Seattle Study Club Treatment Planning Template

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Seattle Study ClubTreatment Planning Template
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Patient Name

• Date of presentation

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Treating Clinicians (Enter name(s) of
clinicians here)Age at initial presentation
(Enter age gender here)Initial presentation
date (Enter date here)
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Introduction Background

• Enter case description here.

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Medical History

• Enter patient information here.

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Diagnostic Findings
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• Full Face Smile

• Full Face Repose

• Enter patient data here.

Extraoral/Facial Findings
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• Full Face Profile Smile

• Full Face Profile Repose

• Enter patient findings here.

Extraoral Findings, cont.
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• Smile Close-Up

• Repose Close-Up

• Enter data here.

Smile Analysis
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• Retracted Closed

• Retracted Open

• Enter dental findings here.

Dental Findings
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• Left Lateral

• Right Lateral

• Enter occlusal findings here.

Occlusal Notes
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• Maxillary Occlusal

• Mandibular Occlusal

• Enter occlusal findings here.

Occlusal Notes
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• Additional Image

• Additional Image

• Enter any additional findings or concerns here.

Additional Notes
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TMJ Mandibular Range of Motion

• Enter TMJ findings here.

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Periodontal Findings

• Enter periodontal findings here.

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Periodontal Probing
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• Panorex or FMX

Insert Date Here

• Enter radiographic findings here.

Radiographic Findings
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Diagnosis Prognosis

• Diagnosis
• Type in here.
• Prognosis
• Periodontal
• Biomechanical/Structural
• Functional
• Esthetic

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Summary of Concerns

• Enter summary of concerns here.

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Proposed Treatment Plan

• Enter proposed treatment plan here.

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Proposed Treatment Plan, cont.

• Continue proposed treatment plan.

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Group Treatment Planning
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Review of Treatment Goals

• Enter the goals here.

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Active Treatment
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Active Treatment - Phase I

• Enter Phase I treatment here.

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Phase II

• Enter Phase II treatment here.

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Phase III

• Enter Phase III treatment here.

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Phase IV

• Enter Phase IV treatment here.

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Phase V

• Enter Phase V treatment here.

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Phase VI

• Enter Phase VI treatment here.

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Phase VII

• Enter Phase VII treatment here.

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• Enter commentary here.

Commentary
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• Enter post-treatment information and/or
  commentary here.

• Post-Treatment Follow-up