4 diagnoses · 5 CORE questions · 6 tools (Robbins & Rouse, 2016)
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Global Diagnosis is a treatment-planning system from J. William Robbins and Jeffrey S. Rouse. It builds on facially generated treatment planning, which starts from where the incisal edges belong in the face. The authors found that edges can be in the right place and the result still fail, because the gingival levels or the smile frame are wrong.
So the system starts from one question: why are the gingival levels where they are? Once the cause is named, only a few treatments fit it. In the authors' words, the diagnosis leads to the treatment plan. Pulpal, periodontal and occlusal findings still matter, but as "regional" diagnoses that adjust the plan rather than set it.
The Exam tab follows the GAD form from the face inward. Fill it in at the chair in this order. Any field can stay blank; the read-out on the right only uses what you enter.
Set up. Seat the patient upright in natural head position, ideally standing for the face and midline views. Have a digital caliper or millimeter ruler, a periodontal probe and an explorer.
Patient. Enter sex and age. The lip and display norms depend on both. The lip length norm rises 1 mm for each full decade after 40 (+1 mm from age 50); the Exam tab shows the adjusted range.
Q1 Face. With lips and teeth slightly apart, measure the middle third (glabella to subnasale) and lower third (subnasale to menton). Add the Angle class, and from the profile, how far each lip sits behind the nose–chin E-line.
Q2 Lip. In repose, measure lip length at the midline and how much central incisor shows. If the lip covers the edge, record a negative number. Then ask the patient to laugh; "smile" usually gets a clenched grimace. Record gingival display above the margins, and measure mobility directly if you can.
Q3 Gingival line. Look at the line through the canine and central gingival margins against the horizon: parallel, concave or canted. To judge the incisal plane, stretch the upper lip level with your fingers and use it as the horizon.
Q4–5 Teeth. Measure crown length on #5–#12. On teeth that measure short, also record the width and feel for the CEJ with an explorer. A CEJ you can't feel on a short tooth means altered passive eruption.
Smile frame and context. Midline, wear, buccal corridors and the rest of the form enrich the note. Mark whether orthodontics or anterior restorations are planned; that unlocks the sequencing advice.
Copy the note. Press Copy note and paste it into the chart or case presentation. Press Clear form before the next patient. Nothing is saved, so refreshing the page erases everything.
Each question shows Normal Outside norm or Not recorded. A diagnosis appears as soon as a measurement triggers it, even with other questions still blank.
One card per cause. The small label gives the family, the line under the title shows the measurement that triggered it, and the chips list the primary and secondary treatments from the book.
1 graft · 2 crown lengthening · 3 intrusion · 4 extrusion · 5 surgery · 6 plastics. R restorative, O orthodontics, E education, exercises or appliance.
Sequencing appears when orthodontics or restorations are planned, or when there is more than one diagnosis. Other findings are not global diagnoses but still belong in the plan: midline, W:L ratio, wear, an aged smile.
Several diagnoses at once is normal, and it's the point: a gummy smile often has more than one cause, and each cause needs its own treatment. No global diagnosis means the gingival levels are explained by normal anatomy. Incomplete means fewer than three questions are answered and nothing has triggered a diagnosis yet.
How to read it: the 5 mm of gingival display has four contributors. Crown lengthening corrects only the altered passive eruption. The skeletal excess needs a Le Fort I impaction, or Botox if she declines surgery. Measure lip mobility directly before deciding on Botox for the lip.
This is case EX-10 of 12. The other fictional cases are in the Load a practice case menu at the bottom of the Exam tab. Load one, work out the diagnoses yourself, then check the panel.
Diagnoses and treatments follow chapter 3 of the book; sequencing follows chapter 11. The book gives no tolerance for the 1:1 face ratio, so the ±5% is this tool's.