Seattle Study ClubTreatment Planning

Template

Patient NameDate of presentation

Treating Clinicians: (Enter name(s) of clinicians here)

Age at initial presentation: (Enter age & gender here)

Initial presentation date: (Enter date here)

Introduction & Background

Enter case description here.

Medical History

Enter patient information here.

Diagnostic Findings

Full Face Smile Full Face Repose

Extraoral/Facial Findings

Enter patient data here.

Full Face Profile Smile Full Face Profile Repose

Extraoral Findings, cont.

Enter patient findings here.

Smile Close-Up Repose Close-Up

Smile Analysis

Enter data here.

Retracted Closed Retracted Open

Dental Findings

Enter dental findings here.

Left Lateral Right Lateral

Occlusal Notes

Enter occlusal findings here.

Maxillary Occlusal Mandibular Occlusal

Occlusal Notes

Enter occlusal findings here.

Additional Image Additional Image

Additional Notes

Enter any additional findings or concerns here.

TMJ & Mandibular Range of Motion

Enter TMJ findings here.

Periodontal Findings

Enter periodontal findings here.

Periodontal Probing

Panorex or FMX Insert Date Here

Radiographic Findings

Enter radiographic findings here.

Diagnosis & Prognosis

Diagnosis

Type in here.

Prognosis

Periodontal:

Biomechanical/Structural:

Functional:

Esthetic:

Summary of Concerns

Enter summary of concerns here.

Proposed Treatment Plan

Enter proposed treatment plan here.

Proposed Treatment Plan, cont.

Continue proposed treatment plan.

Group Treatment Planning

Review of Treatment Goals

Enter the goals here.

Active Treatment

Active Treatment - Phase I

Enter Phase I treatment here.

Phase II

Enter Phase II treatment here.

Phase III

Enter Phase III treatment here.

Phase IV

Enter Phase IV treatment here.

Phase V

Enter Phase V treatment here.

Phase VI

Enter Phase VI treatment here.

Phase VII

Enter Phase VII treatment here.

Commentary

Enter commentary here.

Post-Treatment Follow-up

Enter post-treatment information and/or commentary here.