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Treatment Plan Sequencing/Phasing Proper sequencing is a crucial component of a successful treatment plan. Certain treatments must follow others in a logical order, whereas other treatments may or must occur concurrently and require coordination. Complex treatment plans often are sequenced in phases, including I. urgent phase, II. control phase, III. re-evaluation phase, IV. definitive phase, and V. maintenance phase (that includes reassessment and recare). For most patients, the first three phases are accomplished simultaneously. Generally, the principle of ‘greatest need’ guides the order in which treatment is sequenced. This principle suggests that what the patient needs most is performed first – with pain, bleeding, and swelling at the beginning of the treatment plan and elective esthetic procedures at the end. The process of treatment planning requires that the dentist develop an ever-increasing, comprehensive knowledge of dental disease management in the context of individualized patient care. Study of textbooks devoted to this discipline is indicated.34 Urgent phase The urgent phase of care begins with a thorough review of the patient’s medical history and current condition. A patient presenting with swelling, pain, bleeding, or infection should have these problems managed as soon as possible, before initiation of subsequent phases. Control phase A control phase is appropriate when the patient presents with multiple pressing problems and extensive active disease or when the prognosis is unclear. The goals of this phase are to remove aetiologic factors, eliminate the ecologic niches of pathogens, and stabilize the patient’s dental health. These goals are accomplished by I. removal of active disease such that inflammation may resolve, II. correction of conditions that prevent or limit hygiene efforts, III. elimination of potential causes of disease, and IV. initiation of preventive activities. Examples of control phase treatment include extractions, endodontics, periodontal debridement and scaling, occlusal adjustment, caries arrest and/or removal, replacement or repair of defective restorations such as those with gingival overhangs, and use of caries control measures, as discussed in Chapter 2. The dentist should develop a plan for the management and prevention of dental caries as part of the control phase. After the patient’s caries status and caries risk have been determined, chemical, surgical, behavioural, mechanical, and dietary techniques may be used to improve host resistance and alter the oral flora.34 Chapter | 3 | Chapter 2 presents a detailed discussion of caries diagnosis, prevention, treatment, and control. Re-evaluation phase The re-evaluation phase allows time between the control and definitive phases for resolution of inflammation and healing. Initial treatment and pulpal responses are reevaluated during this phase as the relative effectiveness of control phase treatment may influence and modify the definitive phase treatment plan. This phase is used to reinforce home care habits and assess motivation for further treatment. Patients with an overall low-risk profile, who only require minor alterations in diet, behaviours, and exposure to remineralization agents, may not require a formal control phase/re-evaluation phase process. The treatment plan for these patients may start with a plan to definitively address immediate concerns while simultaneously implementing minor changes and reinforcing habits consistent with dental health. Definitive phase The patient enters the definitive phase of treatment only after the dentist reassesses initial efforts to control disease and, with the patient, determines the need for further care. This phase may include endodontic, periodontal, orthodontic, and surgical procedures. The patient’s active disease must be under control, and preventive efforts habitually established, before fixed or removable prosthodontic treatment. This phase is discussed in more detail in the section on interdisciplinary considerations in operative treatment planning. Maintenance (re-assessment and recare) phase The maintenance phase includes regular reassessment (synonyms include re-evaluation, periodic examinations) that may reveal the need for adjustments to prevent future breakdown, provide an opportunity to reinforce home care, and plan recare treatment steps where disease has returned. Examinations for reassessment most frequently occur as part of strategically planned (recall) appointments for biofilm removal (dental prophylaxis). The frequency of re-evaluation examinations depends, in large part, on the patient’s risk for dental disease. A patient with a low-risk profile may have longer intervals (e.g. 9–12 months) between recall visits. In contrast, patients at high-risk profile should be recalled and examined much more frequently (e.g. 3–4 months).