Phenotype Driven Treatment Planning for the Interdisciplinary Patient. Part I. Definition, Diagnosis and Treatment Options.

Abstract

A recent update in periodontal terminology includes a shift from the term “biotype”, replacing it with the term “phenotype”. Periodontal phenotype evaluation and diagnosis is possible when findings from both the clinical examination to establish the gingival phenotype are combined with assessment of the bone morphotype, commonly using Cone Bean Computed Tomography (CBCT) imaging technology. Such analysis is critical to treatment planning, particularly for interdisciplinary dentofacial therapy patients (IDT) whose treatment can often involve clinical interventions such as surgery, orthodontic tooth movement, and/or extensive restorative treatment. This paper highlights how this shift in terminology can also be considered an evolution of thought process, as phenotype offers a more comprehensive way to guide our planning at the foundational level, and offers an updated approach for diagnosing and treatment planning IDT patients. Being able to identify a patient with a seemingly intact periodontal phenotype that will become susceptible or deficient with planned intervention is critical. Until now, there has been no established protocol recommended for risk assessment regarding iatrogenic sequelae on the periodontium involving tooth movement. A systematic approach, Phenotype Driven Treatment Planning (PDTP), is introduced here, and an updated outcome of treatment termed optimized periodontal phenotype is suggested.