Dear colleagues, I'm happy to talk with you about treatment planning in complex and straightforward patient situations. Here you see a complex patient situation and you see a list of problems that may occur in some situations. How do we go about treatment planning for any patient or in particular, patients with these complex situations? There are two strategically important issues we need to consider. One is follow a sequence of treatment phases. Don't try to do everything at once but go phase by phase to simplify complex situations and help you guide you through all kinds of situations. Secondly, re-evaluate at pre-determined time points. Here you see this list again and we start with initial exam and diagnosis. So we do a patient history, examination and a diagnosis. You see on the right side the images, occlusal images of this patient. And on the left side patient history. We will focus on the patient's chief complaint. We'll do a comprehensive patient history. We'll do a complete relevant examination of all factors and then a diagnosis of all relevant processes. After this, we define the aim of treatment, do a single and an overall prognosis. Based on this, we will do an initial prosthetic planning. This is the treatment planning step. You see on the X-ray we have marked teeth that are secure, teeth that are irrational to treat and teeth that are doubtful at the present time. We would then make different suggestions to the patient of where we could go. Let's focus on what we've agreed upon with the patient in this particular situation. We use some tools to illustrate this so the patient can better understand. Very importantly there is a further step it is the simulation of the aim of treatment which we initially define together with the patient. This can be done in an analogous way by a wax-up with digital means on a computer but it's important to simulate the aim where we want to go. Now we go into active treatment. The systemic phase deals with systemic medical issues of the patient. We'll not go into details here. We'll go to the hygienic phase where we have the first active form of therapy with our patients. It's cause-related therapy. Patient information and motivation, oral hygiene instructions, assessment of the progress of oral hygiene measures, scaling and root planing. Furthermore, we'll treat carious lesions, endodontic problems. We'll extract teeth which are irrational to treat and we'll end with the first form of temporization. Many times dental hygienist will support us in doing this first phase. After the phase and during healing, we will reevaluate the different aspect to see how far healing has progressed. Maybe we need to change our initial planning a little bit. In our patient situation, we've lost tooth No.45, and we now plan a fixed dental prosthesis in this area. We have fixed dental prosthesis planned, single crowns and implant bone reconstructions. Now comes the surgical phase with periodontal surgery, augmentation procedures, and notably, implant placement. How do we know about the ideal location of the implants to be placed? Well, this is done at the prosthetical correct position and this is determined by stents based on the prosthetic simulation of the end result. Remember our prosthetic simulation that we did, now it comes in handy because we know where to place the implants to most easily reach this prosthetic solution we have agreed upon with our patient. Surgical phase also includes guided bone regeneration and other surgical measures. Again, after due time we would re-evaluate the effect of this phase and then we move on to the prosthetic phase. Here we will fabricate a new provisional on the abutments that have been prepared on the implants which are osseointegrated by now or we can also adapt an existing provisional. This will also help us do soft tissue conditioning and please note, this new temporary plays a very important role in making the final decisions for the final reconstruction. It helps the patient understand what the final reconstruction will look like. It helps us to solve problems here and there. This is followed by a final impression you see in the maxilla. Teeth are prepared for single crowns as abutments for fixed reconstructions and we have some implants for fixed implant bone reconstruction. In the mandible, we have single crowns again fixed reconstructions. All teeth have been prepared as abutments for these types of reconstructions. Delivery of the final reconstruction as you can see here. Again, partly implant bone, partly tooth bone. This is the end of active therapy but it's not the end of treatment. We still keep to our scheme of different steps. Now we include the patient into maintenance phase where we have regular assessments of periodontal and dental parameters and peri-implant parameters, regular oral hygiene re-instructions and comprehensive maintenance care including the reconstruction, patient history, examinations, diagnosis and everything which is included. We conclude: following patient history, patient examination and diagnosis, we define the aim of treatment. We simulate the desired aim of treatment prior to initiation of therapy. We follow a sequence of treatment phases. Treat all diseases and problems present prior to implant placement. Reevaluate the predetermined time points. Use the simulation of the aim of therapy to guide you through all phases of therapy including implant placement. Finally, enroll the patient into maintenance care program after active therapy. Thank you very much for your attention.
