35: The Treatment Plan

The Treatment Plan

Fermin A. Carranza and Henry H. Takei

After the diagnosis and prognosis have been established, the treatment is planned. The plan should encompass short- and long-term goals.

The short-term goals are the elimination of all infectious and inflammatory processes that cause periodontal and other oral problems that may hinder the patient’s general health. Basically, the short-term goals are to bring the oral cavity to a state of health. This may require periodontal procedures, as well as other dental therapy, such as endodontics and correcting oral mucous membrane pathology. Referral to other dental and medical specialties will be necessary.

From a periodontal viewpoint, the short-term goals are important, since they consist of the elimination of gingival inflammation and correction of the conditions that cause and perpetuate it. These include not only elimination of root accretions but also pocket eradication or reduction and establishment of good gingival contours and mucogingival relationships conducive to good periodontal health. Restoration of carious areas and the correction of poor existing restorations may also be necessary.

The long-term goals are the reconstruction of a healthy dentition that fulfills all functional and esthetic requirements. Long-term planning involves consideration of prosthetic reconstruction of the dentition, which may require implant therapy, including surgical preparation of the implant site. Also, the need for orthodontic treatment should be evaluated. The financial impact of long-term treatment requires careful consideration and understanding by the patient. The age and medical health status of the patient must also be considered.

The treatment plan is the blueprint for case management. It includes all procedures required for the establishment and maintenance of oral health and involves the following decisions:

Unforeseen developments during treatment may necessitate modification of the initial treatment plan. However, except for emergencies, no therapy should be initiated until a treatment plan has been established.

Master Plan for Total Treatment

The aim of the treatment plan is total treatment, that is, the coordination of all the short- and long-term goals for the purpose of creating a well-functioning dentition in a healthy periodontal environment. The master plan of periodontal treatment encompasses different areas of therapeutic objectives for each patient according to his or her needs. It is based on the diagnosis, disease severity, risk factors, and other factors outlined in previous chapters.

Extracting or Preserving a Tooth

Periodontal treatment requires long-range planning. Its value to the patient is measured in years of healthy functioning of the entire dentition and not by the number of teeth retained at the time of treatment. Treatment is directed to establishing and maintaining the health of the periodontium throughout the mouth rather than attempting spectacular efforts to “tighten loose teeth.”

In the past two decades, implant replacement of missing teeth has become a predictable course of therapy. Therefore attempts to save questionable teeth may jeopardize adjacent teeth and may lead to the loss of bone needed for implant therapy. Teeth on the borderline of a hopeless prognosis do not contribute to the overall usefulness of the dentition. Such teeth become sources of recurrent problem to the patient and detract from the value of the greater service rendered by the establishment of periodontal health in the remainder of the oral cavity.

Removal, retention, or temporary (interim) retention of one or more teeth is a very important part of the overall treatment plan. A tooth should be extracted under the following conditions:

In some cases, a tooth can be retained temporarily, postponing the decision to extract until after treatment is completed. A tooth in this category can be retained under the following conditions:

Jan 15, 2015 | Posted by in Periodontics | Comments Off on 35: The Treatment Plan
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