Full Mouth Rehabilitation
Correspondence Address :
Dr Yamir Gopal:Email: firstname.lastname@example.org
Full mouth rehabilitation cases are one of the most difficult cases to manage in dental practice. This is because such cases involve not only replacement of the lost tooth structure but also restoring the lost vertical dimensions. Full mouth reconstruction is basically a set of procedures that are aimed at correcting an improper bite position as well as restoring chipped or worn out teeth. Improper jaw position is implicated in various neuro-muscular disorders as well as in headache and neck ache. Correcting the jaw position not only restores proper function, but also helps in enhancing the cosmetic appearance of the patient.
Described below is the full mouth reconstruction with rampant caries.
Patient arrived at the office complaining of:
1. Leakage of saliva while talking
2. Hoarseness of voice
3. Chipped roots & teeth.
1. Full mouth IOPA x-rays
2. Routine medical check up
Rampant caries along with generalized attrition. After a thorough examination, the following treatment plan was advised.
First of all periodontium was examined thoroughly, both clinically and radiographically.Secondly, endodontic therapy of all pulp involving teeth as a basic step should be done.
(Table/Fig 1). Pre-operative photograph demonstrating gross wear & tear of all teeth and loss of vertical dimension .
The main aim of the treatment plan was to raise the vertical dimensions by increasing the height of molars.
Alginate impression of upper & lower teeth was made and study casts were made. Two sets of study casts were prepared, one for lab technician & one for the doctor
DOCTOR <---------> PATIENT <------> LAB TECHNICIAN
Mutual understanding & team effort is very important for the success of treatment .
Teeth no.25 and 48 could not be restored because these were grossly decayed & infected, needed extraction. Teeth no.17, 26,27,34,36 did not require endodontic therapy and were restored as such.
Endodontic therapies were started for the remaining teeth. There were a total of 20 teeth in the mouth which required extensive endodontic therapy. The most important step in this case was to raise vertical dimension(V D).
Two equal lengths of pink modeling wax were taken. Some glass beads from glass bead sterilizer, around 2mm in diameter, were packed in the folds of wax sheet & placed in between posterior teeth. Now, the patient was asked to bite on the wax sheet gently. Glass beads present in the wax bite help in giving 2mm of free space required. After this, upper & lower jaw impressions were made using alginate impression material. Stone plaster was poured & models prepared. Recorded wax bite was placed in between upper & lower casts and articulation was accomplished as per the requirements of the patient.
Sequence Of Temporization
Firstly, upper posterior crowns were made with well formed cusps & fossae. For this, we had the option to choose prefabricated stainless steel crowns for exact anatomy. Afterwards, lower posterior crowns were prepared in occlusion with the upper crowns. There should be good cusp to fossa relationship and Angelâ€™s class-I relation should be established, wherein the mesio buccal cusp of upper first permanent molar should fall into mesio buccal groove of lower first permanent molar. Occlusion is set in patientâ€™s mouth because of his jaw deviation and unbalanced occlusion. Articulating paper is used to remove high points and establish correct occlusion.
For this, repeated visits are required for proper setting of crowns. This is a very important step as the success of the full mouth rehabilitation hinges on correct setting of the crowns. Wherever the occlusion is set now, permanent crowns will be set in the same plane. While grinding temporary crowns for occlusion correction, occlusal table is also sometimes required to be narrowed down.
Once the posterior crowns were set, then anterior crowns were built up. Screwed posts are used as retentive forms. Light cure composite is used to prepare core.
For incisal plane, upper lip line is used as guide plane.
31, 21, 11,21,22,23
43, 42, 41,31,32,33
Full Mouth Rehabilitation is very useful in correcting improper bite positions and also in augmenting the smile. In this case, the procedure acted as a template for the eruption of permanent teeth. More often than not, young children are good candidates for the procedure because the permanent teeth are yet to erupt. This gives the dentist an opportunity to shape and guide the occlusion in the permanent teeth.
The latest technology used to assist doctors in determining the jaw positions is called Tens, which is a low level electrical impulse machine that massages the muscles and releases the tension built up as a result of muscle overuse in imbalanced jaw positions.
Generally speaking the recovery stage is one of the most important stages in this procedure. Patients need to be constantly monitored for at least 12 months after the procedure in order to ensure that they do not accidentally revert to the previous jaw positions.
Conflict of Interest: None declared
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