Coming Soon to a Clinic Near You: 5 Phases of Treatment! Tavis Sisson,
Phase you are most likely completing a core buildup here in the initial restorative phase.
Also considered to be part of the Disease Control Phase is a Re-Evaluation. During this re-evaluation all actions taken up until D3, ASDA Synergy Weekend Chair this point are reviewed for their ability to control disease in the mouth. We would typically think of this as our Phase I Evaluations (both perio and operative). The question to answer here is “Is the he UF College of Dentistry has patient ready to move to the Definitive Phase?”. recently approved a new method In the ‘Definitive Phase’ (4th phase for those who are countof organizing treatment. While this is still a work in progress the roots of the ing) we are preparing for and completing any prosthetic restorations new treatment plan phases are estab- deemed necessary. This is what we normally would consider to be Phase II and is broken up into two parts. lished.
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The first phase of therapy is titled the ‘Systemic Phase’ and is to be completed before progressing to other treatments. The Systemic Phase consists mostly of items discovered in the medical history or physical exam. Possible actions necessary in the Systemic Phase would include medical consults, biopsies, and any ‘action steps’ necessary for any conditions or medications. Examples of an action step would include getting an INR for patients on Coumadin or making sure a patient has their inhaler at the beginning of every appointment for patients with asthma.
The first part of the Definitive Phase is adjunctive therapy and consists of pre prosthetic surgery, crown lengthening, orthodontics, etc. Anything that is necessary to get the patient ready for their final prosthesis would be considered adjunctive therapy as well as definitive therapies for patients not needing prosthetic devices (orthodontics). This is followed by the second part of the Definitive Phase called the prosthodontic phase where fixed and removable prosthetics are fabricated and delivered. Following the Definitive Phase is another evaluation step called ‘post assessment’ and is essentially what we would currently consider a case completion. After this, the patient is placed on a recall schedule and has entered the ‘Maintenance Phase’. This fifth and final phase is meant to support the long term dental health of the patient and can feed back into the previous phases as situations arise in that patient’s maintenance.
The ‘Acute Phase’ of therapy is begun after systemic complications have been addressed and is broken up into first addressing emergency problems followed by urgent problems. Problems such as trauma, pain, and infection are addressed as emergency problems. This is not just limited to extractions and root canals as large carious lesions may be addressed as well as rapidly progressing periodontal The presented phases of treatment, while approved, are still diseases, such as ANUG. being tweaked and the final presentation may differ slightly from what you see above. For example, they may be listed as phases 0-3 + The second part of the Acute Phase treats urgent problems. maintenance rather than phase 1-5 as listed above. However, the What we currently consider to be a ‘caries control’ situation with numbering system assigned should not change what is addressed in multiple sedative restorations would be considered an urgent probeach of the phases. I hope this helps prepare you for what is coming lem. Extraneous patient needs as well as pure dental needs can also down the pipeline in the near future, and I preemptively wish you classify something as urgent. For example, a patient who has a good luck in explaining the 5 phases of treatment to your future pachipped front tooth and is getting married in two weeks makes that tients. class IV restoration an urgent problem based on the time limitations. What we currently think of as Phase I therapy would be considered the third phase of treatment in the new model called the ‘Disease Control Phase’. In the Disease Control Phase we are addressing the prime dental diseases: caries and periodontal disease. This phase is also broke up into two parts. The first part is disease control treatment and primarily would revolve around oral health instructions, scaling/root planning, and adult prophylaxis. This is essentially periodontal in nature since ‘caries control’ patients are addressed in the Acute Phase. The second part of the Disease Control Phase is the ‘initial restorative phase’. During this portion of treatment you are utilizing your standard compliment of operative ADA codes and should bring the patient to a stable restorative situation. Even if the ultimate goal is an indirect restoration in the Definitive
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1.
Systemic Phase
2.
Acute Phase (Emergency Problems and Urgent Problems)
3. Disease Control Phase (Disease Control Phase and Initial Restorative Phase) Re-Evaluation 4.
Definitive Phase (Adjunctive Therapy and Prosthodontic Phase) Post-Assessment
5.
Maintenance