Full Mouth Reconstruction

By John Utama
Full mouth reconstruction is the Rolls Royce of dentistry with the Rolls
Royce price tag!
Essentially, every single tooth in the mouth is crowned with the highest
quality porcelain. In some cases, additional periodontic, orthodontic, root
canal and implant treatments are carried out in conjunction with the crown
work. The objective is to restore the existing teeth in the mouth to be as
close as possible to their original condition, with optimal function and
cosmetics.

Who needs full mouth reconstruction?

For different reasons, and sometimes there are really good reasons, some
people mainly over 40 years old have neglected their teeth. The
combination of poor diet and oral hygiene would have destroyed a
substantial amount of tooth structure and gum tissues.
The photo below shows an extreme example of broken down teeth. There
are numerous reasons why people may have neglected their teeth to such a
state, the most common is fear. They may have had a traumatic experience
in the past that stopped them from seeing the dentist. Or they may have
suffered from certain illnesses or physical disabilities that compromises the
ability to clean teeth. And some would say they had been too busy with
their career and/or looking after the children. On the other hand, there are
no excuses for the rest.


What a dentastrophy!







Below is another case with grossly broken down teeth.





In this case, there are also multiple missing teeth, gradually changing the
bite. The destructive process has been occurring throughout the patients
life, who is now in his late 50s. As discussed on theabout me tab, the
mouth tells a lot of story about the patient. Typically, the patient suffers
from sleep disorders, headaches and clicking TMJ joints. The toxic bite is
very deep and the lower jaw is pushed back bringing the tongue with it,
narrowing the airway. The patient has been aware that he has many dental
issues and finally decided to do something about it now. Looking at many
broken down teeth over the years and the associated damage to the other
parts of the mouth, I do admire the ability of the human body (and the
mind) to adapt to these conditions for so many years. However, while the

mind can be most resilient in ignoring the bodys cries for help by
exhibiting the above mentioned symptoms, the body ultimately has the
final say, it ultimately sends pain signals to the brain, severe enough not to
be ignored.

What can we do?

Not so long ago, the only solution is to remove every single tooth and to
place dentures.
Fortunately these days, the mouth can be restored to almost its original
function by building up the teeth.

Can we do it?


Yes, we can, Bob the builder says.

First, we must take records:

X rays to check the conditions of the existing teeth and the TMJ joints.
The main consideration is to assess the roots of the teeth, whether they are
going to be strong enough to accommodate the crown.
Scans 3D scans may be required if airway problems are suspected.





Photographs (profile and inside the mouth) just like xrays, photos are
medical records. We look at the patients profile to assess both function
and aesthetics.
Impressions (mould) of the teeth study models are constructed to assess
the bite
Sleep study If sleep disordered breathing is suspected, a sleep study is
strongly recommended.

We then take the record of the bite in the neuromuscular position. The
neuromuscular position is where the lower jaw is in the most
physiologically neutral position, where the jaw wants to be.
The bite is then transferred to the models in the laboratory.







Waxed mock-up models are then carefully constructed as shown in the

photos below.





The wax build-up on the models also tidies up the teeth to their optimal
aesthetics appearance.

Preparation appointment
This is a big appointment, under local anaesthetics, every tooth is
prepared, any existing old fillings are removed and all decay cleaned.
Impressions of the teeth are then taken, and finally the temporary crowns
are inserted. The temporaries are made of acrylic constructed from the
waxed up models.

The appointment may take up to 8 hours, I usually schedule the whole day
for this procedure, with multiple breaks in between. The patient will then
wear the temporaries for about 4 weeks while the porcelain crowns are
being constructed in the laboratory.


The patient is warned before the insertion of the temporaries that there will
a big change in the appearance of the teeth, some patients may find the
teeth to be too big. This is quite normal, as the teeth have been shaped
and sized to approximate the original condition of the patients teeth, and
in broken down teeth, they are mostly worn down. Its not surprising that
patients will find the new teeth to be big as they are used to the
appearance of their worn down teeth for about half of their lives. A
predetermined formula of the widths and lengths of every tooth has been
applied on the waxed up models.
The temporary crowns are all joined together. Oral hygiene is most
important while wearing the temporaries., as flossing is not possible.
Keeping the gums healthy is is of primary importance.
I also usually choose quite white temporaries, white teeth reflect youth
and health. Many patients are anxious of having teeth that are too white,
that look fake. I would encourage them to give the white teeth a chance,
otherwise they will never know. At the end of this appointment, I dont
particularly want the patient to look too hard at their new teeth, as their
eyes need to adjust to the new appearance, additionally, the lips are
swollen up from the anaesthetics.
After the anaesthetics wear off, there could be pain and sensitivity. In rare
cases, one or two teeth will flare up which may require root canal therapy.
The reason is that some of these teeth may have pre-existing conditions,
the preparation procedure aggravated the teeth and tipped them to flare up.





One week after the preparation , an appointment is made to review the

patients feedback. Any changes to the temporaries can be made at this
appointment, according to the patients directions.

Another subsequent one, two or more appointments can be made for more
adjustments. The objective is for the patient to be happy with the
appearance of the temporaries, and to be comfortable with the bite.
When these objectives are achieved, the porcelain crowns insertion will be
made, this procedure will also take a whole day.

Insertion appointments
Under local anaesthetics, the temporaries are removed and the porcelain
crowns are cemented individually.





Full mouth reconstruction is one of the most rewarding and challenging

procedures in dentistry. This is one time when we as dentists have the
chance to make a difference in peoples lives in restoring the persons
well-beingas a whole.
Fees vary from $20,000.00 to $50,000.00 depending on the complexity of
each individual case.

John Utama BDS MBA

Robina Town Dental
Dentists @Capri
Gold Coast Australia
www.thewholedentist.com



johnutama@me.com