PROSTHODONTICS - American College of Prosthodontists

100 Parameters of Care Tupac et alb. Failure to manage or eliminate clinical conditionc. Need for further specialty referralSelected ReferencesLiterature references for the Adjunctive Therapies Parameter cover all areas of dentistry and would betoo extensive to list. Members are encouraged to be conversant with the literature for each and everyprocedure attempted.Preface14) Terminal Dentition ParameterTerminal dentition describes a condition in which the teeth are insufficient to maintain function, andthe arch, as a whole, will transition to the edentulous state. The etiology might be periodontal disease,caries, trauma, inadequate number of remaining teeth to maintain function, prosthodontic comfort,and/or patient desires. Transition to complete edentulism should only be considered when the patientis fully informed of all variables (e.g., prognosis of teeth, chance of success measured against longevityof treatment) and consequences, which affect the value of treatment. Patient desires and expectationsmust be considered in conjunction with the professional knowledge and judgment of the prosthodontist.The decision to remove one or more teeth has a multi-factorial rationale ranging from patientpreferences, cost, prosthetic need, tissue preservation, reduction of infection/disease, medical necessity,and inadequate restorative prognosis. Since removal of a tooth/teeth is an irreversible, permanent act,the decision process must include a rigorous review of the myriad results of such treatment both inthe short term and the long term. Patient expectations must be balanced with the realities of toothremoval including the ongoing costs of long-term prosthodontic rehabilitation and maintenance, as wellas reduction in overall function depending on the prosthodontic treatment anticipated. Proper imagingrecords are critical in establishing an accurate prognosis based on the presenting anatomic factors andpatient expectations since all information will be lost after extraction unless previously recorded.General Criteria and StandardsInformed Consent: All prosthodontic procedures should be preceded by the patient’s consent. Informedconsent is obtained after the patient has been informed of the indications for the procedure(s), goalsof treatment, the known benefits and risks of the procedure(s), the factor(s) that may affect the knownrisks and complications, the treatment options, the need for active maintenance by the patient, the needfor future replacements and revisions, and the favorable outcome.Documentation: Parameters of care for prosthodontic procedures include documentation of objectivefindings, diagnosis, and patient management intervention.Coding and NomenclatureDiagnostic and procedural codes have been included in the ACP Parameters of Care only for generalguidance. The codes listed may not be all-inclusive or represent the most current or specific choices. Theinclusion of codes is not meant to supplant the use of current coding books or to relieve practitionersof their obligation to remain current in diagnostic and procedural coding. The ACP Committee onParameters of Care and Committee on Nomenclature do not endorse the use of this document as acoding manual.The diagnostic and procedural codes listed throughout this section may not be all-inclusive and shouldserve only as practice guidelines. ICD-9-CM (International Classification of Diseases, Ninth Revision, ClinicalModification) diagnostic codes may change yearly and must be reviewed and updated annually to ensureaccuracy. Specific diagnoses must be obtained from a current, recognized ICD-9-CM code source and2010 CDEL Re-recognition of the Specialty Report 140 of 279