Full Mouth Rehabilitation: Strategies for Success

Dentists and technicians both face major challenges when performing a full mouth reconstruction. The goal of a full mouth reconstruction is to reestablish functional harmony, pulpal health, esthetics, and protect the dentition from further damage in patients with excessive wear.

Reconstructing a person’s mouth can improve his or her self-esteem and health in general. The success of these types of cases depends on proper planning and support.

Prescribing a Full Mouth Rehabilitation

The most common reason for prescribing full mouth rehabilitation is tooth wear. In most cases, people choose this treatment plan to regain a more youthful and functional dentition. Uncovering the possible etiological factors is extremely important to determine the cause of the wear.

Some of these may be:

• External forces, such as a toothbrush, are responsible for creating abrasion. Teeth usually have a notch near the gumline after experiencing this type of wear.
• Flattening a tooth’s surface is usually the result of grinding or a poor bite.
• Tooth abfraction caused by misaligned bites or grinding.
• Erosion of the surface of the tooth is caused by acid in the mouth, usually as a result of dietary issues.

The Diagnostic Wax-Up

The diagnostic wax-up allows the lab to work up the case according to the clinician’s specifications. This will be the roadmap to the final restorations, as the patient will be able to try out the restorations prior to the final restoration being fabricated. During this phase, the patient can approve the proposed case or request changes.

To properly fabricate the restorations, it is best to follow these steps:

1. Provide the dental lab with the number of teeth being restored along with the type of restorations.
2. Any tissue surgery that will be necessary should be disclosed.
3. Will there be any changes to the VDO?
4. Provide the proposed material choice for the final restorations
5. Include the patient’s goals or concerns.
6. A preliminary shade selection

Along with the above information, digital photos are also necessary. Burbank Dental Lab recommends sending along the following photos:

• Forehead to chin full face
• A close-up of the full smile
• A close-up of the lips resting

Along with this information, either a digital impression or a traditional impression will be provided for the wax-up process.

When the wax-up is completed, the following will be provided:

• The completed wax-up
• The stent to make the temporaries
• Preparation Guide (if requested)

The Provisionals

Provisionals are provided to the patient so the proposed new treatment can be worn and evaluated. To ensure patient satisfaction, it is important to gather feedback from the patient regarding their experience with the temporaries. After the patient has approved the proposed case, provide the following:

• The same series of pictures that were sent with the initial wax-up request.
• With the provisionals in place, take new bites.
• If there are no VDO or occlusal adjustments made to the provisionals, then a bite, temp to temp, should be taken.
• If there are VDO or occlusal adjustments, then three bites should be taken of the altered provisionals to the preparations.
• Impressions of the provisional models
• A new prescription detailing all of the pertinent information regarding the restorations, patient’s requests, and shade selection.

The Final Restoration

After the provisionals have been approved, the case is ready for the final restoration. The restorations are fabricated using the material best suited for the specific case.

All of the preplanning information is used in the final case. It is highly recommended that a bisque try-in (see the above image) is done before the final glaze. This will allow the opportunity to make any adjustments to the case, and then the final glaze can be completed.

A full-mouth case can be a life-changing experience for a patient.

These cases are challenging; however, if the proper steps are followed, and a plan is developed, these cases can be completed with exceptional results.

Do you have a patient that might benefit from a full mouth rehabilitation?

Call or chat with a Burbank Dental Lab team member for help on your next case.