Predictability with Full Mouth Rehabilitation

Predictability with Full Mouth Rehabilitation

A Proper Plan To Ensure An Accurate Outcome

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

Tooth wear is a growing problem that affects many people both in severity and occurrence. This is especially true for older adults as this population continues to live longer, fuller lives. There are many treatment options for patients who suffer from wear issues to help minimize the damage. However, when wear is severe and the cause is controllable, a full-mouth reconstruction treatment can help bring a patient back to full function. These cases require a proper plan to ensure an accurate outcome.

Initial Patient Assessment

In larger cases where a full-mouth reconstruction is being considered, it is essential to first assess why the patient’s teeth are in their current condition. Severely worn dentition can be the result of erosion, attrition, or abrasion, or a combination of these. Once the cause or causes of the patient's current situation is determined, the plan to restore can begin.

This beginning phase of planning will consider the following:

  • How many teeth need to be restored to achieve desired results?
  • How much space is available?
  • What material should be used to fabricate any necessary restorations?
  • The vertical dimension of occlusion (VDO) needs to be evaluated to ensure occlusal balance.

The VDO is especially important in cases where the anterior teeth have severe wear. If the decision is to lengthen the anterior teeth, then the VDO may need to be altered to accommodate this correction.

Patient Assessment

Functional Wax-up

After a comprehensive examination has been completed and the overall preliminary treatment concept has been determined, it is best to begin a workup of the proposed treatment. At this point, the Smiles by Design team at Burbank Dental Lab can be brought into the planning to help with creating a mockup of the desired end results.

This step requires initial impressions as well as bite records and a face-bow record to mount the case on an adjustable articulator. This step can be done with traditional impression methods, or fully digitally with an intraoral scanner. In addition, a centric relation occlusal record using a face-bow transfer and a leaf gauge should be sent for proper mounting.

Functional wax-up

This information can be sent to Burbank Dental Lab to begin the functional wax-up. Along with providing the necessary data to mount models for evaluation, it is imperative that photographs be sent along as well.

These photos should include:

  • A full-face photo
  • A close-up photo of the full smile
  • A close-up photo of the lips resting
  • Photos with the shade selection information, including the shade tab

This data is then used to create a functional wax-up.

The wax-up will take into account the preliminary treatment data and incorporate this information into a mock-up. This is the step where the VDO should be evaluated, and a determination made as to whether the VDO is to be changed.

The wax-up is completed and sent back with the following:

  • The wax-up
  • A matrix of the wax-up that can be used to make temporaries chair-side or milled temporaries
  • A preparation guide to help with the final prep design to ensure the best possible end result

The mockup should be shared with the patient, and the details of the plan discussed. Once treatment is agreed upon, tooth preparation can be completed. If there are any issues with the wax-up, these issues can be discussed with the laboratory, and corrections can be made.

Once the teeth are prepared, the final impressions, either conventional impressions or digital scans and bite records, should be taken. At this step, the case has been evaluated as to whether or not the bite can be opened and to what degree. It is important to prep the case in stages and carefully record the bites.

Temporization

The case is now ready to be temporized. Temporaries can be done chairside using a matrix taken from the wax-up, or they can be milled such as Burbank Dental Lab’s DuraTemp PMMA lab-fabricated temporaries.

Once tried in, the temporaries should be evaluated to ensure passive seating is present.

At this time, the occlusion and VDO should be checked for accuracy, then the temporaries should be inserted using the following steps:

  • Clean and dry the temporaries.
  • Block out any undercuts and then reline with a cold-cure acrylic.
  • Trim any excess from the margins.
  • Polish using pumice and polishing paste.
  • Temporarily cement using a non-eugenol cement.

The temporaries will act as a diagnostic representation of the final restorations. Both the clinician and patient can use the temporaries to evaluate the shade, contours, shape, and length.

The temporaries should be worn for several days, then the patient can provide any necessary feedback that can be incorporated in the final restorations.

DuraTemp PMMA - Full Mouth Rehabilitation

Patient Feedback

After the patient has worn the temporaries and provided feedback, the case is ready to move to the next phase.

If the patient approves the temporaries, the final restorations will be based on these temporaries.

If there are changes the patient wishes to see in the finals, then these need to be considered.

If the changes are minor, these changes can be shared with the lab through the prescription form.

However, with major changes, it is advisable to make the changes from the temporary and have the patient wear the altered/new temporary with the changes. With the temporaries inserted, take the same series of photos as previously discussed.

Once the temporaries have final patient approval, it is important to record an occlusal bite record of the mandibular and maxillary temporaries. Taking these bite records is extremely important and must be done in steps.

The maxillary should be done first.

Keep the anterior temporaries in place while removing the posterior sections, and then take the posterior bite records.

Next, remove the anterior temporaries while the posterior bite records are in place and take the anterior bite. Then, take impressions of the temporaries in place along with a facebow recording such as the Kois Facial Analyzer. This will allow for cross mounting in the laboratory.

Final Restorations

Now the lab will have all of the information necessary to fabricate the final restorations.

The final restorations will be very close to the mock-up the patient has been wearing in terms of length, shape, and contour. The final esthetics will be more natural in the final restorations, but overall the case should have a predictable final result.

Cases that present with wear can be challenging. In many cases, opening the vertical is essential to achieving the esthetic results the patient desires.

Creating a treatment plan is critical in ensuring these cases offer a successful, satisfactory, esthetic result for the patient while including the functional aspects that are essential for case success.

To help plan your next large complex case, call us or chat with a Burbank Dental Lab team member today!

All On "X" Success Guide Coming Soon

Did you like this article?

Let us know by giving us a clap!

1+

Top 10 Most Clapped Articles

Resource Center

Products

Resources

Slide 1

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.