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Facially Generated Treatment Planning (FGTP) is the cornerstone of Spear Education. Rather than learning how to treatment plan all the different possible permutations of dental needs, FGTP can be applied to all cases. Since its introduction in 1985, tens of thousands of patients have benefited from the concept. Unfortunately, an interdisciplinary approach in dentistry such as FGTP doesn't reach enough patients. Instead, the practitioner falls back into dental school teachings of simply focusing on structural and biologic issues which leaves patients with many esthetic and functional issues undiagnosed and untreated.

Creating an Interdisciplinary Approach in Dentistry

The differences between stagnant practices and successful, growing practices can be rooted in the lack of comprehensive examinations. The first step in getting patients into a more comprehensive exam such as FGTP, is by “filtering” new patients from the initial phone contact and determining who can benefit from this level of care. Most people think that what they see in the mirror is “normal” and just want a cleaning, but we know there is always more to their story. By setting the expectation from the initial appointment that the patient transitions from hygiene operatory to a comprehensive evaluation which allows the doctor the time required to diagnose, visualize, plan, and present care. Everyone that has been exposed to FGTP will agree on two things: it works, and it cannot be accomplished in a new patient hygiene visit.

Hygiene Aware

You can also get patients beyond hygiene operatory, by incorporating your hygienist more fully into your diagnostic team. Giving them tools and the training required to diagnose smiles, they become more invested in patient care and the success of the practice as a whole. Then when a new patient enters the practice, the discussion of normal and abnormal can begin before the dentist enters the room. The dentists job then becomes one of confirmation when you invite them back for a more comprehensive examination. If you do not charge for these initial exams, you are more likely to reduce one of the barriers for additional patient care.

Hygienist Directed

You can also develop the process further to where the hygienist creates an awareness of the problem and provides the solution. Through conversation and examination (with or without photos) they can diagnose issues in the smile or bite. They then ask the patient for permission to refer them for further evaluation. This conversation may sound something like this:

“I would like to refer you to Dr. Rouse for a more comprehensive evaluation of the problems we discussed today. May I make that referral?”

This is a similar discussion to that one you have when referring for care at a specialists' office, yet it stays in practice. The hygienist provides a preliminary diagnosis to elicit a desire for further evaluation. A referral for care has a strong influence on a patient. It also provides a role for the hygienist that raises their position within the team structure.


In these discussions with patients, moving the focus to their airway and their overall dental health can be a way to keep the conversation going. FGTP is focused on tooth position and occlusion before structure and biology. The Spear model of esthetics has always been very two-dimensional. The transverse and anteroposterior positioning of the teeth was mentioned but in a very limited manner. We typically focused on the vertical position of incisal edges and gingival architecture. This was mostly because we didn't have many solutions beyond orthognathic surgery. With the evolution of orthodontic techniques to alter the existing skeletal position of teeth, we now view the esthetic positioning of teeth in a 3-D manner. This brings a more comprehensive view of the patient and their health to the forefront. Interestingly, medical literature on sleep breathing issues blends perfectly with our vision of ideal tooth positioning. Literature from specialists in Otolaryngology confirm that narrow maxillary arches in the premolar and molar region increases your risk of having sleep apnea. The points of obstruction will vary based on where in the arch it becomes narrow. Finally, correction of the transverse relationship in adults improves or resolves the airway issues. By starting these discussions with your patients, you can build on initial findings and encourage a more thorough evaluation.

Today, the current medical research tells us, all the issues that impact the patient's esthetics and function could be playing a direct role in their health. Now, instead of saying, “I think we should address those issues before they get much worse”, the discussion starts with a question like this:

  • “How long has your wife/husband complained about your snoring?”
  • “Do you wake up at 3:10 or 2:47 every morning?”

Once they respond, it leads into the explanation of the current medical literature and the connection between patients with specific smiles and bites and airway issues. The medical complications associated with these conditions can be lessened or solved completely with modern complex dentistry. This discussion is usually enough for them to return for a more comprehensive examination and gets them interested in the FGTP process.

taking photos of patient for FGTP approach

FGTP: A More Comprehensive Exam

Many dentists struggle with getting the patient out of the hygiene operatory for further evaluation. Dentists are typically afraid to scare off new patients by telling them everything that they find at that first visit. The treatment planning process requires time for the patient to tour their mouths and own the issues. Rushing those discussions typically ends poorly. The best way to get them out of the hygiene operatory and back for a comprehensive examination, such as FGTP, is through hygiene aware, hygiene directed or airway health discussions. FGTP is absolutely the finest systematic process for Interdisciplinary approach in dentistry and will bring the best outcomes to your patients.

Jeffrey Rouse, D.D.S., is a member of Spear Resident Faculty.