, Structure, Biology is the order used for treatment planning. Many say reverse the order when working through the diagnosis: Biology, Structure, Function, Esthetics. We need to make the diagnosis BEFORE we treatment plan.  This system is based on the idea of treatment planning from the outside in, using the face and then the occlusion (global diagnoses)  to determine where the teeth go. <\/span><\/span><\/div>\n
    Structure and Biology can be combined because they are shorter and simpler.<\/b> This part is stuff we all learned in school (pretty much). Though there are always advancements being made and there are definitely different philosophies and deeper learning available, this part is the most straight-forward and least complicated.<\/span><\/span><\/div>\n
      Structure and Biology are “local” diagnoses instead of “global” diagnosis.<\/strong> Esthetics and function are global, which means big picture, taking into account the face, jaws and muscles, etc, whereas structure and biology are diagnosed tooth by tooth. <\/span><\/span><\/div>\n
     I literally have a piece of paper for structure and one for biology that has each tooth number and a line for the diagnosis and prognosis of each tooth. I go through the xrays, exam, and photos (and sometimes clean-up phase dentistry) tooth by tooth and note the diagnosis, i.e. state of the tooth currently (RCT, large buildup and crown), and the long-term prognosis (excellent, good, fair, poor and hopeless). <\/span><\/span><\/div>\n
      Then when creating the treatment plan, I take these notes into account, remembering that I want to pay attention to the impact of failure; asking myself, where is this most likely to fail and what happens if\/when it fails?<\/em><\/span><\/span><\/div>\n
Remember diagnosis comes from information we get from the examination and records<\/strong>. Urgent care and\/or specialist consultations may be necessary and helpful to make a correct diagnosis and decide the treatment plan for questionable teeth.<\/span><\/span><\/div>\n
 We want to:<\/span><\/span><\/strong><\/div>\n
1. Gather information first<\/span><\/span><\/div>\n
2. Identify the condition (make a diagnosis) and the prognosis<\/span><\/span><\/div>\n
3. Decide on the desired outcomes (treatment goals)<\/span><\/span><\/div>\n
4. Decide how to get to the desired outcome (treatment plan and sequence). <\/span><\/span><\/div>\n
In the structural part of the exam, we look at:<\/span><\/span><\/strong><\/div>\n
a. teeth needing restoration due to a problem<\/span><\/span><\/div>\n
b. teeth needing restoration for non-structural reasons<\/span><\/span><\/div>\n
c. <\/span>adequate or inadequate retention or resistance – do the teeth need build-ups, crown lengthening, or bonded restorations?<\/span><\/span><\/div>\n
d.  Material choice and prep design<\/strong><\/span><\/span><\/div>\n
e.  Missing teeth, teeth to be removed, plans for tooth replacement with implants, fixed prosthodontics and removable prosthodontics (look at bone levels, esthetic considerations including gingival levels)<\/span><\/span><\/div>\n
In the biological part of the exam, we look at:<\/span><\/span><\/strong><\/div>\n
a. teeth requiring endodontics<\/span><\/span><\/div>\n
b. periodontal therapy needed or elective<\/span><\/span><\/div>\n
c. <\/span>oral surgery required or elective<\/span><\/span><\/div>\n
Structural and biological diagnosis and treatment planning is usually done from the exam, the radiographs and photos.<\/strong> Photography is a great tool for diagnosis, treatment planning, patient education\/case acceptance, and case documentation. I find photography particularly valuable when discussing with patients and helping them become more aware of their problems, the consequences of doing nothing and the benefits of treatment:<\/span><\/span><\/div>\n
This works well when we show them the photos of their<\/span> teeth and\/or gums vs.<\/span><\/span><\/strong><\/em><\/div>\n
1. What is ideal\/appropriate, a non-compromised patient<\/span><\/span><\/div>\n
 <\/div>\n
2. A patient that had the same problem and treated it- outcomes and benefits of treatment <\/span><\/span><\/div>\n
 <\/div>\n
3. What happens if they do nothing? (show photos of someone that is more broken down than them)<\/span><\/span><\/div>\n
 <\/div>\n
4. Risks of treatment, options for treatment and materials (don’t give them too many—start with the best one and if they decide that’s not what they want, go to plan B)<\/span><\/span><\/div>\n
 <\/div>\n
When I help dentists with treatment planning, there is often a tendency<\/strong> to treatment plan the way we were taught in school — phase 1, phase 2, etc. This works sometimes, but only if the big picture has been accounted for first. It is very important to look at the big picture of what the patient wants and needs for the long-term and the ideal esthetics, function and health\/structure so they don’t waste their time and money on things that do not take them toward the desired outcome. <\/span><\/span><\/div>\n
Happy Treatment planning! If you have any questions or you’d like a copy of my diagnosis and treatment planning form, please contact me at insights@allisonwatts.com<\/a>. Also, let me know if there’s something you want to hear more about.  <\/span><\/span><\/div>\n
You can also leave a comment or question below, or connect with me on my Facebook Page.<\/b><\/a> I will be more than happy to assist in any way that I can!<\/span><\/span><\/div>\n
See you Thursday… <\/span><\/span><\/strong><\/em><\/div>\n
\"\"<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

Structural and Biological Diagnosis and Treatment Planning by Allison Watts, DDS We are walking through the steps of a  full – mouth reconstruction.  Much of this can also be applied to other types of cases — this one especially! I enjoy learning all the parts of something and putting it all together and presenting it […]<\/p>\n","protected":false},"author":1,"featured_media":475,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_cloudinary_featured_overwrite":false,"footnotes":""},"categories":[310,22,25,24,27],"tags":[12,19,58,41,140,184,115,16,186,116,63,56,188,185],"class_list":["post-474","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles","category-clinical-excellence","category-communication","category-leadership","category-patients","tag-allison-watts-dds","tag-builiding-a-profitable-dental-practice","tag-clinical-excellence-2","tag-communicating-with-integrity","tag-dental-coaching","tag-dental-consutlting","tag-dental-mentoring","tag-dental-practice-long-term-success","tag-dental-practice-success-guide","tag-dental-training","tag-full-mouth-reconstruction","tag-full-mouth-rehabilitation","tag-structural-biological-diagnosis-treatment-planning","tag-successful-dental-practices"],"yoast_head":"\nStructural 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