Note the second molars highly tilted toward the front of the mouth, while there is a premolar and molar missing on the right side and the molar is missing on the left, and the second premolar is worn off to the gumline. These Casts are for the case described above. I ended up taking 2 1/2 years to complete this case, spending every one of the three calendar years the maximum that his insurance would cover – and they eventually covered everything! Casts when first Examined: As a pastor in the public eye a lot, he was aware that the appearance given to him by the wear he had inflicted on his teeth was a disadvantage. He was keenly interested in getting things fixed up so he could look normal again. The front teeth had all been ground down about half way, and a similar story was true for the back teeth. By measurement at the front of the mouth, the wear on his front teeth had shortened the height of his bite by approximately 6 mm. He did not have significant periodontal issues. His opposing teeth to the second molar were still present and healthy. He was missing lower first molars and the second molars were tilted considerably toward the front of the mouth, to get into the space of the teeth that had been missing for a long time. In the case of my patient, he had ground down his teeth and had the appearance I described above. And, during the entire process, a faculty mentor was appointed so I could run every step past him. He even invented the Panadent articulator to make it easier for dentists to do such cases well. There were such classes at the time being given by Dr. I fought hard to be allowed to tackle this case, and the deal with the Dean was that I would take classes outside of the school to learn about how to do it responsibly. I was at a school that had no graduate Prosthodontics department at the time, so when this gentleman came to the school for help, an undergraduate would need to do the work. Return A Full Mouth Rehabilitation ExampleĪs a dental student I was tremendously lucky to do my first full mouth rehab case. Illustrating Excessive Wear to Teeth Appearance Affected by Worn Down Teeth Earlier Stage of Wear When you see someone whose lips seem pursed or sticking out a little too far for their face, and the lips are turned a little outward so the inner portion shows that normally wouldn’t be seen, AND you notice when they smile that it is hard to see the incisal edges of their teeth, but when you can they are very flat from one side to the other – they are a likely candidate for full mouth rehabilitation. This could and often IS true of a completely edentulous person that has been wearing dentures for a long time and the bone has resorbed more and more, and fixed restoration on implants brings the mouth open again – but in that case the TEETH are not being restored – just the vertical height of occlusion. In general, full mouth rehab or reconstruction is done when there are plenty of teeth but they have been worn down so far that the bite has collapsed – that is the nose and chin have become too close together. The difference between this kind of case and when the dentist creates a removable partial denture that replaces most of the teeth, is that here the appliance is not removable, and, second, the level of the bite – the occlusal plane and vertical dimension of the bite – is not being changed with an RPD. The difference between this kind of case and when the dentist rebuilds the patients entire mouth with an implant-borne prosthesis, is that here most of the teeth are still left. Organization of this Chapter You May Skip to Whatever Subject Interests You Now The Collapsed Dental Bite: Basics A Full Mouth Rehabilitation Example Important Issues during Full Mouth Rehabilitation Basic Steps in Full Mouth Rehabilitation Variations Bottom Line for Full Mouth Rehabilitation This loss of the vertical dimension of occlusion – basically the height of the teeth from bottom gumline to top gumline – is discussed in Wikipedia with a couple of useful references. When the teeth are flattened out, basically ground down to 50% of their normal height, serious effects occur, and it is very expensive to recover normal function and appearance. The collapsed dental bite is a serious condition, which affects functioning of the teeth in chewing and speaking, and the appearance as well.
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