Dental treatment plan in digital dentistry: the role of technology

Treatment planning in dentistry is a step-by-step personalized protocol designed to achieve the patients’ desired oral health. In digital dentistry, a personal dental treatment plan represents the 3D model of the actual condition of the teeth and gums, as well as predictions, designs or visualizations of the desired outcome.

In order to get to this stage, the doctor will use digital imaging equipment combined with treatment planning software to help with visualization and design of the dental treatment. Solutions like these, also called CAD/CAM (Computer Aided Design and Manufacturing) dentistry can be helpful in almost any field in dentistry.

For instance, a virtual simulation of orthodontic treatments will give patients a realistic picture of how their teeth will look at the end of the treatment cycle. In just a few seconds, this type of simulation software relieves the patient of potential fears and doubts associated with the outcome of the treatment. Digital design solutions, for digital denture design for example, make it easy for the patient to relate to all the concrete steps their treatment consists of. Their dentist can show exactly what is done in each stage of the process by pulling up 3D visualizations of the treatment on screen. When combining digital dental design with a digital impression, it makes the planning phase of dental treatment a comfortable and pleasant experience, without uncomfortable and invasive impression trays and materials or insecurity around treatment outcome.

A comprehensive dental treatment plan which meets the expectations of today’s patients and gives them a feeling of satisfaction after each visit should:

• Be clear and transparent, present the current oral health conditions, and a step by step treatment plan as soon as all information is collected.
• Visualize the progress of treatment with a clear time frame.
• Be clear and realistic about patients expectations, fears and insecurities; and communicate possible outcomes and potential nuances that might affect the dental treatment outcome.
• Acknowledge that every patient is unique: the plan should be adapted to suit the patient's financial possibilities, motivation, and last but not least health conditions and treatment urgency.
• Give the patient a clear understanding of the final or potential outcome of treatments.

Some solutions allow dentists to superimpose a future smile on patients' photographs and send a live visualization directly to their mobile phones. Such smile simulators significantly increase patients’ engagement in the treatment planning process.

The success of dental treatment depends on many factors. The correct diagnosis and collection of accurate, precise and reliable patient data (e.g. impression scan) lays the foundation, but ‘soft factors’ such as the relationship between doctor and patient also play a vital role in the dental hygiene diagnosis and treatment planning process. The most common reason for treatment abandonment is poor planning. This can lead to a lot of stress on the patient’s (and doctor’s!) end. Digital technology in dentistry can help achieve optimal fit and eases communication in the planning phase, but they only make up one part of the picture.

Below, we list the five most important stages of dental treatment planning:

1. Phase 1: Diagnosis. This includes (pre)clinical examination and can consist of assessing the patient's record plus a verbal explanation by the patient, for the first visit 1. Newsome P, Smales R, Yip K. Oral diagnosis and treatment planning: part 1. Introduction. Br Dent J. 2012 Jul 13;213(1):15-9. doi: 10.1038/sj.bdj.2012.559. PMID: 22790747.. At this stage, it is important for the clinic to collect as much information (including impressions, either conventional or digital impressions) as possible from the patient, and for the patient it is vital to express all doubts, wishes and questions. Depending on the patient's complaints, additional tests may be conducted, with focus on potential periodontal, TMJ (temporomandibular joint) occlusal, oral cancer or airway issues.
2. Phase 2: Disease control. After the doctor has defined strategies in dental diagnosis and treatment planning they will use their knowledge, experience, and possibly involving peers to start disease control with a realistic and accurate dental treatment plan. In digital dentistry, treatment planning is done with the help of dental design and dental treatment software. The focus of the disease control phase can be on periodontal therapy, endodontic therapy, removal of existing restorations or caries control.
3. Phase 3: Restorative. In case of restorative treatment, the next phase of dental treatment will revolve around (a series of) appointments where the restorations are tried, fitted, refined and placed. Appointments will be about crown lengthening or implant surgery, gnathologic technique, or long-term provisional restorations, cast restorations or cast RPDs.
4. Phase 4: maintenance. The final phase of dental treatment is the maintenance phase. After the patient has gotten (or started) their treatment, it is the job of the dentist and patient to maintain oral health by a check-in visit every 6 months, fluoride supplements, or a change in diet for example. It is a vital part of the dental treatment planning process, as it is not only a factor of influence for treatment success, but it is also a way for the doctor to prevent future problems from arising. Closing treatment with a proper maintenance plan in place is a way to offer preventative care.

A key aspect to keep in mind with treatment planning in dentistry is that there is always the possibility of the plan not being a 100% match with reality. Dentists can never be fully sure whether the patient will feel comfortable with the new prosthesis, if they will follow post operation instructions, or whether the implant will be accepted by the body. A lot of factors are at stake that influence the final treatment outcome. However, when it comes to predictability, digital tools can greatly help treatment planning and outcomes.

Digital dental solutions that embrace the full spectrum of 3D visualization and digital design are not yet widely spread among dental clinics. Dental laboratories, however, were the ones that introduced and implemented digital workflows and treatment planning decades ago. They were scanning dental cast models and impressions with lab scanners, and later started receiving intraoral scans from different IOS solutions.

More and more dental specialists on the clinic side confirm that solutions like intraoral scans and treatment planning software significantly improve and simplify dental treatment planning cases of any complexity. It seems that broad adoption of these technologies is just a matter of time.

When it comes to embracing a fully digital workflow, it seems that dentists these days have a lot of providers, brands and solution types to choose from, which can lead to many questions. Which hardware and software to choose? Will these products work together with my existing solutions? Will intraoral scanning be suitable to my existing treatment offering? Can I reproduce the same results if I implement a digital approach? Will digital offer me the same level of predictability as the analogue approach I am so used to? Is it going to be difficult to learn?

The reality is that not every brand is the same. Not every workflow is the same. And also not every dentist is the same. Some solutions focus on only solving one problem, for certain cases or treatment types. But then there are also solutions, brands and platforms that work like an open ecosystem and that can help the dentist combine different dental technologies into a single workflow, making dental treatment planning as easy as it can be.

Try and feel a new level of dental treatment with digital technologies!