Rapid Efficient Treatment Planning (RETP)

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Rapid Efficient Treatment Planning (RETP) article

Oct, 2026
Dr Michael Frazis, BDS, FICOI, FASID. Global Director of Education, RipeGlobal

Start With the Goal, Not the Procedure: A Simpler Way to Plan and Present Treatment

Most treatment plans that stall aren’t clinically wrong. They were just built in the wrong order. Dr Michael Frazis shares the three-step structure he teaches dentists for planning any case, from a single tooth to a full rehabilitation, how to step down options without abandoning the ideal and what the rest of the team can do to keep a plan moving.

Most stalled plans are built in the wrong order

A treatment plan can be clinically sound and still be hard to present.

You’ve done a proper exam, taken photos and checked the bite. You can see the heavily restored molar with recurrent decay and a fractured cusp, and you’re already weighing up onlay versus crown. The patient is sitting there thinking, “But it doesn’t even hurt.” They nod, take the quote home, and you don’t hear from them again.

It’s tempting to blame the fee. Sometimes that’s fair. More often, though, the problem is the order the plan was built in. Dentists are trained to think in procedures: an onlay here, a crown there, an implant for the gap. Patients don’t think that way. They think about chewing on that side again, smiling in photos, or not having another tooth break on holiday.

Build the plan procedure first and the conversation starts with a list of treatments and a number. Build it goal first and it starts with what the patient wants, and the dentistry turns up as the way to get there.

Plan in three steps: goal, strategy, procedures

The structure I teach is the same for a single tooth or a full rehabilitation. It has three steps, and you can remember them as three questions: how should it look, how do we make it fit, and how do we make it last?

  1. Goal (look). Before you suggest anything, find out what the patient wants their mouth to look and feel like. “What worries you most?” or “What would you like to change first?” will tell you more than any list of options. Then stop talking. Hold the silence a few seconds longer than feels natural; that’s usually when people tell you what actually matters to them. It’s worth checking what “better” means to this particular person, too. Some want whiter teeth and wouldn’t change the shape for anything. Others hate the shape and couldn’t care less about the colour.
  2. Strategy (fit). Now work out the path. Think like an architect: foundations, then walls, then finishes. What has to happen now, and what can wait? Do teeth need to be moved, reduced or built up? Does the plan fit their bite, their budget and the rest of their life? Sequencing is where patients get lost, so give each step a reason they could repeat back to you, for example: “We need to settle the gums down first, because the crowns will be far more predictable once the tissue is healthy.”
  3. Procedures (last). Only now do you pick treatments and materials, choosing the ones that serve the strategy and will hold up to everyday chewing and grinding. This is also where longevity belongs in the conversation. A restoration that lasts is value, not just cost.

If you’re stuck on what to recommend, it’s usually because step one isn’t finished. Ask more questions until the answer is obvious.

When the ideal doesn’t fit: step down, don’t give up

Start with the ideal plan and compromise from there, with reasons. Don’t start with the compromise. A plan that begins low has nowhere to go.

When cost or complexity gets in the way, step down through a “waterfall” of options, each of which still moves the patient forward. For someone with a worn dentition it might run like this:

  1. Comprehensive ceramic rehabilitation.
  2. The same plan, spread over a payment plan.
  3. Ceramic where it matters most, resin elsewhere.
  4. Good-quality resin throughout.
  5. Staged resin treatment, or a Dahl approach.
  6. A few resin restorations and a night guard to stabilise things until they’re ready for more.

Notice that the payment plan comes before any change to materials or treatment. And none of these steps is a failure. Patients can climb back up later when their circumstances change. “We can still move forward. Here’s what that looks like for now” does a lot of work in that conversation.

Present the plan in three sentences

By the time you sit down to present, most of the hard work should already be done.

Narrow the options first. Two or three choices you’d be proud to deliver is plenty; patients want guidance, not a menu. Think travel agent planning a safe route, not someone handing over a road atlas.

Then say it in plain English, in three sentences or fewer. Compare “The tooth has insufficient remaining structure and requires cuspal coverage” with “The tooth has lost a lot of its natural structure, so a filling won’t protect it well enough. We need to cover and support the weak parts.” For a bigger case: “You’ve lost some height in your bite and you’ve got a few holes. Let’s fix the holes first to stabilise things. Then we’ll plan how to rebuild your bite in ceramic over time.”

Tie it back to what they told you: “You said keeping this tooth was the main thing. This option gives us the best chance of doing that.”

When the fee comes up, give a range rather than one number, say what will narrow it, and offer payment options without apologising. If naming the fee makes you uncomfortable, that’s often a sign you’re not fully convinced by the plan yet. Go back to step one.

The whole team keeps the plan moving

Plans don’t usually stall in the surgery. They stall at the front desk, in the car park, and in the quiet week after the appointment. The same thinking applies to everyone the patient talks to.

Start with a shared goal. If the dentist notes the patient’s goal in their own words in the handover (“wants to chew on the left again”), reception, nurses and the treatment coordinator can all talk about the same outcome instead of a string of item numbers. Front desk staff shouldn’t have to re-present the plan; they should describe the first phase the way the dentist did. A one-page summary of the goal, the first step and the overall direction gives the patient something to explain at home.

Whoever handles fees should work the same way the dentist does: ranges, what narrows them, a health fund estimate where it helps, and payment options offered calmly. Hesitation reads as doubt.

Try not to let anyone leave with an open plan and nothing booked. It doesn’t have to be the whole case. A first phase, a records appointment or a review is enough to keep momentum.

And treat “I’ll think about it” as a question rather than a no. It often means the patient is nervous or hasn’t quite understood the plan. A follow-up call a few days later keeps the door open. Nurses and reception often hear the real worry, whether it’s cost, time off work or needles, so make sure that reaches the dentist before the next visit.

Five things to try this week

  • Ask one goal question before you mention any procedure: “What would you like your mouth to look and feel like?”
  • Once you’ve asked, wait. Longer than feels comfortable.
  • Write the plan in three sentences before you present it and cut the options to two or three.
  • If cost is the barrier, step down the waterfall: payment options first, then materials, then staging.
  • Don’t let a patient with an open plan leave without a booked next step or a follow-up call in the diary.

About the author

Dr Michael Frazis (BDS, FICOI, FASID) is a general dentist in Adelaide and Global Director of Education at RipeGlobal, where he leads a team of more than 50 clinical educators. He has presented RipeGlobal’s Rapid Efficient Treatment Planning course in Australia, New Zealand and the United States.

About RipeGlobal

RipeGlobal trains general dentists to perform advanced restorative, implant and orthodontic procedures through simulation-based learning, structured repetition and live mentoring. Its online library holds more than 700 hours of lectures, 400 of them CPD-accredited, alongside EduQual Level 7 diplomas in implant and restorative dentistry.

The frameworks in this article come from Rapid Efficient Treatment Planning (RETP), RipeGlobal’s two-day, case-based workshop on planning and presenting treatment. The next Australian course runs in Sydney on 19 to 20 March 2027, presented by Dr Michael Frazis.

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