During a recent Facially Generated Treatment Planning workshop I was talking to a participant about how much of an impact the routine use of Facially Generated Treatment Planning, a concept that I learned from Frank in 2001, changed my career.

So many dentists struggle with the "big cases." They don't know what to look at first, they struggle to visualize the end before they begin or they are not sure how they could or should phase the treatment. This is when they remember learning about EFSB (esthetics, function, structure, biology) while here at Spear Education. I think we can all agree that this is a commendable response to a confusing case.

The dilemma: It's not quite as easy as riding a bike.

If you have not implemented or do not utilize FGTP on a routine basis, it seems a bit awkward. It's a lot like being a freshman in high school and taking the senior-valedictorian-homecoming-queen to the prom. Yes, you are so lucky to have such beauty and brilliance as your date, but you just don't know how to use it.

I was relating to the workshop participant that I have actually used the EFSB process for every patient case, small or large, since I learned about it. It helped me become very comfortable with the process and to trust the process. It helped the small cases seem more predictable. It also helped clarify that the case that looked small actually needed more attention and saved me some serious heartache down the road (please, reference the prom date here with your personal humor).








A patient that I am currently treating is a great example. I evaluated the edges first, regardless of how perfect the position initially looked (Fig.1-2).

TP_Fig3I put the edges where they belong and made them look as they should look. This represents the "E" of EFSB (Fig 3).








I made the small changes on the model with intention, based off of the photos (again, trusting the process), which completely changed her function, and, in turn improved the issues she was having with the worn molars. This represents the "F" of EFSB (Fig 4-6).

The systematic approach allowed me to pick the appropriate material for her after evaluating the esthetic and functional needs. This represents the "S" of EFSB. Anywhere there is wax represents some restorative material (Fig 7-8). Similarly, anywhere I reduced or re-contoured is either enamel or a restorative material, which may result in another restoration. For that very reason, it is at this point that we should initially consider material choices. Attempting to plan the material prior to this point often results in regretful choices (again, insert your own prom analogy here).









Finally, waiting to evaluate the periodontal concerns until the end helped solidify the predictability of the suggested grafting in this case by understanding the probable etiology (childhood orthodontic treatment attempting to correct a skeletal discrepancy in a purely dental manner) and feel confident that I was doing my part to alleviate any further structural breakdown caused by excessive or inappropriate forces placed on the periodontium. This represents the "B" of EFSB.

Using and trusting FGTP and following the EFSB approach for every patient will not only guide you to appropriate treatment, but it will help you feel more comfortable with all levels of difficulty in your practice, including the complex case that might initially seem out of your league. You'll be leading the "Happy Song Dance" or maybe even the "Macarena" at your prom in no time with the date of your dreams.



Commenter's Profile Image Michael Putt
June 12th, 2014
As a relatively recent graduate of the FGTP course, I am the Freshman trying to entertain the Prom Queen at this point. But I am enjoying the process and love the sequential nature of it to help predictably plan cases. The first sentence of the second to last paragraph states: "Finally, waiting to evaluate the periodontal concerns until the end of_____ helped solidify the..." I assume that "the end of" refers to the end of the "process". Is there another word that you intended to be here? Just curious Mike