Introduction

Treatment Planning

Richard T. Kao, DDS, PhD, and Donald A. Curtis, DMD

Copyright 2002 Journal of the California Dental Association.

Treatment planning should be the single most important thing we do as practicing clinicians. Unfortunately, the nature of dental education and clinical practice tends to orient us toward simply recognizing and correcting the damaging effects of dental problems. If we see caries, we are oriented toward thinking about placing a filling. If periodontal disease is present, we think about scaling and root planing, or possibly periodontal surgery. If a patient is partially edentulous, we simply think about filling the space with a prosthesis. This procedure-driven approach tends to de-emphasize the value of diagnosis, treatment planning, or problem solving, and thus stagnates our development as dentists. In this issue, we challenge the readership to considering how recent advances should change the way we diagnose and treatment plan.

Several recent issues of the Journal of the California Dental Association have focused on the importance of technological and therapeutic advances. The use of local antimicrobial delivery systems in periodontal case management, the periodontal-systemic health link, and the OralCDx computer-assisted brush biopsy system for screening oral cancer are just a few topics that the Journal has recently covered, and these are exciting and relatively new advances that will likely affect how we treatment plan. The focus of this issue will be on techniques and approaches, which are also recent, but are more established and time-tested. For example, recent advances in adhesion dentistry, periodontal surgical procedures, and dental implants have drastically increased the options when treatment planning. Additionally, a more complete appreciation of periodontal risk factors, as well as a better understanding of growth and development, will affect the timing and sequencing of a treatment plan. In this issue, we present a collection of articles that will challenge our perceptions of the treatment-planning process.

The first article by Dr. Don Curtis and co-authors is a synopsis of factors that affect treatment planning. The realities of how insurance coverage, patient/clinician interactions, and subtle media messages affect treatment planning are reviewed. In addition, scientific advances and the impact of those advances in the areas of biomaterials, prosthodontics, periodontics, and orthodontics will be outlined with the goal of providing updated information that the general dentist can use to develop a more cohesive treatment plan.

The second article, written by Dr. C. Pettengill and co-authors, emphasizes the importance of a systematic assessment of a patient’s psychological profile. When a clinician is first evaluating a patient’s personality, his or her initial impression or gut instinct is often correct; but a systematic approach offers a more predictable evaluation. The authors outline psychological traits, a medication profile, and other features that will affect treatment-planning decisions.

The third article, by Drs. R. Kao and K. Pasquinelli, discusses the importance of "thick versus thin" periodontium in restorative treatment planning. In this article, the impact of gingival tissue anatomy on the periodontal diagnosis, treatment, and prognosis will be outlined. How the quality of the gingival tissue responds to restorations will also be outlined. A practical appreciation of the soft tissue response is important when treatment planning.

The fourth article, by Dr. G. Conte and co-authors, describes how implants can effectively replace failing dentition in the maxillary anterior esthetic zone. These authors describe criteria and treatment options that the restorative dentist should consider for achieving the optimal result. This article will provide the restorative dentist with an appreciation of soft and hard tissue considerations needed to provide an esthetic environment for the implant-supported prosthesis.

Lastly, Dr. J.J. Salehieh and co-authors review the importance of the "team approach" in esthetic dentistry. To achieve optimal results, the restorative dentist needs to perform appropriate case analysis as well as coordinate the "preparatory" procedures to be provided by the various specialists in the field of periodontics, orthodontics, and oral and maxillofacial surgery. This article provides the general dentist with an approach when coordinating treatment plans for patients with esthetic dentistry needs.

We hope these papers will stimulate the readership to consider the importance of treatment planning when providing patient care. This should be a very exciting period for clinicians because of the rapid improvements in materials, techniques, and technologies. Treatment-planning concepts and philosophies need to reflect these changes.

Contributing Editors

Richard T. Kao, DDS, PhD, is an adjunct associate professor in the Department of Periodontology at the University of the Pacific School of Dentistry and is in private practice in Cupertino, Calif.

Donald A. Curtis, DMD, is a professor in the Department of Preventive and Restorative Dental Sciences at the University of California at San Francisco School of Dentistry.