Treatment Planning for Implant Dentistry

Michael Tischler, DDS


Treatment planning is about communicating treatment recommendations clearly to a patient. Unless the doctor and team are united in a common direction and culture, the many facets of presenting a treatment plan may not appear to be coordinated, and therefore, will not be as effective to a patient.

This month’s Implants Today topic is treatment planning for implant dentistry. Of all of the topics we revisit each year, treatment planning is the most important, since it requires a combination of practice management and clinical disciplines. It is the starting point of many things that affect our patients’ lives.

When a dentist treatment plans an implant case, whether it is one implant or an entire arch, there are many clinical decisions and core individual philosophical opinions behind the plan. I believe a clinician should have a core practice vision, also known as a mission statement, that backs up any presented treatment plan. This vision statement defines the goals and culture of the dental practice, and from that vision statement, all interactions with a patient are driven. The reality is that most dental practices do not have a written vision statement. The reason for that is perplexing, as the concept of setting goals, writing them down, and committing to a vision statement is recommended in almost every New York Times best-selling leadership and business book. As dentists, we are running a business, and the core philosophy of having a vision statement for your dental practice for success is ubiquitous to all businesses.

A mission statement is not just about the bottom line of your practice. It is about representing your personal vision as a committed statement that affects your employees, your treatment decisions, and ultimately the business as a whole. I believe patients can sense the culture of a dental practice when they first call the office and again once they arrive. The vision statement and practice culture sets the tone for everything that occurs in a dental practice. Think about the vision and culture of the Ritz Carlton Hotel chain, or Lexus as a car manufacturer. These companies are both committed to excellence, and everything that they do, from their products to customer services, represents their vision and mission statements. Their visions create choices such as the quality of the towels Ritz customers touch to the leather the Lexus customers sit on. As a dentist, having a defined vision will translate to the front desk employees’ communication skills, to the efficiency of clinical care, and even to the quality of materials a doctor chooses to use on his or her patients. I believe that without a strong vision statement, treatment planning will not be as effective. Treatment planning is about communicating treatment recommendations clearly to a patient. Unless the doctor and team are united in a common direction and culture, the many facets of presenting a treatment plan may not appear to be coordinated, and therefore, will not be as effective to a patient.

Treatment Plans Solve Problems
Our patients usually come to us with a problem needing a solution. The problem could be replacing failing teeth or replacing missing teeth. We are honored with that responsibility and should appreciate the vulnerability of our patients’ feelings as they come to us for help. There are many subliminal background factors involved when we communicate our treatment plans with the goal of a patient accepting and also affording that treatment. A vision statement, which is put in writing and committed to, is the backdrop behind the implementation of every treatment plan given to a patient. When presenting a treatment plan, there are many facets to consider: clinical decisions, material choices, staff involvement choices, technology choices, and office environment choices that directly affect your patient’s life. Behind all of those components are marketing decisions for your practice that help bring that patient in for treatment. Again, I recommend that every dental practice, whether an implant-focused one or not, define their practice with an individualized, written vision statement that incorporates the identity of the practice and owner’s core beliefs.

A practice vision statement affects many aspects of attracting patients and treating them. This starts from the first contact a patient has with a dental practice. This could be the front desk staff or an advertisement a patient may have seen. A vision statement of excellence, appointed by the leader (owner) of the practice that a staff collectively commits to, will affect the decisions that shape advertisement choices and staff dialogue that helps a patient choose a dental practice for his or her treatment. This vision statement also affects the patient’s experience after arriving at the practice.

A vision statement might incorporate a focus of providing the latest technology in a practice. That commitment directly affects the quality of treatment. I have often highlighted the important role of technology with respect to ideal implant treatment in these monthly Implants Today introductions. Choosing the latest technology is based on core choices. This directly affects treatment planning. For instance, having an in-office CBCT machine has many benefits to both treatment planning and actual treatment. In my practice, I see a higher treatment plan acceptance rate since we often take a CBCT at a patient’s first implant treatment visit. By doing this, I feel a patient shows his or her level of commitment to treatment, as well as my commitment to being current and state of the art. This means a lot to patients, as they are making financial decisions and are feeling vulnerable.

Core practice visions should also incorporate scheduled communication between staff and the practice leaders. When a dental team is well coordinated with respect to communication of a proposed plan and practice values, there are many benefits. First, the patient is more likely to accept treatment. Beyond that, all informed consent forms are adequately presented, the financial arrangements are clearly communicated, and in the end, there is increased medical legal protection and reduced problems as a case is planned.

Standard operating protocols (SOPs) should be established with all aspects of patient communication and treatment. A leading dental consultant, Dr. Bill Blatchford, often recommends checklists similar to what an airplane pilot does. SOPs and good staff communication through scheduled meetings, as well as defined coordinated staff roles, creates an ideal treatment plan presentation for a patient. I have found, once again, in my practice that presenting implant cases and following up on the plans are best done with a team. My practice incorporates a philosophy of having me, as the implant surgeon, build trust and confidence with the patient, then having my clinical assistants and financial treatment coordinator follow up with the details. It makes sense from a practice management standpoint. None of this happens by chance; it has to be preplanned through core practice vision commitments.

This month, one of our Implants Today advisory board members, Dr. Scott Ganz, presents an article entitled “Enhanced Diagnosis and Treatment Planning for Implants.” This article exemplifies the principles outlined in this introduction by demonstrating how a commitment to excellence in technology and continuing education translates to ideal treatment planning. Scott’s commitment to providing the absolute highest level of CBCT-based treatment results in his patients receiving the best care possible. This month’s other offering under the topic of implants is by Dr. Rick Winter et al and describes a multidisciplinary case that demonstrates how to treat a patient with a severely atrophied mandible, vastly improving the patient’s function and self-esteem.

If you hoped to read this introduction and see more clinically based treatment planning steps, then I might have disappointed you. My intention was to use this venue to share core concepts behind those clinical steps. Our goal as implant dentists is to provide clinical excellence; however, without a core plan to communicate those clinical steps, financial steps, appointment steps, follow-up hygiene steps, etc, those clinical steps may either not be chosen by the patient, or miscommunications could hamper a great treatment experience for the patient, thus creating possible subsequent patient relation issues.

In summary, treatment planning is done from a core practice vision that is created by the clinician as a leader of the practice. As a leader who has created a solid written vision, your treatment team will then help your patients who are looking for the best solutions to their clinical problems get the ideal treatment they deserve. Treatment planning, as I have laid out, involves so many things. Under your direction and leadership, everyone involved, from the team to the patient, will benefit.

Also From Implants Today

The Future of Implant Dentistry

CBCT Planning for Implant Dentistry

Provisionalization for Implant Dentistry