Full Mouth Reconstruction: The Pathway to Success

A full mouth reconstruction poses a significant challenge in dentistry, requiring both the clinician and dental lab to collaborate. It is crucial in restoring functional harmony, pulpal health, esthetics, and safeguarding the dentition from additional harm for patients experiencing excessive wear of their dentition.

A complete transformation of the mouth can have a profound impact on an individual’s confidence and well-being. Such complex cases necessitate meticulous preparation and assistance to guarantee favorable outcomes.

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41295

Full Mouth Reconstruction Challenges

1. Tooth wear

Full Mouth Reconstruction: The Pathway to Success

The primary reason for prescribing full mouth rehabilitation is tooth wear, which necessitates this type of treatment. The objective is to restore the teeth to a functional and youthful state. An examination is crucial (as demonstrated in the image above) to determine the underlying causes of the wear.

Possible inclusions:

Erosion due to acid in the mouth is usually related to dietary issues and appears as a hollowed-out area on the tooth’s surface.
Attrition caused by grinding or an improper bite – this can usually be diagnosed by visualizing a flattened tooth surface.
Abfraction is caused by a misaligned bite or teeth grinding, creating irregular forces to the tooth. Abfractions often appear as a notch on the side near the gumline.
Abrasion is created from an external force, usually mechanical (toothbrush). A tooth that has experienced this type of wear usually has a notch at the gumline.

2. Vertical dimension of occlusion

Full mouth rehabilitation aims to address tooth wear and optimize oral health by addressing proper function, muscle concerns, periodontal health, and temporomandibular joint issues. It aims to restore harmony among these factors, leading to an overall improvement in oral well-being.

Initiating the journey towards restoration can commence following a thorough evaluation. To ensure an effective approach aligning with occlusion principles, it is crucial to ascertain the patient’s vertical dimension of occlusion (VDO).

Individuals who exhibit excessive wear are typically classified into one of the following categories:

Drooping at the corners of the mouth usually indicates a loss of vertical dimension, which requires an increase in the VDO.
No loss of vertical dimension and space is available. May require gingivoplasty and adjustments to the opposing to make room for restorations.
No loss of vertical dimension and space is limited. These cases usually show wear on the anterior and minimal wear on the posterior. These cases may require ortho, repositioning, or surgery to make room for restorations.

Once the patient’s dental health is assessed, a treatment plan is created to determine which teeth to treat, the vertical dimension of occlusion, available space, and condylar position for restorative options.

3. Digital photography

After the diagnosis is made, it is important to work with the dental lab. Involving the lab early on in the process is crucial. The proposed treatment plan can be further refined and strengthened by providing the dental lab with preliminary models and a functional diagnostic wax-up.

To begin the process, you must take the necessary digital photographs.

The suggested photos include:

A picture of the full face from forehead to chin
A close-up picture showing a full smile
A close-up picture with lips at rest
An overall shade picture with the shade tab held next to the tooth with the body and incisal of the tab next to the body and incisal of the tooth
An incisal shade picture with the incisal edge of the shade tab held directly above the incisal edge of the tooth (see the above image).

3. The plan

Before starting the fabrication of the functional wax-up, it is crucial to communicate the proposed plan and manage the patient’s expectations.

To accurately transmit the data necessary for the fabrication of the wax-up, the following must be provided:

Provide the number of teeth to be restored. This should include the tooth numbers and information regarding types of restorations.
Indicate any tissue surgery that might be necessary.
Describe any proposed changes to the VDO.
Provide information concerning what material to use in the fabrication of the restorations.
List any specific concerns or goals the patient is hoping to receive.
Provide information regarding the desired staging of the case. This is dependent on whether or not there will be a change in the VDO.

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4. Functional wax-up

Using this information, a functional wax-up that meets the specified requirements can be created. The wax-up can be made using the traditional chemical impression method or a digital scan.

Once the wax-up is finished, the following is submitted to the patient for approval.

A functional wax-up
A stent of the wax-up
Prep guides

Preparation can begin after the wax-up is approved, and the proper VDO staging strategy should be followed. This is an important step in ensuring the appropriate function of the case. The staging will fall into one of three possible scenarios:

There is no change in the VDO.
There is a change in the VDO
Both arches are being restored.

5. Temporaries

Full Mouth Rehabilitation - Burbank Dental Lab

Once the patient wears the temporary dentition, it’s important to gather their feedback to ensure their satisfaction. It’s recommended to take the same pictures as step one to visually compare the temporaries in the mouth.

Additionally, ensure that new impressions are taken while the temporary restorations are in position. In cases where no modifications were made to the occlusion or vertical dimension of occlusion (VDO) on the temporaries, only a single bite recording, from one temporary restoration to another, is required. However, if adjustments were made to the occlusion or VDO, it is necessary to take three bite recordings for each modified provisional restoration in relation to the prepared teeth.

Now that all preplanning information has been gathered, Burbank Dental Lab can start fabricating the final restorations using the most suitable material for each individual case.

It is possible to do a bisque try-in of the restorations as an added step before the final glaze.

This is not always a necessary step, but it is available.

Once everything is finalized, the case is glazed and sent in for insertion (see above image).

Restoring patients’ oral health by addressing wear-related problems is a crucial aspect of dentistry. Despite the complexities involved, there are methods to guarantee consistent and anticipated outcomes.

Over the years, Burbank Dental Lab has successfully restored numerous cases involving full-mouth rehabilitation and complex dental procedures, and they are enthusiastic about assisting you throughout the entire process.

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