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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.
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