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Every day in practice, two fundamentally different approaches to dentistry play out—often within the same office.

The first approach is what most of us were taught: identify the problem, apply the solution, move to the next patient. A crown needs replacing? Replace it. A tooth needs filling? Fill it. This approach seems logical, efficient, even professional.

Yet this same approach routinely produces failures that puzzle everyone involved. Perfect technical execution fails within months. Beautiful restorations deteriorate rapidly. Patients experience recurring problems despite “successful” treatment.

The second approach is rarer. It seems counterintuitive at first—sometimes even inefficient. Master clinicians spend time examining areas that appear unrelated to the chief complaint. They ask questions that seem irrelevant. They delay treatment to address issues patients didn’t even know existed.

But these “inefficiencies” create outcomes that appear almost magical. Restorations last decades. Patients report profound improvements beyond their original concerns. What looks like a single successful treatment is actually a systematic transformation.

The difference? The first approach treats teeth. The second approach treats systems.

This is the essence of principle-based dentistry—the ability to think in systems rather than symptoms, to see the macro pattern while executing at the micro level.

Most dentists treat teeth. Masters restore systems.

The Flawed Foundation: Why Most Treatment Plans Fail

Before diving into what works, let’s address what doesn’t. The failure rate of comprehensive treatment plans isn’t due to poor execution—it’s due to flawed thinking at the foundational level.

The most common failure pattern I’ve observed in reviewing hundreds of cases is what I call “Symptomatic Myopia”—the inability to see beyond immediate presenting problems to the underlying systemic patterns creating those problems.

Consider this scenario: A patient presents with worn anterior teeth and anterior crowding. The standard approach focuses on the symptoms:

• Crown the worn teeth
• Align the crowding
• Patient leaves “restored”

Six months later, the crowns are chipped, and the orthodontic result is relapsing.

The fundamental error? The treatment addressed symptoms without understanding the aetiology. The wear wasn’t random—it was the visible manifestation of TMD, bruxism, and possible airway compromise. The crowding wasn’t genetic—it was adaptive reorganisation in response to functional demands.

A systems-based approach would have recognised these symptoms as communication from the body about deeper dysfunction requiring different intervention entirely.

The Three Core Pillars: The Foundation of Systems Thinking

Every master clinician I’ve studied—whether Kois, Spear, Mahoney, Dawson, or Dickerson—ultimately returns to three fundamental principles:

1. Functional Harmony

The concept isn’t just about “balanced occlusion.” It’s about creating neuromuscular harmony where the joints, muscles, and teeth function as an integrated system rather than three competing entities.

The Functional Assessment Matrix:

• Temporal-Mandibular Joint Health: Not just absence of pain, but optimal loading patterns
• Neuromuscular Stability: Repeatable closure without muscle recruitment patterns
• Occlusal Stability: Tripod contacts in centric relation with minimal muscle activity
• Functional Range: Pain-free lateral and protrusive movements with appropriate guidance

This isn’t technical perfection—it’s biological harmony. The goal is creating an environment where the system can self-maintain rather than progressively destruct.

2. Aesthetic Balance

True aesthetic success isn’t about beautiful restorations—it’s about creating smile architecture that appears natural within the patient’s unique facial framework.

The Aesthetic Hierarchy:

• Facial Analysis: Golden proportions, facial height ratios, and soft tissue support
• Smile Design: Gingival zenith relationships, incisal edge positioning, and connector zones
• Microtexture: Surface characteristics that create age-appropriate light reflection
• Dynamic Movement: Natural lip movement and tooth display throughout function

The key insight: Aesthetic success requires understanding that teeth exist within a biological and mechanical context, not as isolated artistic elements.

3. Biological Health

This goes beyond “healthy gums and no decay.” It encompasses the creation of an oral environment that supports long-term systemic health and aging.

The Biological Foundation Elements:

• Microbiome Optimisation: Creating conditions that favour healthy bacterial populations
• Immune Response: Avoiding inflammatory triggers that cascade systemically
• Regenerative Capacity: Maintaining tissue architecture that supports self-repair
• Age-Related Changes: Planning for predictable biological changes over time

What matters isn’t perfection—it’s sustainability. We’re creating systems that remain healthy and functional as patients age, not just immediately after treatment.

The Treatment Planning Pyramid: Kois’ Revolutionary Framework

Dr. John Kois revolutionised modern dentistry by codifying what master clinicians instinctively understood: successful treatment requires a hierarchical approach where each level depends absolutely on the levels below it.

Level 1: Biological Foundation (The Base)

Periodontal Health and Structural Integrity

Before any other treatment considerations, the biological foundation must be established. This isn’t just about “healthy gums”—it’s about creating an environment where all subsequent treatment can thrive.

The Biological Assessment Protocol:

1. Tissue Phenotype Analysis: Thick vs. thin biotype determines approach to restorations
2. Keratinised Tissue Quality: Width and thickness affect long-term tissue stability
3. Bone Architecture: Three-dimensional support for teeth and restorations
4. Inflammatory Status: Not just probing depths, but tissue response patterns
5. Regenerative Potential: Patient’s ability to heal and maintain improvements

Critical Insight: Any treatment plan that doesn’t first establish biological health is building on quicksand. No matter how perfect your crowns or how beautiful your veneers, if the biological foundation isn’t sound, the case will eventually fail.

Level 2: Functional Architecture (The Body)

Occlusion and Neuromuscular Harmony

Once biological health is established, functional considerations guide all treatment decisions. This level determines how forces will be distributed throughout the system.

The Functional Analysis Framework:

1. Centric Relation Assessment: Repeatable, unstrained reference position when engineering a new bite position
2. Habitual Closure Evaluation: Slides, deflections, and prematurities
3. Lateral Guidance Examination: Group function vs. canine protection
4. Protrusive Assessment: Incisal guidance and posterior disclusion
5. Vertical Dimension Analysis: Support, aesthetics, and phonetics

The Power Insight: The occlusion you create today determines the maintenance requirements for the rest of the patient’s life. Get this wrong, and you create a lifetime of adjustments, remakes, and complications.

Level 3: Structural Considerations (The Framework)

Restorative Design and Implementation

With biology and function established, structural decisions follow established principles rather than arbitrary choices.

The Structural Decision Tree:

1. Material Selection: Based on force distribution and aesthetic requirements
2. Preparation Design: Dictated by biological and functional demands
3. Provisional Planning: Serving as test drives for the definitive treatment
4. Integration Strategy: How each restoration interfaces with the system

Key Understanding: At this level, technical execution matters enormously, but only within the context established by lower levels. Perfect margins on functionally compromised restorations guarantee failure.

Level 4: Aesthetic Expression (The Crown)

Smile Design and Restorative Artistry

The aesthetic level is where individual personality and preference express within the constraints of biology and function.

The Aesthetic Integration Protocol:

1. Patient Preference Analysis: Understanding desires within realistic parameters
2. Facial Framework Assessment: Working within natural proportions
3. Optical Properties Planning: How light affects perception
4. Age-Appropriate Characteristics: Avoiding the “denture look”
5. Maintenance Considerations: Creating sustainable beauty

Crucial Recognition: Aesthetics cannot violate biological or functional principles. When they do, the case appears beautiful initially but degrades predictably.

The Conformative vs. Reconstructive Decision: The Foundation of All Occlusal Treatment

The Critical First Choice

Before any technical execution, master clinicians make a fundamental decision that determines the entire approach: Will we conform to the existing occlusion or change it?

This isn’t a casual choice. It’s the most important decision in complex dentistry, with profound implications for function, aesthetics, and long-term stability.

Conformative Approach:

• Work within existing occlusal patterns
• Respect adapted neuromuscular patterns
• Maintain current vertical dimension
• Accept established guidance patterns

Reconstructive Approach:

• Change occlusal relationships
• Create new neuromuscular patterns
• Establish ideal functional patterns
• Use centric relation as the reference

The key insight: Conformative approach requires absolute precision within existing parameters. You can’t partially conform—either the new restoration perfectly fits the existing pattern, or it disrupts the entire system.

Reconstructive approach requires establishing a repeatable reference position (centric relation) and building from there. The joint position becomes the foundation for creating ideal occlusal relationships.

Centric Relation vs. Centric Occlusion: Why the Difference Matters

When changing occlusion, masters rely on centric relation as their reference because:

1. Repeatability: CR position can be reproduced accurately
2. Joint Health: Optimises TMJ loading
3. Muscle Harmony: Minimizes muscle involvement
4. Treatment Reference: Provides stable foundation for reconstruction

Centric occlusion (maximum intercuspation) represents adaptation. Centric relation represents ideal. When changing the bite, we must work from the ideal, not the adapted pattern.

The Aesthetic-Function Integration: Starting with What “Looks Right”

Master clinicians use what I call the “Aesthetic-First Protocol”—a counterintuitive approach that yields superior results.

The Protocol:

1. Establish Ideal Aesthetics First
   • Position incisal edges for optimal display
   • Create harmonious curve of Spee
   • Ensure proper incisal plane relationship
   • Establish ideal gingival architecture
2. Work Backwards to Function
   • Determine required vertical dimension
   • Calculate posterior build-up needs
   • Plan functional guidance patterns
   • Design protective posterior relationships

This approach recognises that “if it looks right, it usually is right” from both aesthetic and functional perspectives. Natural-appearing tooth positions typically coincide with optimal functional relationships.

Why This Works:

• Aesthetic proportions evolved for optimal function
• Visual harmony often indicates mechanical harmony
• Patient acceptance increases with aesthetic appeal
• Functional problems often cause aesthetic distortion

The key insight: Don’t compromise aesthetics to achieve arbitrary functional parameters. Instead, achieve aesthetics that naturally incorporate functional excellence.

Macro Level: Systems Perspective

The 30,000-Foot View

Before considering any single tooth, master clinicians assess the entire orofacial complex as an integrated system.

The Systems Assessment Matrix:

1. Airway Evaluation
   • Nasal breathing efficiency
   • Oral breathing compensation patterns
   • Sleep quality indicators
   • Pharyngeal space assessment
2. TMJ Analysis
   • Joint sounds and movement patterns
   • Loading distribution between joints
   • Muscle palpation and recruitment patterns
   • Range of motion assessment
3. Facial Support Analysis
   • Vertical dimension assessment
   • Lip support and thickness
   • Nasolabial fold analysis
   • Facial aging patterns
4. Occlusal Plane Evaluation
   • Curve of Spee analysis
   • Facial plane relationships
   • Posterior support adequacy
   • Anterior guidance compatibility

This macro perspective reveals patterns invisible at closer magnifications. A worn dentition might actually be compensation for airway compromise. Anterior crowding might be the only thing preventing TMD symptomatology.

Meso Level: Regional Integration

The 10,000-Foot View

This level focuses on how different oral regions interact and influence each other.

The Regional Analysis Framework:

1. Posterior Support Zones
   • Bilateral symmetry in support
   • Distribution of chewing load
   • Stability in lateral movements
   • Integration with TMJ function
2. Anterior Guidance Zone
   • Incisal guidance adequacy
   • Canine protection effectiveness
   • Anterior coupling with posteriors
   • Speech and aesthetic integration
3. Transition Zones
   • Premolar function integration
   • Force distribution patterns
   • Aesthetic blend regions
   • Maintenance access areas

At this level, decisions about regional treatment become clear. Should posteriors be replaced individually or as units? How will anterior changes affect posterior function? This meso perspective prevents the fragmentation that leads to long-term failure.

Micro Level: Individual Tooth Considerations

The 1,000-Foot View

Only after macro and meso analysis do we focus on individual teeth, and even then, within the context established at higher levels.

The Individual Tooth Protocol:

1. Biological Assessment
   • Endodontic status and prognosis
   • Restorative foundation adequacy
   • Root morphology considerations
   • Tissue health around the tooth
2. Functional Requirements
   • Force vectors during function
   • Guidance responsibilities
   • Stability requirements
   • Integration with arch form
3. Structural Needs
   • Restoration type selection
   • Preparation design optimisation
   • Material property matching
   • Longevity expectations
4. Aesthetic Integration
   • Individual characterisation
   • Biological width respect
   • Visual proportions
   • Soft tissue interaction

This macro-to-micro approach ensures that individual tooth decisions serve the greater system rather than compromising it.

The Diagnostic Hierarchy: Searching from Least to Most Invasive

Master clinicians follow a specific diagnostic sequence that reveals information systematically rather than jumping directly to obvious problems.

1. Airway Assessment First

The Foundation of All Function

Before examining joints, muscles, or teeth, assess breathing patterns and airway adequacy. Oral breathing, snoring, and sleep disturbances affect everything that follows.

Clinical Indicators:

• Mouth breathing at rest
• Narrowed maxilla or high-arched palate
• Enlarged tongue with scalloping
• Forward head posture
• Dark circles under eyes

When airway is compromised, every other “problem” may actually be adaptation to maintain breathing. Treating symptoms without addressing airway is like rearranging deck chairs on a sinking ship.

2. Joint Function Analysis

The Hinge of Oral Function

Once airway is assessed, examine TMJ health and loading patterns. Joints provide the stable platform for all muscle and tooth function.

Assessment Protocol:

• Palpation during movement
• Loading test responses
• Movement quality observation
• Range limitation patterns

Joint dysfunction forces muscular compensation, which creates dental wear patterns. Understanding joint health guides treatment sequencing.

3. Muscle Pattern Recognition

The Power Source of Function

With airway and joints assessed, examine muscle function and recruitment patterns. Muscles adapt to joint problems and create dental wear.

Evaluation Framework:

• Palpation for tenderness and hypertrophy
• Observation of movement patterns
• Assessment of muscle balance
• Recognition of compensation patterns

Muscle dysfunction creates the destructive forces that teeth must resist. Understanding these patterns guides occlusal design.

4. Occlusal Analysis

The Interface of Function

Only after understanding upper-level influences do we examine how teeth contact and function within the system.

Analysis Components:

• Centric relation to centric occlusion assessment
• Lateral and protrusive movement evaluation
• Guidance pattern analysis
• Force distribution observation

Teeth reflect what happens above them in the system. Reading these patterns correctly guides treatment direction.

5. Individual Tooth Evaluation

The End Result, Not the Cause

Finally, examine individual teeth within the context established by system-level analysis.

Individual Assessment:

• Structural integrity evaluation
• Endodontic status determination
• Restorative needs analysis
• Biological tissue health

Individual tooth problems usually result from system-level dysfunction. Treat the system, and many “tooth problems” resolve themselves.

Risk-Based vs. Reactive Dentistry: The Master’s Approach

The Four Risk Categories

Master clinicians categorise patients by risk profile rather than immediate needs, dramatically changing treatment approach and sequencing.

1. Periodontal Risk

• Bacterial profile and response patterns
• Genetic susceptibility markers
• Systemic inflammatory status
• Tissue phenotype and resilience

2. Biomechanical Risk

• Force generation and distribution patterns
• Joint loading tolerance
• Tissue repair and maintenance capacity
• Age-related changes trajectory

3. Functional Risk

• Neuromuscular coordination stability
• Sleep and airway adequacy
• Stress response patterns
• Behavioural factors affecting function

4. Aesthetic Risk

• Aging pattern predictions
• Tissue response characteristics
• Smile design sustainability
• Maintenance complexity

The Risk-Based Planning Matrix:

High-risk patients require different strategies than low-risk patients, even for similar presentations. A broken tooth in a high-risk patient might indicate immediate systematic intervention, while the same break in a low-risk patient might justify conservative monitoring.

This approach shifts from reactive crisis management to proactive system maintenance.

Case Types in the Global Approach: The Kois Classification System

Type 1 Cases: Localised Problems in Healthy Systems

Characteristics:

• Individual tooth or region issues
• Healthy surrounding system
• Minimal interdependence with other areas
• Predictable isolated treatment

Examples:

• Single crown on intact tooth
• Isolated implant in otherwise healthy arch
• Limited orthodontic correction

Treatment Approach:

• Focus on individual tooth restoration
• Maintain existing system harmony
• Minimal systemic intervention

Type 2 Cases: Worn Dentition with Adequate Function

Characteristics:

• Generalised wear with stable VD
• Functional adaptation present
• Adequate posterior support
• Stable neuromuscular patterns

Examples:

• Generalised attrition with stable function
• Erosion with maintained VD
• Moderate wear with adequate support

Treatment Approach:

• Restore at existing VD
• Maintain adapted function
• Protect established patterns

Type 3 Cases: Loss of Vertical Dimension

Characteristics:

• Collapsed posterior support
• Reduced facial height
• Altered facial proportions
• Compromised function

Examples:

• Multiple posterior tooth loss
• Severe wear with VD collapse
• Over-eruption with VD loss

Treatment Approach:

• Increase VD to restore function
• Establish posterior support first
• Create new functional patterns

Type 4 Cases: Compromised Esthetics

Characteristics:

• Functional system intact
• Anterior display problems
• Smile design issues
• Acceptable posterior function

Examples:

• Anterior crowding or spacing
• Intrinsic discolouration
• Proportional discrepancies

Treatment Approach:

• Maintain functional stability
• Focus on anterior refinement
• Preserve posterior harmony

Type 5 Cases: Complete System Breakdown

Characteristics:

• Multiple system failures
• Complex interdependencies
• Compromised biology, function, and aesthetics
• Requires full reconstruction

Examples:

• Advanced periodontitis with mobility
• Complete occlusal collapse
• Combined functional and aesthetic failure

Treatment Approach:

• Systematic reconstruction
• Establish biological foundation first
• Rebuild function before aesthetics
• Comprehensive team approach

The Mental Facebow: Creating the Master’s Perspective

Visualising the Articulated Mind

Master clinicians develop what I call the “mental facebow”—the ability to visualise and mentally manipulate the entire oral system as if it were mounted on an articulator.

The Mental Mounting Process:

1. Establish Reference Planes
   • Camper’s plane orientation
   • Occlusal plane relationships
   • Facial midline references
   • Vertical dimension assessment
2. Create Dynamic Visualisation
   • Mental movement simulation
   • Contact pattern prediction
   • Force vector analysis
   • Interference recognition
3. Project Treatment Outcomes
   • Sequential change visualisation
   • Long-term stability prediction
   • Maintenance requirement forecasting
   • Adaptation pattern anticipation

This mental capability develops through experience but can be accelerated through deliberate practice with treatment planning exercises.

The Reverse Engineering Protocol

Thinking Backwards from Ideal

Masters don’t just plan forward from current state—they work backwards from the ideal outcome, identifying necessary steps in reverse order.

The Reverse Planning Process:

1. Define Ideal End State
   • Biological health parameters
   • Functional harmony characteristics
   • Aesthetic achievement goals
   • Maintenance simplicity targets
2. Identify Final Steps
   • Last procedures required
   • Final adjustments needed
   • Verification protocols
   • Delivery sequence
3. Trace Prerequisites Backwards
   • What enables the final steps?
   • What must precede each element?
   • How do steps interconnect?
   • Where are critical dependencies?
4. Create Forward Timeline
   • Proper sequencing order
   • Healing periods required
   • Patient adaptation time
   • Progress verification points

This approach reveals dependencies and sequences invisible in forward planning alone.

Clinical Integration: From Theory to Practice

The Master’s Daily Routine

Information Gathering Sequence:

1. Initial Assessment
   • Medical history review
   • Chief complaint analysis
   • Airway observation
   • Facial analysis
2. Clinical Examination
   • TMJ palpation and movement
   • Muscle assessment
   • Occlusal analysis
   • Individual tooth evaluation
3. Documentation Protocol
   • Digital imaging sequence
   • Intraoral scanning
   • Radiographic assessment
   • Photography standards
4. Synthesis and Planning
   • Pattern recognition
   • Risk factor identification
   • Option development
   • Sequencing determination

Implementation Protocol: Developing Master-Level Thinking

The Three-Phase Mastery Development

Phase 1: Foundation Building (Months 1-6)

• Daily Practice: Analyse every case using the macro-meso-micro protocol
• Diagnostic Discipline: Force yourself to follow airway → joint → muscle → occlusion → teeth sequence every time
• Pattern Recognition: Document connections between different system levels and track patterns across cases
• Mental Mounting: Practice visualising cases three-dimensionally and simulating movements mentally

Phase 2: Systems Integration (Months 6-18)

• Risk Classification: Categorise every patient by risk type and adjust treatment approaches accordingly
• Case Type Mastery: Practice using Kois classification system and type-specific treatment approaches
• Reverse Planning: Weekly exercises in backward planning from ideal outcomes
• Conformative vs. Reconstructive Decisions: Practice making this critical decision with clear rationale for each case

Phase 3: Master-Level Application (Year 2+)

• Advanced Education: Attend systems-based education (Kois, Spear, Dawson Institute)
• Mentorship Networks: Connect with systems-thinking mentors and form study groups
• Teaching Others: Begin educating team and colleagues on systems thinking
• Outcome Tracking: Build comprehensive outcome tracking systems to verify approach effectiveness

Essential Daily Habits for Systems Thinking

1. Always Start with Aesthetics: Position incisal edges and curve of Spee first, then work backwards to function
2. Question Every “Obvious” Problem: Ask “What system created this symptom?”
3. Use the Mental Facebow: Visualise every case mounted and in motion
4. Apply the Conformative/Reconstructive Framework: Make this decision explicitly for every case
5. Think in Time Scales: Consider 5-year, 10-year, and 20-year outcomes for every decision

This systematic development transforms treatment planning from reactive problem-solving to proactive system optimisation.

Your Master’s Journey Begins Now

The difference between good dentists and masters isn’t talent, luck, or even initial training. It’s the commitment to see beyond symptoms to systems, to think beyond teeth to the whole person.

This isn’t abstract philosophy—it’s practical wisdom that transforms how you practice dentistry. Every case becomes a system to understand rather than a problem to fix. Every patient becomes an integrated whole rather than a collection of teeth.

The principles outlined here represent decades of distilled wisdom from the greatest minds in dentistry. They offer a path from reactive dentistry to proactive system management, from fixing problems to creating health.

Your journey to master-level thinking starts with your next patient. Will you see just teeth, or will you see the system?

Your Next Steps:

• Mind Over Matter Manual: Download the framework I use to present and close high-value treatment without pressure, persuasion, or second-guessing.​
• Weekly Mastery Concepts: Join my newsletter for advanced treatment planning insights delivered every Saturday—content designed for serious practitioners.
• Direct Implementation Support: DM me on Instagram @waleedarshadd with your complex cases—I personally review and respond to practitioners showing systems thinking application.
• Intensive Mentorship: Book a strategic consultation to discuss joining my elite mentorship program—where we work together to elevate your thinking to master level. Limited spots available for practitioners ready for transformation.

Most dentists will continue treating teeth. A few will choose to restore lives by thinking in systems.

Which will you be?