full mouth rehabilitation of the patient with severely worn dentition a case report

Is full-mouth rehabilitation of severely worn dentition possible?

The patient’s severely worn dentition was restored, and a stable, comfortable occlusion was achieved, with care taken to minimize biomechanical risk. Full-mouth rehabilitation of the worn dentition presents the clinician with many challenges and potential pitfalls.

What are the key features of full mouth rehabilitation?

KEY WORDS: Full Mouth Rehabilitation, Vertical Dimension, Anterior guidance. the appearance of the patient and corrects imperfections in the occlusion. Vertical di mension, centric relation, speech a nd m uscle tone are essential fundamentals of f ull m outh rehabilitation.

What is the philosophy of mouth rehabilitation?

There are many concepts followed for mouth rehabilitation like Hobo's philosophy and Pankey Mann Schuyler philosophy. Pankey Mann Schylur philosophy is one of the most accepted concept with well-organized procedure that permits smooth progresses with less wear and tear on the patient.

Is there space for restoration of severely worn dentition?

However, the rehabilitation of the severely worn dentition is challenging when the space for restoration is not sufficient. In 1975, Dahl et al.6reported the use of a removable cobalt-chromium anterior occlusal device to an 18-year-old patient with advanced localized attrition to generate interocclusal space for subsequent restoration.

What is gradual wear of the occlusal surfaces of teeth?

The gradual wear of the occlusal surfaces of teeth is a nor- mal process during the lifetime of a patient. However, exces- sive occlusal wear can result in pulpal pathology, occlusal dishar- mony, impaired function, and esthetic disfigurement.1Tooth wear can be classified as attrition, abrasion, and erosion depending on its cause.

How is vertical occlusion maintained?

In many cases, the vertical dimension of occlusion (VDO) is maintained by tooth eruption and alveolar bone growth. As teeth are worn, the alveolar bone undergoes an adaptive process and compensates for the loss of tooth structure to main- tain the VDO.

Why is differential diagnosis not always possible?

A differential diagnosis is not always possible because, in many situations, there exists a combination of these process es.2Therefore, it is important to identify the fac- tors that contribute to excessive wear and to evaluate alteration of the VDO caused by the worn dentition.3.

Where is the Department of Prosthodontics?

Department of Prosthodontics, School of Medicine, Ewha Womans University, Seoul, Korea. The severe wear of anterior teeth facilitates the loss of anterior guidance, which protects the posterior teeth from wear during excursive move- ment.

Should VDO be conservative?

Therefore, VDO should be conservative and should not be changed without careful approach.4,5Especially, increasing the VDO in bruxers puts a severe overload on the teeth and often results in the destruction of the restorations or teeth themselves.4.

Why are all teeth planned for restorative correction?

All teeth were planned for restorative correction due to the severity of wear on the anterior teeth and the need to increase the occlusal vertical dimension (OVD.) 3 To minimize the biomechanical risk of tooth preparation, adhesively retained, enamel-supported restorations were planned wherever possible.

Why is posterior tooth wear not consistent with sleep bruxism?

Posterior tooth wear was not consistent with sleep bruxism because cusp tips were preserved and secondary occlusal anatomy was present.

What is staged restoration?

When presented with a full-mouth rehabilitation of a worn dentition, a staged approach to restoration offers the clinician the chance to assess how a patient will respond to occlusal and esthetic changes. In this case involving an older patient who was concerned about wear on his teeth, a systematic, step-by-step process was employed to develop a comprehensive and specific treatment plan that would achieve all treatment goals. The patient’s severely worn dentition was restored, and a stable, comfortable occlusion was achieved, with care taken to minimize biomechanical risk.

What is periodontal pocket reduction?

This provided more favorable clinical crown heights for the necessary restorative treatment. Teeth Nos. 6 through 11 and 23 through 26 had esthetic crown-lengthening surgery to expose the entire anatomical crowns. Scaling and root planing was also performed during the periodontal surgery appointments. After the completion of initial therapy and surgery, the patient was placed on a 3-month maintenance schedule.

What is a PFM crown?

Initially, since a metal ceramic FPD was planned for teeth Nos. 7 through 9, porcelain-fused-to-metal (PFM) crowns were planned for all porcelain-faced, cohesively retained restorations to maximize the esthetic result by using the same type of veneering porcelain.

How deep is the probing depth of a tooth?

Periodontal: The examination revealed probing depths of 4 mm to 8 mm on the lingual surfaces of posterior teeth with areas of bleeding. Facial probing depths were primarily 2 mm to 3 mm, with a few 4-mm measurements and an isolated 5-mm pocket on the distobuccal of tooth No. 31. No gingival recession was noted. In fact, the patient’s free gingival margins were equal with or coronal to the cementoenamel junction (CEJ). The patient exhibited thick, buttressing alveolar bone. Moderate horizontal bone loss with pseudo- and real periodontal pocketing was present. He was diagnosed American Academy of Periodontology (AAP) type III, moderate periodontitis.

How is caries risk assessed?

Biomechanical: Caries risk assessment was evaluated using a self-reported questionnaire for risk factors, an adenosine triphosphate (ATP) bioluminescence test, radiographs, and a clinical examination. 1 The patient had no cavities within the past 3 years, and no carious lesions were currently present. The ATP bioluminescence test was low (less than 1,500 RLU). His caries risk assessment was determined to be low. Defective restorations were present on teeth Nos. 14, 18, and 31. Many questionable restorations were noted, including the fixed partial denture (FPD) Nos. 7 through 9 ( Figure 2 ). All molars were structurally compromised. While the caries risk was low, the patient’s overall biomechanical risk was increased due to the number of restored teeth, structurally compromised teeth, and failing restorations.

What is the goal of full mouth rehabilitation?

DISCUSSION AND CONCLUSION : The goal of full mouth rehabilitation should be the res toration and maintenance of the health of the entire oral mechanism. It demands rehabilitation wi thin the physiological and functional harmony of the stomatognathic system. Careful evalu ation of the etiology, history and factors relative to occlusal vertical dimension are essenti al to appropriate treatment planning. The complexity in treating full mouth rehabilitation cas es is not only because of its long treatment time but also at times the lack of clarity in the t reatment objective

What was the prepared teeth ma de with?

the prepared teeth were ma de with irreversibl e hydrocoll oid in stock trays (Fig. 4). The

How much dimension was raised in the occlusal sp lint?

dimension was raised by 2 mm in the occlusal sp lint (Fi g. 2) The patient w as asked to wear the

What is an occl usal splint?

verify the lost ve rtical dimension. Occl usal splint is used as a means to raise the vertical

Why do wearfacets occur?

wearfacets because of severe worn out teeth. Pankeymann- Schuyl er philosophy was followed

What record was used for facebow transfer and mandibular cast?

Facebow transfer and mandibular cast was mounted using centric relation record. All the

Is it critical to verify loss of occlusal wear?

eruption depending on the etiology of the wear. Therefore, it i s critical to verify loss of occlusal