​Esthetics – Function – Structure – Biology (EFSB) is the system of treatment planning developed by Frank Spear in the early 1980s. I heard about it in the mid-80s when I first saw and heard Frank speak. It challenged my thought process and changed the way I “saw” what I wanted different for my patients. It pulled me from thinking “solution” and taught me to observe and then claim what I wanted different – not a solution to make it different, an outcome that I desired so I could see what would happen and not how it happens.

EFSB figure 1

The dental world of 1988 was different than that in which we live today. There are therapeutic possibilities that my teachers never imagined, and there are many more coming that I cannot and will never imagine. Having said that, I am willing to wager that the protocol of the EFSB system will continue to work as well for my daughter who graduated in 2014 and all of her dental descendants, should any of them decide to go into the “family” business. The solutions may change, but people will not.

A Guide That Lasts

In the more than 30 years since Frank titled a lecture Facially Generated Treatment Planning, and introduced the EFSB process,  there has been almost no change in what we gather, how we look and what it shows us because it does not tell the clinician what to do, it shows us what we would hope to make different.

EFSB figure 2

There is one thing that has changed in the past few years to alter how I look at my patients: airway. The impact of breathing on dental health is becoming more and more clear to us every day, and it has become part of our process of evaluation.

When airway has been considered, teeth must still be put in the patient's face esthetically, they must be put where they belong. I designed the EFSB Guide to create a workflow that becomes natural for the restorative dentist. In a short time using it, you begin to think that way and you don’t need the sheet. I do, however, always keep a copy of the EFSB Guide on my desk for those times when I am feeling lost.

A Guide for All Levels

I made some minor changes to the Guide that I hope make it easier to use for beginners and veterans alike. I hope you like them. You might want to download and print the form first so you can look at the Guide as you read.

EFSB figure 3

A box has been added to note that a color change is wanted and whether that came from the patient or from the doctor’s observations.

EFSB figure 4

The left side of the form in the Esthetics section has check boxes that will note where you would like to make changes. So after noting what you see, the only things you have to think about are those for which there is a checked Change box in the left hand column. When that box is checked, the notes entered to the right will direct the changes made on the templates to address the findings.

EFSB figure 5

The Function section is very slightly changed, and like the Esthetics segment, if there are things that must be considered for this patient, there will be checked boxes in the left column of the sheet.

The Structure and Biology sections are unchanged and have always followed the format of the left column noting where something is needed.

A Guide to Change How You Think

dentist checklistThe EFSB Guide, combined with treatment planning using the templates, can create for every restorative dentist a process that becomes a natural way of thinking. It lets me look at and think about cases that seem insurmountable because I can consider the situation one section at a time without the need to “know” what I need to do. After the end is visualized, the options for treatment become much more self evident. It also makes it easier to ask for help when I wonder what’s possible.


Commenter's Profile Image Kevin H.
June 21st, 2016
I love these modifications! They will definitely streamline the process. Thank you!
Commenter's Profile Image Joseph I.
July 30th, 2016
Great to have . Thank you!
Commenter's Profile Image Judit S.
November 9th, 2018
Please!! - Where can I get a copy of the Guide? I got several when I attended two Workshops some years ago but they got filled in, then lost. Please could someone send me a link/PDF? Thank you in advance!
Commenter's Profile Image Gary D.
November 9th, 2018
E-mail me directly Judit (gdewood@speareducation.com) and I will get you a 2018 version of the guide.