Zwischen bedarfs- und bedürfnisorientierter Behandlungsplanung

Wo liegen die Grenzen?

Abstract

Clinical assessment and decision-making in dentistry are variable and shaped by uncertainty. Differences in diagnostic weighting, therapeutic concepts, and patient-related preferences can generate markedly divergent treatment plans even in comparable clinical situations. Guidelines provide orientation but do not ensure uniform implementation — particularly where medical goals intersect with esthetic and comfort-related objectives and purported claims of “quality”. 

Using a clinical case example, substantial differences in scope and costs between two treatment plans are presented: the first opinion proposed a multi-phase full-mouth rehabilitation (total treatment estimate CHF 74'409), whereas the second opinion pursued a stepwise, deliberately risk-oriented and tooth-preserving strategy. Independent third opinions from an academic setting likewise converged towards the latter approach. 

To contextualize this breadth of treatment options, a three-tier heuristic model was proposed that combines two levels: analytically, it categorizes options by their underlying rationale; normatively, it delineates a zone of increased ethical justification. (1) “Need” denotes indication-based, medically necessary care; (2) “Want” describes legitimate, preference-sensitive optimizations within acceptable boundaries; and (3) “Greed”, as a normative warning and boundary term, refers to situations in which treatment scope and costs are expanded beyond what can be supported by a sufficiently transparent incremental-benefit rationale. The model is not intended to classify proposals as “right” or “wrong”, but to enable comparable communication of benefit-risk-cost trade-offs, alternatives, irreversibility, and downstream consequences within shared decision-making.