Full Mouth Rehabilitation, Laguna Beach
When teeth become so worn, chipped and abraded, full-mouth rehabilitation becomes necessary so that additional tooth structure is not lost. Full-mouth rehabilitation is the most complex and critical procedure in cosmetic dentistry. It should not be attempted by dentists with limited experience.
As the biting surface of the teeth become abraded or worn, the vertical dimension (the distance between the chin and the nose becomes less). As this happens, the jaw is forced posterior in the glenoid fossa (the space where the lower jaw hinges with the skull). Determining the correct physiologic position of the jaw in the glenoid fossa when all of the teeth are prepared for crowns is what makes full-mouth rehabilitation complicated and exact. Incorrect positioning can lead to or exacerbate TMJ dysfunction.
Procedure
Dr. Boling has completed hundreds of full-mouth rehabilitation cases and his technique is now taught in several dental schools at the post-graduate level. Essentially the procedure involves replacing tooth structure that has been lost due to abrasion and chipping.
Dr. Boling always begins by fabricating an orthotic, an acrylic appliance that is worn over the teeth. The patient is checked regularly to determine if adverse symptoms occur from wearing the appliance. Once it is determined that the orthotic has placed the jaw in the correct anterior-posterior and lateral position, and the vertical dimension has been restored, we are ready to begin the case.
Full-mouth rehabilitation involves preparing all of the teeth for crowns at the same time. Therefore, it is critical that the dentist maintain references and indexes so that the position of the jaw as dictated by the orthotic is never lost. After upper and lower impressions are taken of the prepared teeth, provisionals that replicate the morphology of the new crowns are temporarily cemented into place. The impressions are sent to our laboratory to fabricate the crowns.
During the temporary phase, the patient is monitored to make sure that no adverse symptoms are encountered. When the crowns are returned from the laboratory, the crowns are cemented with temporary cement, again to determine that we have the correct vertical dimension and no reoccurring symptoms.
Dental Laboratory
Dr. Boling uses only the top dental laboratory for full-mouth cases. We are not fabricating one or two crowns where the shape of the teeth can be copied from adjacent teeth. With full-mouth cases, the laboratory technician must understand head and neck physiology and the relationship to dental anatomy. Incorrect crown morphology can cause the jaw to slide laterally or anterior-posterior as the teeth come in contact. Inaccurate lateral excursions can result in tooth mobility and eventual bone loss. It is critical that the clinician and technician work in harmony.
Consultation
If you believe that you may be a candidate for full-mouth reconstruction, please call our office for a complimentary consultation. These are manageable cases; however, they should not be attempted by clinicians with limited training and experience.
