Information Resources Sample Cosmetic Dentistry Treatment Plan
The following treatment plan has three key areas (Report of Findings, Treatment Planning Worksheet and Financial Arrangements) that you will be presented with by your cosmetic dentist. Each area should be carefully reviewed with your dentist, and you should ensure that any and all questions you have are answered to your complete understanding.
Jeffrey S. Cummings, DMD
Waltham, Massachusetts
REPORT OF FINDINGS
Analysis For (patient name) Date ___________
1. Full Mouth X-Ray
2. Panoramic Radiographs
3. Periodontal Charting
4. Oral Exam of Existing Restorations
5. Occlusal Analysis
6. Study Models
7. Photographic Series
8. Preview Models
The Following Risk Factors Were Noted:
1. ____________________________
2. ____________________________
3. ____________________________
4. ____________________________
5. ____________________________
6. ____________________________
7. ____________________________
8. ____________________________
Problems:
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