Summary of Prosthodontic Treatment Planning and Sequencing
All direct procedures should be completed (Operative Case Complete – D0003) prior to initiating fixed prosthodontics treatment. Exceptions to the operative case complete are to be entered into the treatment plan as “planned” treatment and approved by the covering faculty.
Periapical and bitewing radiographs of the teeth to be restored should be current (<6 months) and approved in Axium.
Casts should not be more than 6 months old and should reflect current conditions. Cases that are to be sequenced should have a set of original casts mounted on a Stratus articulator with a facebow and the horizontal condylar inclinations set with a protrusive record. If a diagnostic waxing is indicated, this should be done on a set of mounted duplicate casts.
The clinical Occlusal Analysis form must also be completed and approved prior to the treatment planning appointment. The need for occlusal adjustment, the articulator selection, and the impression technique are all determined at this time. A determination of the need for a diagnostic waxing should also be made (esthetic considerations, occlusal plane corrections, provisional options, etc.).
At the clinical treatment planning appointment, a “Phase 3” treatment plan should be created by the student in Axium to include all anticipated fixed and removable prosthodontic treatment. This plan should only be activated on the clinic floor by the covering faculty if it involves 3 or less single fixed units. All other cases (all FPD’s, all RPD’s, 4 or more single units, etc.) will need to be sequenced and activated by the faculty that covered the diagnostic review of the patient. This will be a non-clinical appointment. The progress notes should be specific regarding surfaces to be covered in porcelain, margin design, etc. The covering faculty will have the discretion of requesting the team Prosthodontic’s opinion on an individual treatment plan basis.
Complex fixed cases and all RPD cases (with the “exception” of a CUD/RPD with proper plane of occlusion and acceptable periodontal health) must be scheduled for Treatment Planning Board. A treatment planning board checklist is available to the student for review.
Sequencing of 3 or less single unit fixed restorations will be done using Axium’s “Phase/Sequence” capability, once the treatment plan has been approved.
Sequencing of everything else (4 or more single units, all FPD’s, all RPD’s, complete dentures, etc.) will be done with the faculty that covered the diagnostic review of the patient. This is also the time that treatment plan will be activated. The faculty member will determine whether it is appropriate to scan in a copy of the yellow sequence forms or to use Axium’s “Phase/Sequence” capability.
Comprehensive Care Fixed / Removable Step-by-Step Sequencing
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Operative Case Complete D0003 (OPER) A. Directs completed B. Exceptions added as planned treatment
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Occlusal Analysis D9430 (OCCL) A. Complete form in Axium B. Facebow mounted and records C. LOA? D9951 D. COA? D9952 E. Dx waxup? D9450.A
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Fixed Prosthodontics Tx Plan D9450 (FPROS) Required for all cases: A. Dx casts, PAs & BWs < 6 mo old B. Perio concerns? C. Phase 3 tx plan created D. Axium and paper form sequencing E. Porcelain coverage & margin design noted on sequencing form
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Tx Planning Board (D9450) Indications A. RPDs (except CUD/RPD; proper plane of occlusion; good perio B. Significant esthetic changes C. Occlusal plane discrepancies D. Anterior guidance involved E. Complex implant cases F. Opposing FPDs G. Other complex cases at faculty discretion H. > 4 Indirect Units I. RPD’s involving survey crowns
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Sequencing [non-clinical appt] Axium & paper form sequencing Phase 3 tx plan approval
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