The personality of an individual is often judged by his looks. A beautiful smile always gives pleasure. However, the personality may be falsely interpreted by ugly and impaired teeth. The term ‘full mouth rehabilitation’ is used to indicate extensive and intensive restorative procedures in which the occlusal plane is modified in many aspects in order to accomplish restoration of the form and function of the masticatory apparatus to as near normal as possible. The word rehabilitate implies
‘To restore to good condition or to restore to former privilege’.
All patients requiring full mouth rehabilitation have one problem in common: stress and strain. Usually the stress is due to malfunction or to poorly related parts of the oral mechanism. Our objective is to minimize these stresses so that they are not destructive. In order to prevent this stress from being destructive, the best thing to do is to distribute it evenly or an as great area as possible, over as many teeth and as much tissue as possible, with the teeth providing a means by which the forces are distributed. The most common reason for doing full mouth rehabilitation is to obtain and maintain the health of periodontal tissues. Temporo-mandibular joint disturbance is another reason. Need for extensive dentistry as in case of missing teeth, worn down teeth and old fillings that need replacement. Full mouth rehabilitation is
indicated to restore impaired occlusal function, preserve longevity of remaining teeth, maintaining healthy periodontium, improve objectionable esthetics and eliminate pain and discomfort of teeth and surrounding structures. It is contraindicated for malfunctioning mouths that do not need extensive dentistry and have no joint symptoms should be best left alone. Prescribing full mouth rehabilitation should not be taken as a preventive measure unless there is a definite evidence of tissue breakdown. In short, it can be concluded that: No pathology- No treatment. The patients were classified into three categories –
Category 1 - Excessive wear with loss of vertical dimension.
A typical patient in this category has few posterior teeth and unstable posterior occlusion. There is excessive wear of anterior teeth, closest speaking space of 3mm and inter-occlusal distance of 6mm, there is some loss of facial contour that results in drooping of the corners of mouth and patients with dentinogenesis imperfecta with excessive occlusal attrition, around 35 years of age and appearing prognathic in centric occlusion also belong to this category.
Category 2 - Excessive wear without loss of vertical dimension of occlusion but with space available.
Patient has adequate posterior support and history of gradual wear, closest speaking space of 1mm and interocclusal distance of 2-3mm, continuous eruption has maintained occlusal vertical dimension leaving insufficient space for restorative material, history of bruxism and para-functional oral habits.
Category 3 - Excessive wear without loss of vertical dimension of occlusion but with limited space available
Posterior teeth exhibit minimal wear but anterior teeth show excessive gradual wear, centric relation and centric occlusion are coincidental with closest speaking space 1mm and inter-occlusal distance 2-3mm. It is most difficult to treat because vertical space must be obtained for restorative material and vertical space obtained by orthodontic movement.
Occlusal wear is most often attributed to attrition. Attrition is defined as ‘the wearing away of one tooth surface by another tooth surface’. The causes for worn dentition are loss of posterior support; posterior collapse that results from missing, tipped, rotated, broken down teeth, malposition and occlusal interference exerts undue force on anterior teeth resulting in teeth mobility and excessive wear of clinical crown.
Treatment is planned after communication and patient education are essential in order to match the dentist’s and patient’s definition of success. Treatment plan is divided into-
1. Pre- prosthetic phase
To develop proficiency in diagnosing the need of occlusal rehabilitation, periodontist, orthodontist, endodontist, oral Surgeon and prosthodontist must all be integrated in establishing an environment conducive to oral health. (POEOP)
2. Prosthetic phase
Prosthetic full mouth rehabilitation is divided into-
• Immediate treatment
• Definitive treatment
3. Maintenance phase