A Simplified Approach to Full Mouth Rehab (Pre Op)

0 Rating(s).


Posted on By Gerald Benjamin In Full Arch & Dentures

Full mouth rehab is, arguably, the most challenging and complex treatment modality in dentistry.
The four aspects of a full mouth rehab are:
1. Maxillary incisal edge position (including length and position in the arch creating esthetics and the fricative { F}sound)
2. Mandibular incisal edge position (anterior guidance and sibilant {S} sound)
3. The occlusal plane (plane of Spee)
4. Correct Joint position (Centric Relation)

In performing full mouth rehabs #1-#4 must be 'knowns'.

I find #1 and #2 by performing a Direct Resin Mockup in the mouth. I generally have a maxillary central incisor of 10.5 - 11 mm. The mandibular central is about 8-9 mm. I then test speech for the F and S sounds.
I find my Centric Relation position by using a leaf gauge and mount my models on a Semi-Adjustible articulator. I wax my own cases and simply wax a 10.5 mm maxillary central incisor and a 8.5 mm mandibular central incisor
The posterior opening has been created (in 'wear' cases) and I wax the rest of the occlusion.

Every aspect on the list #1-#4 has been established. The waxed up occlusion is refined on the articulator and sectional putty matrix's are fabricated to copy the wax up and take it to the mouth.

I spend 4 hours transferring the wax up to the mouth with bonded RESIN and the case is essentially completed. The patient wears the resin full mouth rehab for a few weeks to insure comfort and confirm the incisal edge position of the maxillary and mandibular teeth (Esthetics and Speech.)

I will then convert the:
1. maxillary anterior 10 teeth to porcelain
2. mandibular anterior 10 teeth to porcelain
3. the molars to porcelain

Pre-Op Smile showing significant anterior wear
Pre-Op Retracted view showing anterior wear

Maxillary Occlusal view showing severe gastric reflux and wear
Maxillary wax up Occlusal view


Add to Favorites
Add a comment to the discussion on A Simplified Approach to Full Mouth Rehab (Pre Op)


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

11 Comments

Gerald, it does take considerable time, effort, and skill to accomplish an effective esthetic trial smile as you have shown. However, it is worth all the effort and patient expense to accomplish it because it assures the patient's vision will end in total success.


Reply

Hi Dr. Goldstein;
I believe that the most significant reason that dentists use CO to build their occlusions is that they are petrified to change the vertical or open the bite in CR. The 'what happens if' mentality takes over and the new occlusion looks like the old one.

This technique, while obviously time consuming, totally eliminates any possibility of failure due to opening or closing the bite too much and the failure to find a repeatable bite.

In reality, full mouth rehab was never meant to be performed by the average corner dentist.

Thank you again for taking the time to read my posts and respond to them.


Reply

Hey G
I love learning about your craft, especially how you approach each case.

Not for the average Veterinarian Thank God :)

Beautiful

R


Reply

Hi R;
The average Veterinarian probably has so many fears of failure that they never get out of their comfort zone. US News and World Report declared that being a dentist is one of the best jobs in the country...How can this be when 70-80% of dentists hate being a dentist?
The average dentist is stuck in a rut doing average procedures in a mediocre way.

You and many others on XP have stepped up their game and have decided to be the best of the best. It is extraordinarily exciting to pioneer new directions.


Reply

Dr.Gerald, CASE DONE. One of the most practical and easiest FMR technique i have ever seen. Thanks for sharing your technique in this group. As you always say FMR is just like a Complete Denture fabrication but we do that work in a mouth where teeth are present. Great. Regards, Ashok


Reply

Dear Dr Gerald
Great case. You make it simple!
In this case the patients had crowns in his upper molars but if that wasn't the case , would you consider doing onlays to open the bite ? I think Francesca's Vailati's work would be great for this case.
Margarita


Reply

Great question Margarita;
I opened the vertical by lengthening the mandibular anterior teeth and restoring them to their pre-worn height. By doing this, I created an adequate space to make the mandibular posterior teeth sufficiently retentive for new crowns (which they currently are not as the crowns come off frequently.

With the vertical changed, I am not sure that the maxillary posterior teeth need to be treated at all.

I saw the patient 2 days after building up his teeth, his speech is perfect and I do not think that I can increase vertical any more without impinging on freeway space and he would be unable to to say "66" without his anterior teeth touching.
Regards,
gerald


Reply

Thank You!


Reply

Dear Gerald Great result. Do you follow any particular occlusal concept for treatment planning? My doubt is regarding the order 1-4 of your " aspects of FMR " Thanks


Reply

Hi Suryanarayana;
Yes I do! My original models were mounted in Centric Relation which I obtained by using a Leaf Gauge. If you want to be even more accurate than a Leaf Gauge, then do what you do in dentures...Mock up (in resin) the maxillary anterior teeth to ~10.5 mm then Mock up the mandibular anterior teeth to ~8.5 mm and have the patient gently close as if they were biting on their back teeth...The separation between the maxillary posterior teeth and the mandibular posterior teeth should be recorded in Bite Registration material.

I did not make up those determinants of a FMR...A successful result is dependent on achieving all of those goals.

You should have great confidence in using this technique (once you master it). I have successfully used it since 1999.
gerald


Reply

Thank you for your reply Gerald Highly Appreciated Surya


Reply


NovaBone
PET Kit