31 Fixed Diagnostics Appointment

1. Patient Check-In & Pre-Clinical Review 

• Print patient information and workflow worksheet
• Set up materials :
  • Screening tray, barriers, air water + suction tip, side counter covers, bite registration + dispensing gun + tips, alginate, measuring cup, alginate mixing bowl, spatula, stock trays, tray adhesive, clear plastic bags x 2, disinfectant spray, facebow materials (see image), #15 blade + handle to trim facebow impression
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• Verify patient identity and confirm appointment purpose.

• Review medical history

• Update medications, allergies, and any systemic conditions.

• Take and record blood pressure.

• Review treatment plan and consent

• • Ensure both are signed and plan to complete during this appointment if not

FACULTY CHECK 

2. Chief Complaint & Clinical History 

• Ask patient about symptoms related to the tooth:

• Pain, sensitivity (cold/hot/bite), previous treatment, esthetic concerns.

• Document the patient’s words as the Chief Complaint (CC).

3. Radiographic Evaluation 

• Review existing radiographs (PA and bitewings) for:

• • Decay, periapical pathology, existing restorations, previous RCT, cracks, bone levels.

• Take new periapical radiograph if: (D0220)

• • Image is not diagnostic or outdated (>6 months).

• • Additional diagnostic detail is needed to diagnose tooth of interest

• Take new Bitewing if:
  • Considering Clinical Crown Lengthening
  • D3 Crown Lengthening Policy 2018

4. Clinical Examination + Occlusal Analysis 

• Visual exam: Check for:

• • Fractures, decay, existing restoration defects, staining, recurrent decay.

• • Palpation and percussion: Rule out symptomatic apical pathology.

• • Pulp testing: Cold or EPT if pulp vitality is uncertain or not tested previously

• • Periodontal evaluation: Probing depths, mobility, furcation, and bone support around tooth

• Determine the diagnosis (e.g., fractured cusp, large defective restoration, etc.).

• Assess whether the tooth is restorable based on:

• • Ferrule presence

• • Remaining tooth structure

• • Endodontic status

• • Periodontal stability

• Determine if a core build-up or post and core will be required.
  • Guidelines_Foundations (1)
  • REFER TO OVERVIEW: Click for Background on Foundations/Posts 

• Occlusal analysis form: POWERPOINT

7. Diagnostic Records  

• Take pre-op photographs for esthetics or lab communication.
• Take bite registration as needed for articulation.
• Make facebow transfer record
  • FACEBOW PROCEDURE REVIEW PPT

FACULTY CHECK BITE REGISTRATION AND FACEBOW TRANSFER

• Make diagnostic alginate impressions
  • Alginates will distort, be sure to place in clear bag with moist paper towel after making impression
  • SIM REVIEW PPT: Alginate impressions and diagnostic casts

*Disinfect all clinical impressions + materials before taking to the lab* 

FACULTY CHECK ALGINATES 

8. Shade Selection (if time)  

• Select shade using clean, hydrated teeth in natural light.
• Confirm shade with patient and document selection in note

9. Business Office + Scheduling

• Confirm the patient understands down payment and pre-authorization requirements
• Walk patient to business office to review finances
• Walk patient to schedule with PROS clerks
  • Scheduling arrangements and slip completed together with patient PRIOR to walking patient to clerks