full front teeth with bottoms showing a dark ridge

As the world changes and adapts to the COVID-19 pandemic, so must we as dentists. This is a trying time on many fronts. While our schedules will once again be fully filled, it is highly likely that with the continued uncertainty in the economic market, patients may hesitate to accept larger more comprehensive treatment plans due to the high costs.

It is not uncommon for patients to delay treatment on these larger cases. My goal is to help them understand that if possible, we would ideally like treatment to commence before it advances to the point where other disciplines are needed (e.g., ortho, perio, endo). So, the question is “what can we do to help more of our patients say yes to these larger, more comprehensive treatment plans?” The answer is the concept of “phasing” treatment.

Phasing and sequencing are words that are often used interchangeably, but in dentistry they are in fact quite different. The sequencing of treatment is defined as “the order in which treatment is performed / completed” (e.g., prep, impression, then provisionalization).

PHASING TREATMENT: Spear Online members can take Dr. Kinzer's “Phasing Treatment” course based on his recent webinar to address patient needs amid crisis recovery.

The phasing of treatment is the concept of taking a large case (e.g., full mouth) but instead of doing all of the treatment at once, breaking the treatment up into smaller segments. Essentially, treatment would be performed so that some of the definitive restorations are placed now, while a few restorations placed next year, and so on – thereby spreading the overall treatment over years.

I believe there are multiple benefits to phasing treatment. First, it allows more patients to say “yes” to the treatment that they need, even though they may not otherwise be able to afford it (if they had to do it all at once).

It must be noted though that if the treatment were to be phased, the patient will end up paying more for the overall treatment than if they were to have done all the treatment at once. The reason for this is two-fold:

  1. When phasing treatment, there will often be the need for “interim” treatment (e.g., interim composite build-ups), which wouldn't be necessary if the treatment was performed all at once. In my practice, these interim restorations are typically charged out as true composite build-ups.
  2. The cost for the definitive restorations would reflect whatever the clinician is charging for that particular restoration at that point in time. For example, if the last definitive restorations were seated five years after starting the treatment, I would change the current market value for my crown at that time (not my crown fee from five years prior).

So, then you may ask yourself, “why would someone want to pay more money and yet in the end get the same treatment?” The answer is simple: because if they didn't, they wouldn't be able to afford any of the treatment, because they wouldn't be able to even start.

In my discussions with patients, I have found it useful to use the analogy of purchasing an automobile. There are a lot of very nice cars that I would love to own but wouldn't be able to purchase because I couldn't afford drop the cash to pay for it.

However, if I were to lease that very same car, I could put a small amount of money down and drive it off the lot today. And if I continue to pay on that car over the course of many years, I would own it. But in the end, I would have paid more for it. The benefit though is that I was able to have and use that car from day one.

I truly believe that treatment can be phased for any patient comes into your practice. In a follow-up article, I will outline what needs to be evaluated and how to phase different types of treatment for those larger more comprehensive cases.

Greggory Kinzer, D.D.S., M.S.D., is a member of Spear Resident Faculty.


Commenter's Profile Image Bob G.
June 17th, 2020
This is a great option to help patients get their needed dentistry. Thanks for pointing out the phasing discussion with the patient about expenses.
Commenter's Profile Image Doug S.
June 18th, 2020
I do a lot of phased treatment plans, and I agree that they are a wonderful way to do large cases. I think it also does two other things for the patient. First, it allows them to say "yes" to something smaller and less fearful for them. Once the first phase is done and they see real progress, they feel less anxious about their fears and more confident in our ability to deliver a great result.