What a digital treatment plan should include

A digital treatment plan is a clinical document, not a picture. It is the thing you review, the thing you approve, and the thing that will be read back months later when a case is not going as expected. This is what a complete one contains, written so it can be used as a checklist against any supplier, including this one.

The models

• The initial situation as scanned, so you can see what the plan started from.
• The final setup for each arch, viewable from every direction.
• The arches articulated in the recorded bite at the final stage.
• Every intermediate stage, steppable one at a time rather than only as an animation.

Being able to stop on a stage matters more than a smooth animation. Most of the problems worth catching — a collision, a tooth that jumps, an interference appearing mid-sequence — are visible on a single frame and invisible at speed.

The movement table

A figure per tooth for each type of movement: mesiodistal and buccolingual translation in millimetres, rotation, tipping and torque in degrees, intrusion and extrusion in millimetres. Descriptions such as "minor derotation" are not a substitute. The table is what makes the plan reviewable, comparable between versions, and auditable afterwards.

It should be complete, including the teeth that barely move. A table listing only the teeth with significant movement hides exactly the information you need in order to notice that a molar you asked to hold still is being carried a millimetre mesially.

The attachment list

Tooth number, attachment type, the surface it sits on, and the stage at which it is bonded and, where relevant, removed. It should be readable at the chair without opening the 3D viewer, because that is where it will be used. Where an attachment is placed for anchorage rather than to move its own tooth, saying so helps whoever reviews the case later.

The IPR schedule

Each reduction as a contact, an amount and the stage at which it is performed, with totals per quadrant and per arch. The totals matter: individually reasonable amounts across many contacts can add up to more enamel than a doctor intended to remove, and only a total makes that visible at a glance.

The staging summary

• The number of stages for each arch, stated separately.
• Which stages are passive, if either arch was padded to keep the two in step.
• The per-stage movement limits the plan was built to.
• Any overcorrection applied, on which teeth and how much.

The last two are the ones most often left out and the most useful when a case underperforms. Knowing the limits a plan was built to tells you whether a case that is falling behind was staged aggressively or conservatively, which points to quite different corrections.

Assumptions and limitations

A plan should say what it did not know. Whether roots were estimated from crown morphology or taken from a CBCT. Whether the bite scan registered cleanly or was adjusted. Which instruction could not be met in full and what was done instead. Any region where the scan was incomplete and the model was interpolated. None of this is an admission of weakness; it is the difference between a document you can rely on and one you have to second-guess.

Equally, a plan should not contain things it cannot support: predictions of biological response, guarantees about tracking, or a promise about the number of refinements. A staged simulation shows what the plan intends, not what the tissues will do.

Versioning and the audit trail

Every revision should exist as its own version, with the earlier ones intact and the comments that produced each change attached to it. You should be able to see who asked for what, when, and which version was approved by whom. A plan delivered as a single file that gets replaced each round has no history, and a case with no history cannot be explained later.

What is delivered on approval

• Per-stage models for each arch, in an agreed format.
• Attachment geometry, in a form the laboratory can use for template fabrication.
• The IPR schedule and the movement table in a printable form for the clinical record.
• A reference tying the production files to the exact approved version.

Agree the formats before the first case, particularly if a laboratory is fabricating. Formats are a routine detail until a case is approved and the files cannot be opened by the machine that has to print them.

How the plan is presented

Presentation is not decoration. A plan you can open in a browser, on a tablet between patients, without installing software or downloading a viewer, gets reviewed properly more often than one that arrives as an archive and a PDF. The tables should be readable without the 3D model, because the chairside use of an attachment list and an IPR schedule happens away from the computer. And comments should attach to a tooth or a stage rather than sitting in an email thread, so that six months later the reason for a change is still next to the change.

Using this as a checklist

Not every item is required on every case; a simple alignment case does not need a CBCT-derived root position. But each absent item should be absent for a reason you can name. If you cannot get a movement table, cannot see intermediate stages, or cannot retrieve a previous version, you are being asked to approve something you cannot inspect, and approval is the one part of this workflow that is yours alone.