1. Pre-Treatment Diagnostic Records

    2. Quality assessment is dependent upon the existence of pre-treatment records. Adequate diagnostic records vary with the complexity of the presenting conditions. They must be sufficient to identify the pre-treatment problems, cosmetic or other and enable the development of an appropriate course of treatment plus any alternative treatment plans.

    Records taken in preparation for comprehensive dental treatment should include the following: (These records are also recommended for most limited dental procedures.)

    1. Patient interests and objectives.
    2. Medical/dental history (Physician consult if needed).
      1. Pre-op medication indication
      2. TMJ symptoms and duration
      3. Previous care and treatment outcome
      4. Reasons for the cosmetic reconstruction
    3. Patient profile - The Composite of the Expectations Evaluation and the medical/dental history questions and answers will provide significant patient background information. This step is critical to your evaluation as to whether to proceed any further.
    4. Clinical examination findings.
      1. Oral cancer screening
      2. Periodontal screening - the Periodontal Screening and Recording system or complete probing (The PSR is a screening system designed to detect periodontal disease and recommended by the American Academy of Periodontology. It is not intended to replace a comprehensive periodontal examination when indicated.)
      3. Charting the existing conditions to include, but not limited to, as needed:
        1. Caries
        2. Defective restorations
        3. Aesthetics
        4. Fractures
        5. Joint or facial pain
        6. Impacted teeth
        7. Cysts and tumors
        8. Restorations
        9. Centric relation/centric occlusion relationship or discrepancies
        10. Missing teeth
      4. TMD Screening / Occlusal Screening to include, but not limited to:
        1. Occlusion
        2. Clenching
        3. Headaches, neck and shoulder pain
        4. Tired jaws on awakening
        5. Joint or face pain
        6. Popping and clicking on TMJ
        7. Movement difficulty
        8. Chewing function
        9. Mobility and fremitus
      5. Complete intra-oral and/or panoramic radiographic coverage. If a panoramic radiograph is utilized, it should be supplemented with intra-oral x-rays of diagnostic quality that reveal the crest of the bone on all teeth. The survey should be updated as determined by the patient’s conditions.
      6. Mounted diagnostic models should be constructed for all cosmetic/cosmetic reconstruction cases where a number of crowns are to be done or teeth are missing, especially for all anterior crowns, cosmetic bonding and veneers. Dental practitioners must select an occlusal concept hat is best suited for their patient. It is important to learn several different methods and techniques of capturing mandibular position in order to determine the method best suited for each patient's situation
      7. Other diagnostic material/data.
        1. Prior photographs of face and teeth taken up close
        2. Current photographs of face and teeth
      8. Diagnostic wax up of case mounted.