The treatment plan is a blueprint that outlines the procedures needed to establish and maintain oral health. It includes decisions about emergency treatment, extractions, periodontal therapy, endodontic treatment, restorations, and the sequence of therapy. The plan has immediate goals like eliminating infections, intermediate goals like reconstructing a healthy dentition, and long-term goals like maintaining health through prevention. Therapy follows phases including emergency treatment, non-surgical treatment, surgical treatment, restorative treatment, and maintenance. The ultimate goal is bringing the mouth to a state of health and maintaining it long term.

1. Treatment Plan
Shivani Deshpande

2. The Treatment plan is like a blueprint for case management. It includes
procedures required for the establishment and maintenance or oral health.
It involves the decisions regarding
• Emergency Treatment
• Extractions
• Treatment of periodontal diseases
• Endodontic therapy
• Occlusal adjustment and orthodontic therapy
• Restorations
• Aesthetic demands
• Sequence of therapy

3. Goals of Treatment Plan
1.) Immediate Goals
- Elimination of all infectious and inflammatory processes that may hinder the
patient’s health.
- This may require educating the patient on infectious oral diseases and their
prevention, endodontic procedures, periodontal procedures, oral surgery, caries
control, treatment of oral mucous membrane, etc.
- These goals are important from a periodontal viewpoint as they help eliminate
gingival inflammation and its causative factors
- They include pocket reductions and establishment of good gingival contour and
mucogingival relationship

4. 2.) Intermediate Goals
- These include that reconstruction of a healthy dentition that not only fulfils all the
functional and aesthetic requirements, but last for many years.
- The restoration of health, function, aesthetics and longevity involves considering
endodontic, prosthodontic, orthodontic and periodontic treatments, as well as the
age, health and desires of the patient.
- The financial status of the patient must also be considered.
- The complexity of the case, financial status of the patient and thus the therapy
involved, determine the intermediate goals.
3.) Long-term Goal
- The Long-term goal is the maintenance of health through prevention and
professional support therapy.
- Both, the patient and the clinician work towards achieving it.

5. Explaining the Treatment Plan to the Patient
– Be specific
– Avoid Vague statements
– Begin your discussion on a positive note
– Present the entire Treatment Plan as a unit

6. Phases of Therapy
• Emergency Phase
• Phase I - Etiotropic / Non-surgical Phase
• Phase II - Surgical Phase
• Phase III - Restorative Phase
• Phase IV - Maintenance Phase

7. Sequence of Therapy

8. Emergency Phase
– Treatment of pain, inflammation
– Draining of abscess, followed by short term high dose antibiotic treatment
– Extraction of hopeless teeth

9. Phase I – Non-surgical Phase / Etiotropic Phase
Step 1 : Plaque Biofilm Control instruction
Step 2 : Removal of supragingival and subgingival Plaque biofilm and Calculus
Step 3 : Recontouring defective restorations and crowns
Step 4 : Management of carious lesions
Step 5 : Tissue re-evaluation
It also includes,
– Habit Counselling : Ask, Advice, Assist, Assess & Arrange
– Antimicrobial therapy ; Photodynamic therapy
– Occlusal therapy
– Minor Orthodontic movement
– Provisional splinting and prosthesis, etc.

10. Evaluation of response to this treatment is to be done ideally after 3 months
and includes
Rechecking:
• Pocket depth and gingival inflammation.
• Plaque and calculus
• Caries
• Oral hygiene status

12. Phase II – Surgical Phase
It is an adjunct to phase I
Should only occur once patient demonstrates proficient biofilm control
Objectives
• Primary : access for root instrumentation
• Secondary : pocket reduction (via soft tissue or osseus resection or periodontal
regeneration)
Periodontal Access Surgery
• Resective (gingivectomy, frenectomy, vestibuloplasty)
• Regenerative (flap surgery with flap or osseus graft )
Extraction of hopeless teeth
Periodontal Plastic surgery – aesthetic crown lengthening , mucogingival surgery
Preprosthetic Surgery
• Implant site preparation
• Implant placement
• Prosthetic crown lengthening

14. Phase III – Restorative Phase
– Final restorations.
– Fixed and removable prosthesis.
– Evaluation of response to restorative procedures.
– Periodontal examination.
Rechecking
• Status of the restoration
• Gingival condition
• Plaque
• Calculus
• Probing Depth
• Clinical Attachment level
• Oral Hygiene Status

15. Phase IV – Maintenance Phase
This involves recall of the patient 3-4 times a year or every 6 months and
– Inquiry of changes in patient’s oral and medical health status
– Inquiry of any new concerns
– Oral hygiene assessment and education
– Comprehensive periodontal examination
– Professional Maintenance care
• Supragingival and subgingival biofilm and calculus removal
• Selective scaling and root planing
– Assessment for recall interval
and plan for the next visit

17. Conclusion
– The Ultimate Goal for each and every patient is to bring his or her mouth to a
state of health and maintain it long term
– This begins with educating the patient on his or her problems, their etiologies,
treatment and prophylaxis
– A properly designed Treatment Plan is paramount to achieve this goal
– An efficient Treatment Plan can be modulated only after thorough examination,
proper diagnosis and prognosis and consideration of the needs and desires of
the patient
– As the diagnosis and prognosis change with treatment, therapeutic needs of the
patient may change as well. The Treatment Plan should change accordingly.