Full Mouth Rehabilitation of Severely Worn Out Dentition

Abstract

Full mouth rehabilitation is one of the most complicated cases to treat as it involves the extensive procedures, prolonged treatment time and a multidisciplinary approach therefore the patient has very high expectations to enhance his esthetics. This article presents a case with severely worn out dentition treated using full mouth rehabilitation.

KEYWORDS:Fill mouth rehabilitation, esthatics.

INTRODUCTION

The word rehabilitate implies ‘ To restore to good condition or to restore to former privilege’. The term ‘full mouth rehabilitation means ` restoration of the form and function of the masticatory apparatus to as near normal as possible.`1 is used to indicate extensive and intensive restorative procedures in which the occlusal plane is modified in many aspects in order to accomplish “equilibration”. The modification of plane can be done by occlusal equilibration, splinting, crowns, fixed partial dentures, implant supported prosthesis and orthodontics. By the correction of the occlusal plane, the teeth can be freed of all the unfavourable forces that might lead to periodontal breakdown. Thus the goal is to achieve a healthy, esthetic, well functioning, self maintaining masticatory function.2

CASE REPORT

A 50 year old male patient reported to the Department of Prosthodontics with the complaint of worn out dentition (Fig 1) and his main concern was to improve the esthetics. Complete medical and dental history was obtained. The complete intraoral and extraoral examination was done. The patient did not showed any symptoms of TMJ disorder. There was no gross facial asymmetry found on extraoral examination. The mandibular incisors were absent and the teeth showed severe attrition but no dentinal sensitivity. The loss of vertical dimension was detected through the clinical and radiographic examination. Full mouth rehabilitation was planned and explained to the patient.

Fig1: Pre operative view of patient

Pre operative	Attachments and metal coping cemented	Fig. 2: Diagnostic wax up

PROCEDURE

Maxillary and mandibular arch impressions were made using irreversible hydrocolloid. The study models were made using dental stone and the face bow transfer was done to mount the maxillary cast on semi-adjustable articulator. The interocclusal records were made using bite registration paste and the mandibular cast was mounted on the articulator using these records. The diagnostic mounting was analysed from buccal and lingual view and the diagnostic wax up was done.(Fig 2) The putty index of the diagnostic wax up was made quadrantwise which can be used during the fabrication of provisional restorations.

Tooth preparation and gingival retraction

Wax pattern

The anterior guidance was established and the teeth were prepared and provisional restorations cemented. The mandibular anteriors were fabricated using the anterior guidance records and cemented using temporary cement. The maxillary anteriors were not involved in the treatment plan as per the patient`s desires. The posterior teeth were prepared according to the diagnostic wax up records to receive metal restorations in molars and metal ceramic restorations in premolars. The gingival retraction was done and impressions made using addition silicone elastomeric material. The bite registration was done and the restorations were fabricated and cemented.(Fig 3 and 4)

Fig 3: Prosthesis in occlusion(Right side)	Fig 4: Prosthesis in occlusion(Left side)

Pre-operative view of patient (Fig 5)	Post operative view of patient (Fig 5)

DISCUSSION

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.3 Treating the full mouth rehabilitation patients involves not only the esthetic coverage restorations but also the meticulous planning of posterior occlusion. The rule of thumb is to follow the same occlusion unless the complete posterior occlusion needs to be modified. The three prime requirements of full mouth rehabilitation are healthy TMJ, harmonious anterior guidance and noninterfering posteriors.4 These three factors should be in harmony to the stomatognathic system. This patient had reported with the severe attrition of his teeth due to the parafunctional habits. Such treatment plans should always be preceded by the diagnostic wax ups as this step will help the dentist as well as the patient to better understand the final outcome.

Anterior teeth are usually restored first so as to achieve functional and esthetically viable anterior guidance. The objectives while restoring anterior teeth were achieving adequate esthetics, function (phonetics) and noninterference in the posterior teeth so as to have posterior disclusion. Anterior guidance is the dynamic relationship of the lower anterior teeth against the upper anterior teeth through all ranges of function. Anterior guidance plays a very important role in full mouth rehabilitation following centric relation.5

Posterior occlusion should planned such that it should not interfere with either the TMJs in the back or the anterior guidance in the front. Occlusal interference can be damaging to the periodontal health of the teeth and may cause pain in the muscles, teeth or other orofacial structures.

Conclusion

The primary objective of prosthodontics must be the preservation and health of the remaining existing tissues and structures: teeth, periodontal tissues, temporomandibular joint and oral facial muscles.6 Full mouth rehabilitation is a treatment modality which not only focuses on the esthetics and functional aspect of the dentition but also improves upon the health of the whole stomatognathic system.7

REFERENCES