Fundamentals of Treatment Planning. Lino Calvani
the patient’s needs, wishes, and expectations. Prosthodontists are called upon to improve the function of the dentition as well as the patient’s comfort and quality of life so that both physical and psychologic health are restored.
Prosthodontists should be equipped to manage treatment planing with understanding, expertise, and professionalism. This entails a sound knowledge of patient management, organization, and what is available in terms of clinical therapies that can be suggested to the patient.
Therefore, after the diagnosis, treatment planning is the moment where all the various aspects of education, knowledge, understanding, expertise, experience, observational capabilities, reasoning, dexterity, skills, ethical awareness, responsibility, communication, and critical thinking are distilled into one focus. From this focal point, treatment plans are conceived and presented to the patient. At this moment, professional values such as clarity, precision, and accuracy are key.
What follows are some basic concepts, definitions, and suggestions related to this aspect of the topic. Some may feel that their professional experience means they will not benefit from this level of basic analysis. But for those who humbly approach this subject with an open mind, these basic concepts will hopefully be useful to tune in, so to speak, to the matter of prosthodontic thought in order to enhance their knowledge and understanding. It should also be borne in mind that, unfortunately, the speciality of prosthodontics still does not exist institutionally in many parts of the world outside of the USA.
Some definitions and basic premises
The three cornerstone definitions are:
● Treatment: According to the Cambridge Dictionary, the word ‘treatment’ is defined as “the way in which somebody behaves towards or deals with somebody or something.” 1 In the sense of medical treatment, it refers to the care given to a patient in response to an illness or injury, and in the case of dental medical treatment, in response to an issue or issues concerning the oral cavity.
● Plan: A plan has been defined as “an individual or collaborative enterprise that is carefully planned to achieve a particular aim.” 2 Indeed, a plan is what results after:
● all the appropriate data have been acquired;
● the situation has been carefully studied;
● all the details are understood;
● appropriate conclusions have been drawn;
● one or more solutions necessary to solve the problem/s have been formulated.
● Purpose: The purpose of treatment planning in prosthodontic and restorative dental medicine has been analyzed by many authors.
According to Rosenstiel et al,3 the purpose is to formulate “a logical sequence of treatment designed to repair existing damage and restore the patient’s dentition to good and maintainable health, with optimal function and appearance.”
A treatment plan will only be successful and effective if it is:
● Organized: This important concept may seem obvious but often it is not, so it is emphasized here again that any treatment plan must be well organized and clear, first in the prosthodontist’s mind and then transferred as such to the patient. Only then can the plan be properly understood by the patient.
● Explicable: During treatment planning, we have the chance to understand the prosthodontic rehabilitative course in detail and foresee its possible final results. We then need to organize our conversation with the patient. Indeed, the treatment plan that is well understood and then accepted by the patient is the tipping point after which the clinical treatment may begin.
● Predictable: Predictability of the clinical results is the highest aim of treatment planning. Indeed, during the planning, prosthodontists need to consider all possible variables in order to reduce the likelihood of surprises or pitfalls during the clinical treatment and after the delivery of the prostheses.
Professionalism: four human factors
There are a number of positive characteristics that the prosthodontist (or any clinician) should ideally cultivate and develop in order to grow as a professional. These characteristics are further described in Chapter 7. What follows is a brief description of the main desirable qualities and skills necessary for us to succeed in clinical practice:
1. Proper communication and dialogue with the patient
The ability to communicate clearly is a primary skill. Clear, open communication leads to trust, which is not a given but is something that is earned. Trust is the key to successful patient management and treatment. However, it is not always possible to achieve trust during the first appointment, unless we are able to immediately tune into our patient’s state of mind. Trust often results when we successfully transfer to the patient through optimal communication skills a positive sense of our ability and professionalism from the outset. This entails the ability to clearly explain each step of the procedure and to motivate patients to trust us, to recognize our professionalism and capability, and to feel confident that we are able to solve their problems.
Often, patients must be motivated to be cured. Naturally, a patient’s personality, character, previous experiences, expectations, and other factors may influence this process (this important aspect is discussed later in the book). Clinical experience shows that a number of impediments to communication can be identified when approaching patients such as:
1. Lack of trust or agreement.
2. Stress due to patients’ personal problems.
3. Lack of communication and understanding.
4. Lack of constancy to care.
5. An exacting, fussy, and/or controlling patient.
6. Special physical issues or needs patients may have.
7. Demanding patients, and special psychologic attention they may require.
However, no matter what past experience or personal problems patients may have that could result in a negative attitude on their part, we need to know, understand, and remember to behave professionally at all times in order to inspire trust in our patients and communicate effectively with them.
This is one of the most important skills we need to develop for success in the clinic. Patient management depends mainly on us, and according to psychology is based on two personal qualities of the clinician that should be carefully nurtured and developed: the ability to take responsibility and our freedom of choice (free will).
Some patients have demanding personalities or suffer from complex psychologic problems. These factors could affect our ability to manage their cases.4 For this reason, when we are dealing with difficult patients, we need to pay even more careful attention to our interpersonal management skills because problems with these challenging patients may arise at any time.
Psychologic studies suggest that we should be professionally confident and capable and should take responsibility for everything we say and do. The more we transfer positive feelings to our patients, the more they will trust us and the easier it will be for them to accept the treatment we offer them. A number of psychologists have studied patient–clinician behavior and the kind