Quintessence Publishing Blog

How to Save a Hopeless Tooth (no, really!)

Posted on July 17, 2020 by Quintessence Publishing

Reading time: 4 minutes

Written by: Marieke Zaffron

What adjustments we’ve had to make over the last few months. Replacing waiting rooms with parking lots, screening everyone with questions and temperature checks, having patients sanitize their hands and mouths before treatment. We’ve all had to adapt, and hopefully it’s been a positive experience that’s allowed patients access to the treatment they need as safely as possible.

Now that we’re reopening the world with these new safety measures, maybe it’s time to start thinking about other new techniques and procedures to start implementing. Meetings and seminars may have been postponed until next year, but that doesn’t mean you can’t learn something new! How does a technique for preserving severely compromised teeth sound?

When faced with a tooth that has suffered periodontal damage, the clinician has an important decision to make—extract the tooth or try to save the tooth. While there are certainly cases where extraction is the best or only option, Andreas Filippi, DDS, PhD, coeditor of Tooth-Preserving Surgery, warns against overzealous extraction. There are now so many methods of treating teeth, and these options should be explored before the irreversible action of extraction is taken.

Regardless of your specialty in dentistry, you’re likely already familiar with some of these options. Others may be brand new. Dr Filippi’s new book provides an in-depth discussion of six different treatment options to save teeth that might otherwise have required removal, including the surgical procedure for each one with case examples. Of these procedures, the newest and least widely known is transreplantation, an alternative method often used as a last resort to save teeth with a hopeless prognosis.

Transreplantation involves removing a tooth whole, treating it extraorally, and replanting it in a different position in the same socket with the goal of ankylosis. This treatment can be chosen for adult patients when a single tooth is affected by advanced periodontal disease and symptoms such as probing depths > 10 mm, mobility, and elongation or malpositioning. It is an ideal solution in the esthetic zone because it prevents ridge resorption that would occur if extraction were chosen instead.

Before and after transreplantation. Ankylosis has been achieved with minimal bone remodeling.

Another advantage of transreplantation is that it can be used in unusual circumstances such as when a tooth is recovered after trauma but is no longer vital. The tooth and socket are both cleaned of epithelial cells, and the bone in the socket is exposed. An extraoral root canal is performed, along with apicoectomy for teeth that have been outside the mouth for an extended period of time. The root surface is then prepared and treated with enamel matrix derivative, and the tooth is replaced in the socket and splinted.

This tooth was found outside weeks after the trauma that caused its loss, but it was still able to cleaned and replanted with successful ankylosis.

Transreplantation has had a very high success rate clinically in both the short and long term. It is a newer treatment method and more research should be done, but it is still an excellent alternative for severely compromised teeth.

As Dr Filippi explains, there are many reasons an option to preserve the tooth, such as transreplantation, might be favored over extraction and implant treatment. “Natural teeth,” he says, “have far better long-term prognoses than implants.” In addition, it may be the patient’s desire to keep their natural teeth for as long as possible. Though transreplantation is contraindicated for young patients who are still growing, other methods of tooth preservation may be better suited for children and adolescents than would implant treatment. Other considerations include medical contraindications to implants as well as the financial cost of implants, which is not achievable for all patients.

Rather than giving up on working during a pandemic, our society has explored all its options and found ways to make it work, from increased teleconferencing and telecommuting to increased PPE. Make sure you’re exploring all available options before giving up on saving a tooth. Your patients will thank you!

Preview the first chapter of Tooth-Preserving Surgery here.

Tooth-Preserving Surgery
Edited by Andreas Filippi and Sebastian Kühl

Despite all of the advances that have been made in implantology, many patients still want or need to keep their natural teeth for as long as possible. Tooth-preserving surgery has been performed for hundreds of years, but the last 10 to 15 years have shown a resurgence and a great increase in knowledge regarding these techniques. The aim of this book is to present modern methods of tooth-preserving surgery so clinicians can expand the range of treatments offered in daily practice or to bring them up to date. This volume is not intended as a textbook, but rather as an illustrated atlas and reference work. Each surgical technique is systematically described with indications and contraindications, step-by-step surgical procedure featuring case examples, as well as prognosis and potential complications. Armed with knowledge of methods old and new, clinicians can evaluate whether their patients’ teeth—even potentially hopeless teeth—might still be preserved.

Contents
1. Introduction
2. History of Tooth-Preserving Surgery
3. Exposure and Alignment
4. Apicoectomy
5. Intentional Replantation and Transreplantation
6. Resective Furcation Therapy, Hemisection, and Root Amputation
7. Transplantation
8. Success with Tooth-Preserving Surgery

Posted in Books, Endodontics, Esthetic Dentistry, Periodontics | Leave a comment

Obstructive Sleep Apnea, the Didgeridoo, and You

Posted on June 29, 2020 by Quintessence Publishing

Reading time: 4 minutes

Written by: Bryn Grisham

Which of the following options could you discuss with patients as possible treatments for obstructive sleep apnea (OSA)?

a. Sleep position trainers
b. Mandibular advancement devices (MADs)
c. CPAP (continuous positive airway pressure) machines
d. Didgeridoo lessons

The correct answer is all of them, and yes, that really does include didgeridoo lessons, or more accurately, circular breathing exercises.

Researchers have known for a while that practicing circular breathing can make a real difference for patients with OSA, and some of the early research is fascinating. When a study from 2006 had patients with moderate OSA undertake didgeridoo lessons, researchers discovered significant improvement in their Apnea-Hypopnea Index (AHI) after 4 months.

Another study from 2008 looked into the risk of OSA specifically for musicians who played with orchestras. In that study, researchers found that only musicians who played a double reed instrument (ie, oboe, bassoon, English horn) demonstrated a much lower risk of OSA than any other type of orchestral musician, including other wind musicians. The likely difference for double reed musicians is in their skills with controlled, precise breath support necessary to force air through the double reeds, as well as circular breathing.

Oropharyngeal exercises are cost effective and often have better patient compliance than other treatments for OSA.

So circular breathing can really help patients with OSA. But what if you don’t think your patients want to take up the didgeridoo or the bassoon? Luckily, the same benefits can be had from regular oropharyngeal exercises, and that is very good news indeed. Not only are oropharyngeal exercises cost effective, but they often have better patient compliance than other treatments for OSA (most notably the dreaded CPAP). That alone could recommend the treatment for many patients. However, many studies over the last decade have shown outright that oropharyngeal exercises are effective at reducing AHI for patients with OSA.

Strengthening the tongue similarly engages and strengthens the muscles of the pharyngeal walls.

Although it is a little surprising at first, it does makes a lot of sense that circular breathing and oropharyngeal exercises could be used effectively to address sleep apnea. We think of circular breathing as a type of breath work, but in actuality it is a complex series of movements in which the tongue is moved forward to force air in the cheeks through the instrument, and during inhalation, the soft palate is moved away from the posterior pharyngeal wall. Likewise, oropharyngeal exercises that address sleep apnea also focus on the tongue and soft palate. You may wonder how these exercises could affect the upper airway, but researchers have found that strengthening the tongue similarly engages and strengthens the muscles of the pharyngeal walls, and that is where the magic happens. Given that sleep apnea involves the collapse of the pharyngeal dilator muscles, why wouldn’t exercises that strengthen these muscles naturally increase their tonicity and endurance, even during sleep? It just makes sense.

I started learning more about the correlation between circular breathing and reduced risk of sleep apnea from reading Sleep Medicine for Dentists: An Evidence-Based Overview, Second Edition. If you are interested in sleep medicine in dentistry and are looking for a way to survey the most important research over the last decade, you should pick it up. The first edition was a bestseller that went out of print too soon, and we have been waiting for a long time for this new edition to arrive. So much has changed in sleep medicine over the last decade, and this new edition is full of interesting and compelling research that will change the way you think about sleep-disordered breathing and its treatment.

Sleep Medicine for Dentists: An Evidence-Based Overview, Second Edition
Edited by Gilles J. Lavigne, Peter A. Cistulli, and Michael T. Smith

Dentists are often the first medical practitioners to encounter patient reports or clinical evidence of disorders such as sleep apnea, sleep bruxism, and sleep-disrupting orofacial pain, providing them a unique opportunity to prevent the development or persistence of conditions that strongly impact their patients’ lives. Since the first publication of this seminal book, significant and exciting advances have been made in the field of sleep medicine, and this updated edition gathers all of this new evidence-based knowledge and presents it in focused, concise chapters. Leading experts in medicine and dentistry explain the neurobiologic mechanisms of sleep and how they can be affected by breathing disorders, bruxism, and pain, along the way guiding dental practitioners in performing their specific responsibilities for screening, treating, and often referring patients as part of a multidisciplinary team of physicians. Readers will find this book both fascinating and clinically important as they strive to provide the best possible treatment to patients with these complex and often life-threatening disorders.

Contents
Introduction to Dental Sleep Medicine
Sleep Breathing Disorders
Sleep Bruxism: From Oral Behavior to Disorder
Sleep and Orofacial Pain

Posted in Books, Misc, Multidisciplinary, Occlusion & TMD, Research, Sleep Dentistry | Leave a comment

The Best of the Best in Dentistry: QDT

Posted on June 12, 2020 by Quintessence Publishing

Reading time: 6 minutes

Written by: Lori Bateman

“QDT is so unique compared to any other dental publication we have today.”⁠—Dr Sillas Duarte, Jr

Each February when the annual issue of Quintessence of Dental Technology (QDT) is released during the Chicago Midwinter Meeting week, loyal followers attending the various conferences in the city line up to purchase a copy and get a first peek at the splendors it offers. “QDT is so unique compared to any other dental publication we have today,” says Dr Sillas Duarte, Jr, editor-in-chief for the past 12 years. “Every issue brings something new to the table—a new way of thinking, a new technique, a new approach—but always at the maximum highest standard.”

By studying the techniques and materials presented in QDT, everyone can have success, not only the most skilled.

Now in its 43rd year, QDT continues to offer the “best of the best,” as its name implies, in dental technology, esthetics, artistry, science, and digital techniques. But that is not to say the book is geared only to the best of the best dental clinicians and technicians. Dr Duarte contends that by studying the techniques and materials presented in QDT, everyone can have success, not only the most skilled. The QDT 2020 “Masterclass” article on esthetic restoration of bilateral cleft palate by Drs Iñaki Gamborena, Markus Blatz, and colleagues is one such example. The case is highly complex, but according to Dr Duarte, “presented in such a way that it is not overwhelming; it is just inspiring.”

The inspiration sparked by QDT is not the result of simply compiling a collection of new and interesting articles. The preparation of each annual issue is a yearlong process—one could say, a labor of love. Dr Duarte reviews the many article proposals he receives and will lend his advice to authors, both new and seasoned, at this early stage. He may occasionally solicit an article when he sees or learns of someone presenting on something new and interesting, but nowadays authors overwhelmingly seek out QDT for publication of their work.

Most manuscripts that are finally accepted will go through several revisions, some being entirely rewritten. Dr Duarte painstakingly provides his help and guidance to each individual author, or team of authors, to get the very best from them. “Each image is reviewed to ensure it has the perfect quality and shows what needs to be shown. I have no problem telling even a big-name author to retake the image(s) if not up to a certain standard.” He recalls that initially some authors were taken aback by this, but now they appreciate the thoroughness of the process and what it brings to the final quality of their article and the book as a whole.

The knowledge of photography and artistic sense Dr Duarte brings to QDT also has been key in helping Quintessence produce a beautiful and awe-inspiring book each year. Since he was a child, he has been passionate about books and visual interpretation. He began importing and collecting Quintessence books back in dental school, as not many were available in Brazil then. Dr Duarte explains that the combination of esthetics in dentistry plus the esthetics of the printed page—book or journal—interested him, so he would analyze what he liked so much and why it looked so good. Studying photography he learned to appreciate the composition of a pleasing image. “Also by defying the rules of photography, one can obtain very, very nice results as well as very tricky and interesting results,” he says.

Peruse QDT 2020 and you will see what Dr Duarte is talking about. Each article is carefully composed, first and foremost, to best present the material at hand for clarity and understanding by the reader, but also with a visual sense of style and dramatic photographic display.

Each issue of QDT includes an article or two designated “Masterpiece,” an author’s virtual show-and-tell best clinical case/ceramic work. QDT 2020’s Masterpiece article by Naoki Hayashi, titled “Harmony with Biology,” is a must-see collection of cases. Paulo Kano’s “Masterclass” article on 3D Magic MakeUp for building character into monolithic CAD/CAM restorations is both informative and insightful. Another popular feature of QDT is “Biomaterials Update,” an in-depth scientific review of a particular restorative material or related technique. In QDT 2020, photopolymerization is examined, specifically the scientific background and clinical protocol for its use in indirect bonded restorations.

One might say that the authors of articles featured in QDT are a virtual “Who’s Who” of restorative and esthetic clinicians and dental technicians. They bring their best work to QDT because they know and expect the care with which their material will be handled and ultimately presented in print. Also, as Dr Duarte points out, it is interesting that many of the sought-after internationally known lecturers in the field today have their roots in QDT, so for some it has been a springboard for success.

QDT 2020 is a perfect combination of craft, artistry, science, and technology.

QDT 2020, in Dr Duarte’s words, “is a perfect combination of craft, artistry, science, and technology.” In QDT 2020, and every issue of QDT, esthetic and restorative dentists and technicians will find more than a few things to savor and a great many pearls.

Sillas Duarte, Jr, DDS, MS, PhD, is the Rex Ingraham Chair in Restorative Dentistry, Associate Professor and Chair, Division of Restorative Sciences, and Director of the Advanced Dental Education Program in Operative Dentistry, Ostrow School of Dentistry of University of Southern California, Los Angeles, California. In addition to his 12 years as editor-in-chief of QDT, Dr Duarte serves as co-chair of the International Symposium on Ceramics, sponsored by Quintessence Publishing every 3 years. He lectures and conducts hands-on courses nationally and internationally, teaching cutting-edge clinical techniques and technologies related to esthetic and adhesive dentistry. His research and clinical work focus on bonding to dental structures, composites, and ceramics.

Quintessence of Dental Technology 2020, Volume 40

QDT 2020 presents original articles introducing clinical and laboratory techniques for optimal esthetic results with newer dental materials. Digital dentistry is featured throughout, with articles offering innovative ways to incorporate a combined digital/analog approach to build character and natural esthetics in CAD/CAM restorations. The 3D-printed interim immediate complete denture, self-glazing liquid ceramics, Inside Out technique, and 3D Magic MakeUp are but a few of the novel procedures featured in this beautifully produced annual resource for the laboratory technician and restorative clinician.

Authors include: Mario Alessio Allegri • Michael Bergler• Markus B. Blatz • Anabell Bologna • August Bruguera • James Choi • Victor Clavijo • Allegra Comba • Julián Conejo • Sillas Duarte, Jr • Iñaki Gamborena • Naoki Hayashi • Carlos Alberto Jurado • Paulo Kano • Tai Kim • Alena Knezevic • Rafael Laplana • Cristian Marchini • Masayuki Okawa • Jin-Ho Phark • John M. Powers • Yoshihiro Sasaki • Cristiano Soares • Douglas Terry • Yuji Tsuzuki • Fabiana Varjão • Shogo Yamamoto

Posted in Dental Technology, Esthetic Dentistry, Misc, Multidisciplinary | Leave a comment

Intraosseous Defects: A Complex Problem with a Simplified Solution

Posted on June 5, 2020 by Quintessence Publishing

Reading time: 6 minutes

Written by: Marieke Zaffron

Who here likes to watch cooking shows? Isn’t it so frustrating when your favorite contestant makes a perfect dish, then decides at the last moment that it needs something else it really doesn’t? Maybe they whip up some ice cream to add to an already balanced dessert, or they toss together a side salad to accompany their entrée. And then when time comes for judging, it’s not the dish itself they get criticized for, but the unnecessary component they decided to add. In other words, overcomplicating what could have been a simple task becomes their downfall.

Henri-Louis Bergson once said, “Man should be as eager to simplify his life as he is to complicate it,” and this holds true for so many of us, both personally and professionally. One person who loves to share this quote is Leonardo Trombelli, DDS, PhD, author of the new book Simplified Regenerative Procedures for Intraosseous Defects. A key theme of this book is the first word in its title—simplified. Clearly, more thought and planning should be put into a surgery than making a meal, but Dr Trombelli has learned that taking a simplified approach to his procedures results in more favorable outcomes.

What does it mean to simplify a procedure? Dr Trombelli explains that a procedure can be simplified when it is “characterized by more favorable conditions for the patient and/or the clinical operator.” These may include minimally invasive procedures, but there is much more to it than that. The goal of simplified treatment, Dr Trombelli explains, is to “optimize endpoints while making clinical processes and pathways easier for practitioners and students.” That is the beauty of simplifying treatment—it can then be performed by clinicians at varying skill levels, and as a result help more patients. At the University of Ferrara, where Dr Trombelli teaches and practices, these procedures are taught to students, who can learn them much more quickly and effectively than more complex procedures that might take years to master.

These may include minimally invasive procedures, but there is much more to it than that.

One example of a simplified procedure that Dr Trombelli spent years perfecting is the single-flap approach. This technique, covered extensively in his new book, involves treating a defect by raising a flap on only one aspect, such as the buccal, to preserve the vascular structures as much as possible and promote wound healing. Not only is this surgery much simpler to perform than its double-flap counterpart—many studies have shown better results with the single-flap approach than with comparable procedures. In addition, this is an approach that can be applied to many defect situations of varying severity, not only ideal scenarios.

The single-flap approach raises a flap on only one aspect, in this case the facial, to preserve vascular structures and promote wound healing.

It may seem like common sense to think that a more complex clinical situation would necessitate a more complex surgical procedure. Dr Trombelli and his team have shown that when it comes to intraosseous defects, this is simply not the case. When asked why simplified procedures with all their benefits are not widely used already, he explains, “It is just a matter of closing the gap between the introduction of a new more effective procedure and its routine adoption in daily practice.” Of course, this is not to say that anyone can pick up a scalpel and start performing simplified techniques with perfect results every time. “Simplified” doesn’t necessarily mean “simple.” However, Dr Trombelli still wishes to quash the notion that regenerative treatment of an intraosseous lesion can be performed only by highly skilled clinicians and at a very high cost to patients. His purpose in writing Simplified Regenerative Procedures is “to present techniques that may be successfully performed by the great majority of our colleagues.” After all, the more dentists who have the knowledge of treating an intraosseous defect, the more patients who can reap the benefits.

Regenerative treatment doesn’t require only highly skilled clinicians and a high cost to patients.

And what benefits indeed! The single-flap approach lends itself well to being combined with biologic regenerative devices such as enamel matrix derivative and guided tissue regeneration, and studies have shown decreased recession and probing depths as well as reduced pain and morbidity with this approach. In addition, many nonsurgical procedures—by definition simplified—can be chosen for certain situations. Regardless of whether surgery is performed or not, simplified procedures provide advantages for patients and clinicians alike: These protocols take less time to perform than more complex techniques, they are less expensive, they allow the patient to return to their normal activities sooner than with more serious surgeries, and they frequently allow the final esthetics to mimic the patient’s original esthetics without too dramatic of a change.

The single-flap approach has shown very positive patient outcomes when compared with alternatives such as a double-flap approach.

We could all use a bit of simplification in our lives. For some people, that may mean keeping a dish classic or not overthinking the next low-stakes work task requested by a coworker. For Dr Trombelli, it means developing and refining techniques—surgical and nonsurgical alike—that his students and colleagues can use to treat the maximum number of patients with the greatest success. If you’re a periodontist, then for you it could mean learning about these procedures and applying them in your own practice. Intraosseous defects may seem intimidating, but even what seems like a complex problem may have a simplified solution.

Preview the first chapter of Dr Trombelli’s new book here.

Leonardo Trombelli, DDS, PhD, is the chair of the Periodontology Department at the University of Ferrara in Ferrara, Italy. He was Dean of the University of Ferrara Dental School from 2013 to 2018 and President of the Dental School from 2014 to 2016. Dr Trombelli is also a Past President of the Italian Society of Osseointegration and an Active Member of the Italian Society of Periodontology, the Italian Academy of Osseointegration, and the International Association for Dental Research. He serves as editorial board member for the Journal of Clinical Periodontology and Journal of Dental Research, and he is also a member of the peer-review panel for the Journal of Periodontology. Dr Trombelli also maintains a private practice limited to periodontology and oral surgery.

Simplified Regenerative Procedures for Intraosseous Defects
Leonardo Trombelli

Despite decades of well-established nonsurgical and surgical protocols and techniques, the treatment of deep intraosseous lesions still represents a challenge for clinicians. Therefore, the purpose of this textbook is to present simplified procedures that can be used to treat even the most difficult clinical scenarios. Both surgical and nonsurgical regenerative treatment options are presented and discussed in great detail, including types of instruments and regenerative materials to use, patient and defect evaluation, and step-by-stop protocols for various evidence-based procedures. Detailed clinical photographs and radiographs accompany each discussion to demonstrate the ideal initial situation for each method and the impressive results that can be achieved by following it, and many of the surgical sections also feature video content of procedures on real patients. A significant portion of the book is devoted to the single-flap approach, a technique developed and refined by the authors over many years to simplify surgical treatment while providing the best results for the patient. Both students and experienced professionals will find this atlas a welcome reference when encountering periodontally involved teeth.

Contents
1. Introduction
2. Fundamentals in Periodontal Regeneration
3. Nonsurgical Treatment of Intraosseous Defects
4. Simplified Surgical Regenerative Procedures: The Single-Flap Approach

Posted in Books, Esthetic Dentistry, Oral and Maxillofacial Surgery, Periodontics, What's New | Leave a comment

Why You Need to Up Your Game When It Comes to Treatment Planning

Posted on May 29, 2020 by Quintessence Publishing

Reading time: 8 minutes

Written by: Natalie Schawel

The term treatment planning means to plan a sequence of procedures to provide a solution (or treatment) for a previously identified problem (or diagnosis). Simple enough, right? Not really. “Unfortunately, treatment planning is always implied but never formally taught,” says Dr Antonio H.C. Rodrigues, DDS, MScD, author of Treatment Planning in Restorative Dentistry and Implant Prosthodontics. “Consequently, only a segmented view of the patient’s condition is presented, which may compromise treatment results in the long term.”

“Unfortunately, treatment planning is always implied but never formally taught,” says Dr Antonio H.C. Rodrigues.

Comprehensive treatment planning, on the other hand, allows for total care, which involves treating the entirety of a patient’s situation rather than relying on siloed expertise and addressing problems as they arise. But how are clinicians supposed to learn how to treatment plan like this if they are never taught?

A lack of understanding of how to approach treatment planning is severely detrimental to educators, students, and practicing dentists. As Dr Rodrigues explains, “Most complications and failures, particularly in restorative dentistry, are directly or indirectly related to inadequate planning. When planning procedures are not carried out accordingly, dentists tend to provide either overtreatment or undertreatment for their patients. Either situation may cause problems in the long term.” In the end, poor treatment planning can significantly diminish a treatment’s effectiveness and success, negatively impacting a patient’s experience as well as their outcomes.

Learning from historical and contemporary approaches

To understand the benefits of comprehensive treatment planning, one must first look to the past. Dentists are undoubtedly content to see previous philosophies stay in the past, such as empirically driven decisions or focusing treatment on just one problem, like pain or a missing tooth. For instance, a patient might complain about poor esthetics and functioning of a denture, leading them to request an implant-supported restoration. In an effort to oblige the patient, the dentist may comply—without considering reduced space in the mouth or the reduced number of posterior teeth. As a result of an incomplete examination, and thus an incomplete plan, the future implant-supported prosthesis may endure excessive occlusal forces and, ultimately, fail.

In the past, patients also lacked treatment options—or were never provided enough information to make an informed decision. Once patients did choose an option, dentists often moved forward using segmented planning steps and siloed approaches that did not incorporate other areas of expertise. Historical philosophies compromised treatment after treatment, and it was a welcome move to enter a more contemporary school of thought.

Contemporary planning concepts

Modern dentistry brought new knowledge and new implications. “Making a diagnosis and planning a treatment implies the professional responsibility to omit nothing of consequence for the patient; deviation of this line of thought has become unacceptable and is no longer tolerated,” explains Dr Rodrigues. New diagnostic instruments have led to improved accuracy and predictability. Dentists can now refer to concrete evidence to make decisions rather than solely their own experience, which is an essential factor in the treatment-planning process. Finally, patient-dentist conversations have become more productive as dentists provide patients with thorough information about their individual situation during the planning process. And when it comes time for treatment, advancements in research have led to more sophisticated treatment options.

Though great strides have been made in treatment planning, a gaping hole remains, which threatens the success of treatments, patient satisfaction, and dentistry as a whole. This is where comprehensive treatment planning comes in—offering an option to consider patients in their entirety from very initial procedures to final treatments and outcomes.

Comprehensive treatment planning: From a segmented approach to a seamless one

Contemporary planning concepts should not be completely abandoned; rather, they should be nicely folded into an approach that considers the patient as a whole throughout the entire process.

This requires access to important information for the profession at large, according to Dr Lino Calvani, MD, DDS, CDT, MSc, PhD, author of Fundamentals of Treatment Planning: Guidelines on How to Develop, Plan, Write, and Deliver a Prosthodontic Care Project. This information can guide students and practitioners, helping them better care for their patients.

Gone are the days when dentists can remain focused on the contents of their own specialties.

To begin with, treatment planning should be grounded in a holistic view. Gone are the days when dentists can remain focused on the contents of their own specialties. By focusing on one area of expertise—which is often connected to a patient’s primary complaint—important information may go completely ignored. On the other hand, by dutifully considering all areas of expertise during treatment planning, the entire treatment promises to be more successful and stable in the long term.

With this in mind, comprehensive treatment planning also lends itself to certain principles in order to gather all pertinent information. These include how the patient presents for examination, their original healthy state, and the ideal outcome for the patient’s individual situation. Understanding a patient’s existing condition alongside their original healthy condition allows a clinician to accurately—and holistically—determine a realistic, ideal approach. In the end, knowledge of the problem, the solution, and any treatment modifiers is key to formulating a thorough, successful treatment plan.

Including the patient in treatment planning

Originally, treatment plans were intended just to provide guidance for delivering treatment. At first glance, this doesn’t sound terribly far off from a holistic, effective approach. However, treatment plans are not comprehensive if they do not involve the patient. As a part of treatment planning, patients should be counseled about their condition and what methods are available to solve their problems. Meanwhile, this process can be utilized to obtain informed consent. In its entirety, the goals of treatment planning include developing a comprehensive treatment plan, educating the patient, and obtaining consent from the patient.

In its entirety, the goals of treatment planning include developing a comprehensive treatment plan, educating the patient, and obtaining consent from the patient.

Approaching treatment planning with planning phases

From tooth preparation to implant surgery, dental procedures often come with sequence protocols, which are modifiable steps to ensure a process’s predictability. Yet treatment planning has historically been approached without similar protocols. However, these protocols would provide much-needed assistance from initial consultations to the final treatment plan presentation.

Dr Rodrigues separates these protocols into four phases:

Data gathering and problem identification
Interpretation of data and diagnosis, prognosis, and objectives
Analysis of treatment options and development of a treatment plan
Patient education and informed consent

Dr Calvani similarly separates the treatment-planning process into three distinct phases:

Diagnostics
Improvement, disease, restorative
Maintenance

For both Dr Rodrigues and Dr Calvani, the goals of each phase must be achieved in order for the protocols to be effective. For instance, accurate data is necessary for efficiency in diagnosis. This may require tools, such as checklists or questionnaires, to assist the clinician in gathering of data.

In addition, while protocols remain flexible in that they are continually modified to adapt to the increasing pool of knowledge of an experienced clinician, it is critical to focus on each phase individually.

From identified problems to proposed solutions, treatment planning is a robust endeavor, and overlooking important steps of treatment planning may lead to complications and treatment failures down the road. However, if approached with careful consideration and methodology, patient outcomes and satisfaction can be significantly improved.

If you want to improve your treatment planning and achieve better and more predictable outcomes, check out Dr Calvani’s and Dr Rodrigues’s new books. Preview the first chapter of each book below.

Preview: Treatment Planning in Restorative Dentistry and Implant Prosthodontics by Antonio H.C. Rodrigues

Preview: Fundamentals of Treatment Planning: Guidelines on How to Develop, Plan, Write, and Deliver a Prosthodontic Care Project by Lino Calvani

Treatment Planning in Restorative Dentistry and Implant Prosthodontics
Antonio H.C. Rodrigues

Treatment planning is commonly considered one of the most important phases of any dental treatment and vital for achieving successful long-term results. However, most dental schools do not offer courses exclusively designed for comprehensive planning, and comprehensive planning is rarely discussed at scientific meetings because it is considered a basic topic that practitioners should already understand. This knowledge gap leaves practicing clinicians with few options beyond using their own intuition to solve problems, which is highly unpredictable. Therefore, this book presents clinical guidelines for planning treatments in restorative dentistry and outlines a clear, objective, and simple thinking process that can be easily applied in daily practice, essentially providing the reader with a roadmap to be used as a reference from the very initial procedures until final restorative treatment. Part 1 describes how to identify existing problems by gathering, organizing, and analyzing information obtained during clinical examination. Examination checklists and forms are included to ensure that no important information is left out during the evaluation process. Part 2 focuses on providing solutions to identified problems via restorative treatment options, highlighting the use of implant-supported restorations in the treatment of both partially and completely edentulous arches. Part 3 details how to present treatment options to the patient and includes aspects related to patient education, treatment plan presentation, and obtaining informed consent from the patient. Altogether, this book will transform the way you treatment plan your cases.

Fundamentals of Treatment Planning: Guidelines on How to Develop, Plan, Write, and Deliver a Prosthodontic Care Project
Lino Calvani

This book is a comprehensive prosthodontic treatment guide that outlines and explains the various aspects and possibilities of medical and dental treatment planning as it exists today. The content is logically organized in a step-by-step manner and addresses a wide audience: prosthodontic specialists, graduates and postgraduate students, general practitioners, and specialists in other dental fields. Topics include the goals of treatment planning, prosthodontic tools, first meeting with the patient, diagnostics and prognostics, intraoral and extraoral physical examination, types and structure of prosthodontic treatment, the writing of a treatment plan, and more. All clinicians who organize prosthetic and reconstructive treatments in their daily work will benefit from this book.

Posted in Books, Implant Dentistry, Multidisciplinary, Prosthodontics, Restorative Dentistry | Leave a comment