Treatment Planning and Case Management
From findings to a sequenced plan
A defensible plan is patient-centred, staged, and justified. Start with stabilisation and disease control (pain, infection, caries risk, periodontal status, smoking and glycaemic control), then definitive care, then maintenance. Present options - including the option of no treatment - with their benefits, risks, costs, time commitments, and prognoses. Prognosis language should be calibrated: "favourable with adequate plaque control" is honest; "guaranteed" is not.
Sequencing and staging traps
Questions test whether you treat the acute problem before the elective one, and whether you address aetiology before aesthetics. Common errors include planning an implant or crown in an uncontrolled periodontal or high-caries-risk patient, ignoring occlusal and functional factors, and failing to consider the patient's ability to maintain the result. Medically complex patients require liaison before elective surgery.
Shared decision-making
Document the patient's values and constraints (cost, travel, anxiety, time off work) because the "best" plan for the clinician may be wrong for the patient. Where capacity or adherence is uncertain, build in review points rather than assuming compliance.
Rule of thumb
Ask of every plan: "What is the diagnosis this addresses, what is the evidence, what is the alternative, and what happens if we wait?" If you cannot answer all four, the plan is not yet complete.
Worked example: A patient with generalised periodontitis and a broken molar requests an implant. Correct sequencing is periodontal stabilisation and risk-factor control, extraction and healing, reassessment of prognosis, and only then discussion of replacement options - with a clear statement that implant survival depends on periodontal maintenance.