A Simplified and Stress Free Approach to Full Mouth Rehabilitation
Nothing is more daunting to the general dentist than starting a full mouth rehabilitation. Fear of performing complete mouth reconstruction was created in dental school when we were warned about the challenge of changing vertical dimension and creating a permanent TMD problem. "Better leave FMR to the prosthodontists" was the watchword of faculty members.
Having been rejected virtually every dental school in the country at least once, three years in a row, I understood that full mouth rehab was beyond my level of understanding despite having taken all of Frank Spears courses when he was in Seattle and studying under the great Fred McIntyre, Board Cert Pros. That said, I was quite good at dentures and recognized that if I could treat a fixed case like a removable case, I too could perform FMR. My technique is simple, easy and stress free and relies on two numbers: Maxillary central incisors need to be 10.5 mm (although it can be 11 or 12 mm) and mandibular incisors need to be 9 mm in length. In the case under discussion, the patient had 10 maxillary veneers placed 4-5 years ago and now wanted her mandibular teeth restore. Prior to having cosmetic dentistry, the patient had Invisilign treatment because the maxillary centrals were in lingual version and trapped behind the lateral incisors. The mandibular anterior teeth were 6.75 mm in length meaning that we needed to add approximately 2.25 mm to these teeth. The most straight forward technique is to place 2.25 mm of resin onto the incisal edges of the 6 mandibular teeth and cure (no etching.) Once cured, the patient is asked to count from 60-70 to test the sibilant sound. Esthetics were excellent as was speech. The sibilant sound (ie 66 ) was perfect with the space between the maxillary anterior teeth and the resin enhanced teeth was less than a mm.
Centric Relation or the seating of the condyles in the fossa will occur as long as there are no posterior teeth present. With the 2.25 mm of resin on the mandibular teeth, the patient is asked to gently close as if biting on their back teeth. (Note: This is similar to using a leaf gauge.)With the patient gently closing on the resin sitting on their anterior teeth there is an opening in the posterior region of the mouth. This space is registered using PVS bite registration material. The Centric Relation Recording and the correct Vertical Dimension of Occlusion has been established with little effort. Impressions and a Facebow are taken and mounted on a semi-adjustable articulator. A wax up is then done for 10 mandibular teeth ignoring the posterior teeth for now. When the patient presents for the preparation appointment, the 2.25 mm of resin is placed onto the mandibular anterior teeth. Two patties of GC Resin Pattern are mixed and placed onto the occlusal surface of the posterior teeth (lubricated with a thin layer of Vaseline) and the patient is again instructed to close as if biting on the posterior teeth. A rigid bite registration has been made and can remain in the mouth while prepping teeth 20-29).After the anterior teeth are prepared, another patty of GC Resin Pattern is placed on the mandibular 4 anterior teeth and the patient is instructed to close into the POSTERIOR bite registrations. The CR and VDO have been perfectly recorded and final impressions and temporaries are fabricated. After the temps are placed and adjusted for uniform contacts, resin was added to the buccal cusps of non restored posterior teeth only after the usual adhesive protocol was initiated. The buccal resins may be retained for up to 10 years when indirect restorations are placed.