Consultations, Treatment Strategies and Solutions

The way LCIAD works may be quite different from what you are used to.

Our objective is to provide you with a strategy for treatment and aftercare designed to limit the requirements for extensive dental work in the future as much as possible. This requires a considerable amount of planning in your absence and may require more than one consultation visit to ensure that we have collected all of the information I require to give you the best advice.

Our stages of consultation, planning, treatment and aftercare are broadly:

  1. Listen, observe and collect information
  2. Make a diagnosis
  3. Plan the ideal treatment
  4. Present the ideal treatment and any viable alternatives in writing with realistic estimates and payment options
  5. Carry out treatment to the highest standard with documentation
  6. Arrange a maintenance programme

1.    Listen, observed and collect information
Before you even attend the practice, we will do our best to collect as much information about you as possible through our New Patient Medical History and Questionnaire form. This enables us to prepare for your first consultation visit so that it is as productive as possible.

Whilst we carry out all regular dental treatments, LCIAD is developed mainly towards treating patients with extensive problems with their teeth. Our group of experienced clinicians all have their own strengths and often we will work together on different aspects of your care to provide the ideal outcome for you. LCIAD is know for its systematic approach to dealing with complex issues for patients who have often had piecemeal dentistry and continuing problems throughout their lives.

Often such patients are apprehensive, sceptical and possibly unaware of the options modern dentistry has to offer them. Often they may have a number of unspoken reservations about the prospect of embarking on extensive dental treatment, especially if previous treatment has failed. We are used to this! Some may be handicapped by their dental condition to the extent that it may prevent them from enjoying their life.

It is always our aim to carry out excellent dental work, but our team would also like to get to know the rest of you as well. Good communication is something we value highly and we would like you to be forthcoming as to your expectations and apprehensions from the start. 

All patients that are new to LCIAD need to have a New Patient Consultation, even if it is for a something you may feel is minor and does not require a full hour. We are professionally obliged to examine a new patient fully and it would be unethical of us to concentrate only on one aspect of your dental health. Patients with more complex dental problems also often require a Full Case Assessment in addition to the New Patient Consultation.

Please follow the links to see what each involves.

2.    Make a diagnosis
It would not be acceptable for a medical doctor to treat a disease without diagnosing the underlying problem. Similarly, weI also need to make a diagnosis of all of your dental and oral problems before we recommend treatment. Your dental surgeon will normally spend between 2 to 4 hours in your absence collating information from your New Patient Consultation and (where applicable) Full Case Assessment to make a diagnosis before formulating a treatment plan taking into account your unique wishes and personal circumstances. This is normally done in the peace and quiet of their own time at home at weekends!

3.    Plan the ideal treatment
It is necessary for us to plan not only what we want to achieve as an end result, but how we are to get there, tooth by tooth, area by area. This logistical, customised flowchart of treatment takes literally hours to prepare, especially where a course of treatment is extensive. It is really this aspect of your consultation and planning carried out in your absence that ensures that your whole programme of treatment is seamless. 

We will do our utmost to ensure that your teeth are as comfortable and stable as possible at all times during your course of treatment. This means planning step-by-step how provisional restorations will be supported, the timings of any tissue or bone augmentation and implant placement surgery, hygiene maintenance during long courses of treatment, alternative scenarios where the prognosis of one or more teeth is uncertain, and a myriad of other considerations including your availability and attitudes towards treatment that make up a complex chain of decisions. This is quite possibly the single most important part of the consultation and treatment strategy process. Excellence is never an accident but the result of a series of correct decisions based on experience.

4.    Present the ideal treatment and any viable alternatives in writing
We will send a comprehensive written dental report based on the above plan to you to you normally within 10 working days with an estimate of fees and a list of payment choices. It is our principle to recommend the ideal approach in every case, based on our consultations and your wishes.

If there are alternatives to treatment, we will discuss the relative advantages and disadvantages of each with you at your consultation and include them for reference in your treatment plan. If you wish to discuss anything further relating to the report, we will normally invite you back for a  complementary discussion appointment for you to be able to ask any questions relating to your plan, face to face, after you have received it.

5.    Carry out the treatment to the highest standard
Treatment normally follows a pattern that can be broadly outlined as below. Of course, not every step will be applicable to every patient.

  • Disease control and operative investigation of individual teeth. Old dental work and decay are removed, gum disease is treated, hopeless teeth are removed, infected teeth are root canal treated and a thorough hygiene program is commenced that will continue throughout treatment and after treatment completion. 
  • Stabilisation and temporisation. The foundations are laid for future work such that all remaining teeth are rendered healthy with stable fillings or core restorations. Temporary crowns and bridges are made to replace old crowns and bridges to the existing bite. A bite guard (also called a deprogramming appliance) to stabilise the bite may be prescribed at this stage if there is an unstable bite or if there are are jaw joint or muscle pain problems. 
  • Provisionalisation, refinement and reassessment. The temporary crowns and bridges are replaced with provisional crowns and laboratory-made metal-strengthened bridges to the new bite design where applicable. Provisionals may need to last for 18 months in some cases and are made to be aesthetic and durable. 
  • Surgery. Procedures such as such as bone augmentation, implant placement or gum surgery is carried out with full 24 hour aftercare and provisionals refined and replaced at each stage to maintain function and appearance. 
  • Provisional crowns are further refined and reassessed for comfort, appearance and function. The shapes and edges of prepared teeth are refined and existing provisional crowns are revised to new healed gum lines and tissue contours after any surgery. Individual teeth are reassessed for stability. Bite stability and comfort, appearance and function are checked and revised as necessary.
  •  Impressions and bite records for laboratory work are taken and  consultations arranged with laboratory technicians for selection of  ideal tooth shapes, shades and customisation. We use a very experienced laboratory which regualrly attends for consultations with our patients to allow personalised care with an experienced technician at all times. 
  • Try in, customisation and fitting of laboratory work. This may require several visits to ensure best results. I normally complete the upper arch before the lower. The upper arch is fixed in space and sets the plane and correct tooth positions of the bite. The lower arch is then completed against the upper arch. This also allows my technicians to achieve maximum accuracy. 
  • Final review, X-rays, adjustments, documentation and sign off. The case is completed and commencement of guarantee date set. 
  • Maintenance and follow-up programme.  One year of hygiene visits commences to ensure work is kept clean from the start. I will review you at six months, one year and then each subsequent year as a minimum, even if you have another dental surgeon. These examinations will be chargeable as existing patient checkups each year. Implants are normally x-rayed at 1,2,3 and five years and thereafter as recommended.

    It should be understood that this level of dental care is concerned with you as an individual and we will be as accommodating as possible to your personal timetable and wishes and sensitive to your concerns throughout.

    It is always our aim to ensure that your level of discomfort is minimised both during and after treatment. with excellent after-care and all required medication and sundries provided by the practice.

    We carry out all of our dentistry under magnification and document it photographically throughout. For extensive courses of treatment, it is normally necessary to book full-day appointments to allow us to carry out the work at the correct pace and complete it within a reasonable timeframe.

    Every item of dentistry is handmade and takes time to do well. We cannot rush work and plan for it to be as time- and effort-efficient as possible. Accuracy and precision whilst respecting biology are very important.

    It is important to all of us that you are comfortable (both physically and emotionally) during your treatment and that you feel at home at the practice. It is nice to see that many of our patients fall asleep during treatment!

6.   Arrange a maintenance programme
We will normally arrange for regular visits for you to see our hygienist during treatment as part of your plan. Hygiene visits during treatment are part of your initial treatment to enusre you get into good habits. It is imperative that you are able to maintain excellent levels of hygiene around your natural teeth and dental work . We strongly advise that all of my patients attend a maintenance programme with my hygienists at least every three months and sometimes even monthly if maintenance of oral hygiene is particularly difficult or of critical importance in patients that are susceptible to gum disease. Please see our Oral hygiene, maintenance and guarantees page.


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