Multidisciplinary Treatment Planning
Multidisciplinary Treatment Planning
Tested here is sequencing: the exam wants a defensible order of care and an honest prognosis for each tooth.
Core rules
- Sequence: emergency care → phase I disease control (oral hygiene, SRP, caries, endodontics, extraction of hopeless teeth) → reevaluation → phase II (surgery, regeneration, implants) → restorative/prosthetic → maintenance.
- Prognosis (good, fair, poor, questionable, hopeless) is assigned per tooth from attachment support, furcation, mobility, root form and strategic value; McGuire and Nunn showed initial prognosis alone poorly predicts survival, and smoking and diabetes modify it.
- Perio–prosthodontics: ferrule 1.5–2 mm, margins placed to leave 3 mm bone-to-margin, embrasure form for hygiene, ovate pontic sites developed before the prosthesis.
- Perio–orthodontics: intrusion and forced eruption can improve crown length or reposition margins; molar uprighting removes plaque traps; avoid orthodontics during uncontrolled inflammation.
- Strategic extraction: removing a hopeless tooth early may protect adjacent bone and simplify the plan.
Worked example
A mandibular first molar has a 7 mm pocket, Class III furcation and mobility II, and is planned as an abutment for a three-unit prosthesis. Strategic extraction is preferable: retaining it complicates hygiene, and the adjacent premolar and second molar can be restored or replaced with an implant after healing and reevaluation.
Traps
Starting restorations before reevaluation; using forced eruption as a substitute for crown lengthening in a periodontally involved tooth; treating a furcation-involved molar as an abutment; planning implants before disease control; ignoring the patient's ability to perform hygiene.