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 the clinical examination to establish the gingival phenotype are combined with assessment of the bone morphotype, commonly using CBCT imaging technology. Such analysis is critical to treatment planning, particularly for interdisciplinary dentofacial therapy (IDT) patients whose treatment often involves 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 the phenotype offers a more comprehensive way to guide planning at the foundational level and offers an updated approach for diagnosing and planning treatment for IDT patients. Being able to identify a patient with a seemingly intact periodontal phenotype that will become susceptible or deficient over time without 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.