Full Mouth Reconstruction:

THE PATHWAY TO SUCCESS

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

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One of the most challenging undertakings in dentistry for both the clinician and the laboratory is a full mouth reconstruction.  For patients who present with excessive wear of their dentition, a full mouth reconstruction is critical in re-establishing functional harmony, pulpal health, esthetics, and protecting the dentition from further damage. In short, a full mouth reconstruction can be a life-changing event both in terms of a person's self-esteem and overall health.   These types of cases are challenging and require proper planning and support to ensure success.

Tooth Wear
Full Mouth Reconstruction: The Pathway to Success

Tooth wear is the number one reason for prescribing full mouth rehabilitation to a patient. This type of treatment plan is often selected to reconstruct a person's dentition back to a more youthful and functional state.  It is crucial to uncover what etiological factors might be responsible for the wear (see image above). These may include:

  • Erosion due to acid in the mouth, 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 caused by a misaligned bite or grinding, creating irregular forces to the tooth. Abfractions often appears 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.
Vertical Dimension of Occlusion

When considering a full mouth rehabilitation, the objective is to restore the worn-out teeth and at the same time, consider the proper function, muscle issues, periodontal issues, and the temporomandibular joints. These all need to work together to bring the patient to an overall state of improved oral health. Once a proper evaluation is conducted, approaching the path to restoration can begin.  When determining the appropriate approach with regards to occlusion principles, it is important to identify the patient's vertical dimension of occlusion or VDO.

Patients with excessive wear usually fall within one of the following groups:

  • Loss of vertical dimension usually identified by drooping at the corners of the mouth. These cases require 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.

After the dental health of the patient has been evaluated, a treatment plan can be created to determine restorative options, including the teeth to be treated, the vertical dimension of occlusion, space available, and condylar position.

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Digital Photography
Full Mouth Reconstruction: The Pathway to Success

Once the diagnosis is determined, collaboration with Burbank Dental Lab can begin. It is critical to involve the lab early in the process. Mounted preliminary models and the beginning stages of a functional diagnostic wax-up will help solidify the proposed treatment plan.

The first step in the process is to take the necessary digital photos.

The recommended 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 image above).
The Plan

Next, it is critical to communicate the proposed plan. This includes understanding and managing the expectations of the patient. This step is necessary to provide a starting point for the fabrication of the functional wax-up.

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.
Functional Wax-up

With this information, a functional wax-up can be fabricated to include the above specifications. This wax-up can either be fabricated utilizing the traditional chemical impression method or through a digital scan. After the wax-up is completed, the following is sent back for patient approval:

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

After the wax-up is approved, preparation can begin, and the proper VDO staging strategy should be followed. This is an important step in ensuring the proper 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.
Temporaries
Full Mouth Reconstruction: The Pathway to Success

At this point, the patient will be wearing the temporaries with the proposed new dentition (Fig.3). It is critical to record any feedback from the patient to ensure overall patient satisfaction. Next, take the same pictures as in step number one to provide a visual of the temporaries in the mouth.

Also, record new bites with the temporaries in place. If no occlusal or VDO adjustments were made to the temporaries, then only one bite, temp to temp, is necessary. However, if adjustments were made to the occlusion or VDO then three bites must be taken of each altered provisional to the preps.

Full Mouth Reconstruction: The Pathway to Success

At this point, Burbank Dental Lab can begin the fabrication of the final restorations utilizing all of the preplanning information. Restorations will be fabricated in the material best suited for the specific 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).

Bringing patients back to overall oral health through correcting issues caused by wear is an important part of dentistry. While these cases are challenging there are ways to ensure predictable planned results.

Burbank Dental Lab has restored countless full mouth rehabilitation and complex cases over the years and is eager to help you through the process.

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