The BiteFX Blog for All Things Relating to Occlusion

The Triad Algorithm

Posted by Stuart Harman on Fri, Oct 11, 2013 @ 13:10 PM

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Dr. Michael Racich is the author of a three book Basic Rules series that explains the basic rules of Oral Rehabilitation, Occlusion and Facially Generated Treatment Planning, and authored the following article on his systematic treatment approach he describes as The Triad Algorithm.

Dealing with the whole person can be daunting at times but if approached in a coordinated, systematic manner the journey for all stakeholders can be rewarding, predictable, and harmonious. One such coordinated, systematic approach that allows us to treat the stomatognathic system gnathologically is what I like to call The Triad Algorithm in which we look into the art and science of dental therapy by first meeting the person, then the face, followed by the mouth and then finally the teeth (i.e. facially generated treatment planning).


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Let me explain The Triad Algorithm. In order to practice contemporary, gnathologic dentistry, the dental team must follow the principles of evidence-based dentistry. Evidence-based dentistry involves the blending of the published evidence with patient beliefs and values as well as those of the dental team. All three of these variables must be realized for evidence-based dentistry to be practiced. Looking at The Triad Algorithm we see that after the patient is introduced to our practice we explore the patient’s beliefs, values, wants (expectations) and needs; we decide whether they are compatible with our practice model; we explore the literature as needed to confirm the efficacy of any proposed treatment. As The Triad Algorithm shows, if any of these three evidence-based variables are not favourable then the dental team should stop and think, for to proceed would be pure folly. Stop means we need to either review what our motivations are, reconsider whether we want to proceed, re-relate or try to reconnect with our patient, release or terminate our relationship with our patient, or retrain in order to provide the care that has been requested. On the other hand, if the process of evidence-based dentistry has been successful with all three variables then the patient will give us their consent, an informed consent, to proceed. Without informed consent there is absolutely no justification to continue on with the patient-dental team relationship under any circumstances. Informed consent is the green light for the journey to begin ... and guess what, no difficult patients result as the dental team have clarified patient needs, wants, and real or imagined expectations.

Part Two of The Triad Algorithm is the A,B,C’s. The A, B, C’s of The Triad Algorithm involve pre (“A”) and post (“C”) care strategies while the actual treatment (“B”) is the 1,2,3’s.  Interestingly, it becomes readily apparent that the actual physical treatment (“B”), i.e. what the patient thought they presented for, is in reality the last item to be dealt with using The Triad Algorithm. Please also note that the management of the treatment provided over the years (“C”) and the preparation for care (“A”) are as equally important as the actual physical treatment (“B”).  Once again, if we are not satisfied with the pre and post treatment considerations then it is incumbent upon us to stop (review, reconsider, re-relate, release, retrain).

The last or third part of The Triad Algorithm is what I like to call the 1,2,3’s of Dentistry. The “1” is the starting point, the “2” is the anterior limits or parameter, and the “3” defines the finishing touches. Even though to this point the dental  team has worked through evidence-based dentistry , the patient has provided their informed consent , and the dental team is secure with their pre and post treatment (“A & C”) observations there is still one more opportunity to stop (review, reconsider, re-relate, release, retrain). For once we begin patient care we want it to proceed methodically and predictably (the 1,2,3’s of Dentistry) to everyone’s satisfaction, with each detail of care meticulously carried out. From the patient to the dental laboratory, all should be content. With successful treatment results comes increased team confidence and experience which then lends itself to improved evidence-based dentistry methodology. The cycle then repeats itself. The practice of dentistry then becomes more predictable with, stated once again, no “difficult” patients.

Author's Biography: Dr. Racich, a 1982 graduate from University of British Columbia, has a general dental practice emphasizing comprehensive restorative dentistry, prosthodontics and TMD/ orofacial pain. Dr. Racich is a member of many professional organizations and has lectured nationally and internationally on subjects relating to patient comfort, function and appearance. He is a Fellow of the Academy of General Dentistry and the American College of Dentists as well as a Diplomate of the American Board of Orofacial Pain and the International Congress of Oral Implantologists. Dr. Racich has published in peer-reviewed scientific journals such as the Journal of Prosthetic Dentistry and the Canadian Dental Journal and has authored the books: The Basic Rules of Oral Rehabilitation (2010), The Basic Rules of Occlusion (2012) and The Basic Rules of Facially Generated Treatment Planning (2013). Currently he mentors the didactic/clinical FOCUS Dental Education Continuum (study clubs, proprietary programs, coaching, 2nd opinions only).

  • To contact Dr. Racich directly, he can be reached at: and his website is
Oral Rehab Book Cover Occlusion Book Cover Facially Generated Book Cover

Tags: Guest Blogs, Treatment Planning

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