Restorative treatment planning stepsI just completed a Spear Workshop on complex treatment planning and sequencing. I wanted to elevate my understanding of the orthodontist’s role in supporting a restorative project.

Some of our class discussion included how to communicate with specialists. Participants indicated that it can be difficult aligning with these important practitioners for the benefit of achieving the patient's best outcome.

As I pondered this dilemma I began to wonder, is there a “specialist app”? After all you can find an application for just about everything else. I believe the answer is, “Yes, there is a specialist app for the restorative dentist.” It is on your computer, and it is as easy as taking photos and sending an email.

Six steps to success

The specialist app process can make your treatment planning an efficient and timely process. Follow these steps for your personalized route to specialist input:

  1. Place your photos in PowerPoint/Keynote, expanding to full size the full smile, the lip at rest, and the center view with teeth apart and lips retracted. (Click this link for more on clinical photography.) Use templates to begin an esthetic vision of the upper central, lateral and canine positions. It is not the final vision; it is not the perfect vision. It serves as a starting point of discussion with your specialists to bring you to a common point of reference.
  2.  Make a list of the initial restorative options you want to consider. Share what you think might be possible options. For example –
    • #7 fracture; extract and place implant
    • Missing #30; place implant or consider moving #31 to #30 position
    • #8 adjust the gingival margin apically to match #9
  3. Outline the occlusal concerns related to overbite and overjet. State the desired outcome you are looking for. For example –
    • Concerned with deep bite; need to open 3 mm at the anterior to lengthen upper central 3 mm.
  4. Send this by email to your specialists before you refer the patient to their office.
  5. With this information your specialists are now traveling with you down the same road. They can assist with your planning in three important ways.
    • They can say yes I can achieve that for you. “#8 gingival margin can be moved apically and #6 can benefit from a graft for root coverage to match #11.”
    • They can eliminate options. “Moving #31 into #30 position will take 24-30 months so the implant option is more efficient for the overall plan.”
    • They can refine the options in your plan. “#7 root can be extruded to build the bone vertically for an implant. This might be a more stable and longer lasting option.”
  6. Now with the specialist’s information, you can refine the treatment options based on the confirmation from your specialist team. You can confidently discuss the risks and benefits of treatment possibilities with your patient.

A final point is that your team can be invaluable in preparing for the specialist app process. They can take patient photos, download to Power Point/Keynote and set the templates. Your time can be spent with developing the treatment goals.

This specialist app process won’t lead every patient down the path to accepting treatment; however, it is a minimal investment that will give your patient the opportunity to see what they did not see previously.

Donna J. Stenberg D.D.S., M.S., P.A. Spear Visiting Faculty and Contributing Author.