Revitalizing Smiles: The Art and Science of Full Mouth Rehabilitation

Full Mouth Rehabilitation – Revitalizing Smiles

The prevalence of complex restorative cases has significantly increased over recent years, revealing a wealth of insights on how dentistry can fundamentally impact a patient’s quality of life. Full mouth reconstruction involving opening the bite can be challenging yet highly rewarding.

One of the benefits of this procedure is that it has the potential to alleviate temporomandibular joint (TMJ) symptoms, thereby reducing discomfort and enhancing function for patients. It represents an exceptional intersection of aesthetic restoration and therapeutic intervention. To achieve success, however, there must be a close collaboration between dental practitioners and dental labs.

The following case study showcases the intricacies of the collective expertise in these types of cases.

Case Study

Dr. Isam Estwani, of New Horizons Dental Center in Herndon, Virginia, collaborated with Burbank Dental Lab on a case involving a patient. The patient was dissatisfied with veneers on teeth 7, 8, 9, and 10 that were previously done by another dentist. These veneers did not meet functional guidelines, resulting in poor angulation and contours.

In addition, the patient had a collapsed bite and TMJ pain, which further affected both the appearance and function of her mouth. The goal was to address these various issues and achieve a result that would improve the patient’s aesthetics and overall quality of life by managing her TMJ pain.

Diagnostics

It was determined that the patient needed an improvement in the aesthetics of her smile. Furthermore, an assessment was required to address the collapsed bite, determining the number of teeth to restore and the extent to which the bite could be opened.

After mounting the case on a Panadent articulator, an evaluation revealed that the restoration should cover teeth 4-13 on the maxillary and 20-29 on the mandible. Upon receiving the patient’s approval, 20 temporaries were created for the patient to wear and assess. The patient expressed delight in the aesthetic and tactile aspects of her potential new smile, leading to the progression of the case to the fabrication of the final restorations.

Material Selection

The careful selection of materials played a crucial role in our approach to this challenging case. It is widely acknowledged that choosing the appropriate material can determine whether the outcome is good or exceptional.

Based on a thorough assessment of the patient’s oral health, aesthetic preferences, and individual needs, it was concluded that E.max layered veneers would be the ideal treatment for this case. These veneers are renowned for their superior strength and striking visual appeal, offering both durability and a natural-looking finish. With their translucency, they closely resemble the appearance of natural tooth enamel, making them an excellent choice for those seeking aesthetically pleasing results.

Additionally, E.max layered veneers are robust enough to withstand the pressures of a corrected bite.

Veneer Fabrication

A central component of our efforts at Burbank Dental Lab is our highly skilled Smiles by Design team. This specialized group of dental laboratory professionals brought their comprehensive expertise and refined craftsmanship to this 20-unit case. Under the direction of Dr. Estwani, each of the E.max layered veneers was fabricated to ensure perfect alignment with the patient’s natural tooth morphology.

The patient’s collapsed bite and insufficient lip support were successfully addressed by the ‘Smiles by Design‘ team, who also made sure to correct the angulation and contours of the veneers. To ensure accuracy, the team used the patient’s approved temporaries as a reference for the final restorations.

11 Clinical Procedures for Dentists to Follow

Typically, a dentist would follow these clinical steps when seating a 20-unit veneer case, requiring a methodical and careful approach:

The patient loved her final results and has reported that her TMJ pain has improved. In the future, Dr. Estwani plans on restoring her first molar crowns.

Full Mouth Rehabilitation Workflow

Embarking on a 20-unit veneer case is a significant undertaking. It requires a careful, systematic approach from the clinician. Below are the steps involved:

• Case Discussion: Burbank Dental Lab will begin discussing the case with the clinician highlighting the patient’s needs and expectations, occlusal factors, the degree of bite opening needed, and the planned prosthetic designs.
• Impressions and Bite Registration: The dentist should take accurate impressions of both arches and provide a precise bite registration.
• Fabrication of Diagnostic Wax-Up: Burbank Dental Lab uses the models to create a diagnostic wax-up, which is a 3D representation of the planned restoration. (See above image)
• Verification and Temporary Restorations: Temporary restorations, also known as provisional restorations, are then created based on the approved wax-up design. These temporaries not only protect the prepared teeth but also provide a blueprint for the final restorations.
• Bite Adjustment and Verification: The dentist then works with the patient to ensure comfort, proper function, and satisfaction with the temporary restorations. Any necessary adjustments are made to the bite at this stage, and these modifications are communicated back to the lab.
• Fabrication of Final Restorations: Once the temporary restorations are approved, and the new bite is comfortable for the patient, the dental lab creates the final restorations based on the modified design.
• Insertion of Final Restorations

This well-coordinated approach between the dentist and dental lab ensures a seamless process and a successful outcome for full mouth rehabilitation cases involving opening the bite.

This process is an intricate blend of artistry, technical skill, and profound knowledge of dental anatomy and materials. Both the dental lab and the dentist play pivotal roles in this journey toward achieving the desired outcome.

At Burbank Dental Lab, our dedication to collaboration, utilization of cutting-edge technology, and the refined expertise of our Smiles by Design team have enabled us to contribute significantly to the success of such complex cases.

Special Thanks

We want to thank Dr. Isam Estwani of New Horizons Dental Center in Herndon, Virginia for sharing photos, case notes, and collaborating with us on this case.

Isam Estwani, DDS