I’m sure like I have, you all have heard some version of the following quote:
- You Only Treat What You Plan
- You Only Plan What You Diagnose
- You Only Diagnose What You See
I’ve heard the credit for this statement given to many influential people in dentistry. Whoever gets the credit, they truly understood the essence of what we do, and the balance between clinical excellence and success in business. Dentistry is practiced in many ways, influenced by the leadership of the dentist and the needs of the patient. From higher volume offices where patients have areas of disease corrected to comprehensive practices that partner with patients to establish and maintain long term health, we all improve lives. Many of us leave dental school knowing we have a journey of learning ahead of us in order to serve our patients comprehensively. The question is where to start, what subjects to study and what to learn?
Often our attention turns to new techniques, or improving our technical skills. There is no doubt that technical proficiency is a critical component in dentistry. On the other hand, how does it serve us to know how to do a particular technique if we can not identify where it would benefit our patients, therefore it isn’t part of our treatment plans? I think for every technique we learn it is critical to understand how it integrates into a comprehensive approach to health. With this in mind our growth as dentists comes from becoming a better diagnostician. Diagnosis rests on knowing the signs and symptoms of the process in question, and training our eyes and ears to notice the subtle indications.
So What Do You See? Take a look at the patient photo included with this post and make a list of all the things you see. Some may be definitive findings, and others may be subtle indications that you wonder about. These questions are what will drive the exam process, the records you ask permission to take and the conversations you have with the patient.
Andrew Sauchelli says
Occlusion- posterior crossbite in molar area patients left. Mammelons on lower incisors-possible anterior open bite. #6 rotated mesially.
Periodontally- excessive gingiva on clinical crown of #6. Gingival recession at the apex on #9.
Prosthetically- Missing lateral incisors. Is there enough room for dental implants to replace the laterals?
Radiographic- I would love to see a CBCT to determine the width of bone in the lateral incisor area. Also to see if #9 is too far buccal causing stripping of bone and recession. Also to see the location of the roots of the centrals.
Difficult case because he/she will probably need to go back into orthodontics. Would have been nice to have a consult with you PRIOR to bracket removal. It will be a challenge to develop proper emergence profile on the lateral implants once the roots are in the proper position. He/she may need hard/soft tissue grafting in this area pending CBCT. Have fun, Drew Sauchelli
Lee Ann Brady says
Thanks Drew, great eye!
vinamra dhariwal says
i agree with Andrew’s findings.however there is mild attrition on tooth #24 (distal edge). midline of upper not matching with lower. Y are the maxillary second premolar missing
Also it can be treated more conservatively with a resin retained fpd or a cantilevered fpd with canine as abutment.if the laterals are congenitally missing then scope of good volume of bone being there is less. how and when did she miss her laterals.may be an rpd be the simplest option.what does the patient want. and what is the quality of hard tissues(tooth and bone).
how old is he/she and how is the profile.
Also patient might be having or had tongue thrust or thumb sucking habit. Is the patient a case of skeletal class III malocclusion.
more insight required about the patient to discuss further mam.
Dan O'Rourke says
I agree with what has been seen in the photo, but to truly diagnose a case takes far more than a photo. This one photograph just scratches the surface and is very limiting as far a creating any kind of thorough treatment plan.