Full mouth rehabilitation basics of investing
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Similar failures were observed by Stuart due to unequal wear of the buccal and lingual cusps causing deflective occlusal contacts with a loss of centric-related closure, causing patients to bite their cheeks and tongue [ 12 ]. Stuart and Stallard [ 12 ] observed that the upper lingual cusps stamp into lower fossae and lower incisors, canines and buccal cusps stamp into the upper fossae.
In mutually protected articulation, the anterior teeth protect the posterior teeth in eccentric movements and conversely have the posterior teeth protect the anterior teeth in maximal intercuspation without any deflective occlusal contacts or interferences in speech [ 15 , 16 ]. Requirements for a mutually protected occlusion included that the cusps of posterior teeth should close in centric occlusion with the mandible in centric jaw relation, while, in lateral excursions only opposing canines should contact and in protrusion only the anterior teeth should contact [ 15 ].
Centric relation was the rearmost, uppermost, and midmost position of condyle in the glenoid fossa, which no longer holds true. The Point Centric concept was proposed wherein the condyles should seat in a rearmost position in the mandibular fossae exactly at the time when maximum intercuspation of the teeth occurs in the retruded contact position. In this concept, supporting cusps must make occlusal contact at a point when the condyles are only, and precisely, in centric relation [ 17 — 19 ].
In , Gysi described the masticating functions of the teeth and he was the first to describe the scheme of canine-protected occlusion [ 21 ]. Thus preventing any force other than along the long axis to be applied to the opposing incisors, premolars and molars [ 13 , 22 ].
It relies on cusp-to-surface mechanics [ 23 ]. Long centric accommodated changes in head position and postural closure. The measurable amount of long centric needed is the difference between centric-related closure and postural closure which is rarely more than 0. Pullinger et al. According to Wiskott and Belser, in natural dentition, occlusal contacts are few and not ideally placed.
Also functional and parafunctional forces are not directed along the long axis of the tooth. Based on this, they proposed a simplified occlusal scheme in which; one occlusal contact per tooth usually a cusp-fossa relation is sufficient instead of a tripod contact, all interproximal contacts should be proper and tight as they stabilize the tooth mesio-distally, anterior disclusion mechanics should be applied so that posteriors do not experience any interference on lateral excursive movements, antero-posterior freedom of movement should be provided which is achieved by having concave internal slopes on the cusps of posterior teeth [ 29 ].
This technique helps maintain vertical dimension and allows chewing due to cusp-fossa relation. The overall numbers of occlusal contacts are reduced and it can be used for small as well as extensive restorations.
This design ensures occlusal stability and satisfies esthetic demands. The system can be adapted to most anterior guidances and varying degrees of group function. Occlusal adjustment is simple [ 29 ]. An organized approach to oral rehabilitation was introduced by Pankey [ 30 , 31 ] utilizing the principles of occlusion advocated by Schuyler [ 11 ], known as the Pankey—Mann—Schuyler PMS Philosophy of Oral Rehabilitation [ 26 ].
As a modification of canine disclusion, the PMS philosophy [ 30 ] was to have simultaneous contacts of the canine and posterior teeth in the working excursion group function , and only anterior teeth contact in the protrusive excursive movement [ 31 , 34 ].
It was used to establish functional occlusal plane on the mandibular teeth [ 30 ]. In this, both maxillary cuspids had to be in good functional contact in centric and eccentric positions before beginning the reconstruction of the posterior teeth. If not it must be obtained by reconstruction of the cuspids even if there is no caries [ 31 ].
In PMS technique, the incisal guidance was the developed intraorally with acrylic resin to satisfy esthetic and functional requirements. Optimal occlusal plane is selected as dictated by the curve of Monson and mandibular posterior teeth are restored in harmony with the anterior guidance such that they will not interfere with the condylar guidance. Maxillary posterior occlusal surfaces are developed after the completion of mandibular restorations by the functionally generated path technique FGP [ 32 ].
Use of FGP records allows eliminating all occlusal interferences and establishing functional form of the occlusal surfaces of the restoration. The PM philosophy was developed and its use advocated on a non-arcon articulator, which may not accept interocclusal records made at increased OVD [ 35 ]. Early gnathologic concepts focussed primarily on the condylar path and it was believed that anterior guidance was independent of the condylar path [ 8 ].
However, Hobo and Takayama [ 36 ] in their study revealed that anterior guidance influenced the working condylar path and concluded that they were dependent factors. Hobo adopted the concept of posterior disclusion and gave the Twin-tables Technique. According to him, posterior disclusion is dependent on; the angle of hinge rotation created by the angular difference between anterior guidance and condylar path, and on inclination and shape of posterior cusps which helps in controlling harmful lateral forces.
Each plan differs depending on your goals and budget. However, there are several common procedures involved in teeth reconstruction. Let's take a look at them now. Bruxism Treatments Bruxism treatments are advised to help patients who struggle with teeth grinding and their associated symptoms. Cosmetic Dentistry Cosmetic dentistry procedures are very common with teeth restoration efforts. This will ensure your teeth and gums are healthy and you end up with a beautiful smile. Implants If you have missing teeth, your dentist will advise you to get implants.
They'll replicate your tooth from root to crown and no one will know the implants aren't real teeth. Not addressing an off-balance bite can lead to pain and problems with your teeth in the future. Oral Surgeries You may require oral surgery as part of your dental reconstruction. Your surgery may include root canal therapy, soft and hard tissue grafting, and tooth extractions. Orthodontics Orthodontics may also be advised for patients with misaligned teeth.
Periodontal Treatments And periodontal treatments may be part of your teeth restoration efforts. Periodontal surgery, root planing, and scaling are not uncommon procedures. What Makes a Good Candidate for Teeth Reconstruction If you're someone who has suffered through multiple oral health problems, whose currently oral health problems are affecting most or all of your teeth and its supporting tissues, you're a good candidate for full mouth rehabilitation.
Younger patients have less risk to worry about during their dental procedures. However, if you are older or suffer from health issues, your dentist can also create a treatment plan that involves fewer invasive procedures. Share Your Full Health History With Your Dentist Be sure to provide your dentist with a complete and thorough health history before you embark on any surgeries. And make sure to provide your dentist with a full list of any medications you're taking, including any vitamins and minerals you take.
Be advised that patients who aren't willing or cannot maintain good oral health or those who are taking illegal drugs may not experience lasting, positive results from their dental treatments. The Cost of a Full Mouth Reconstruction There are a variety of factors that will affect the total cost of your dental reconstruction. Different dentists price their services differently. If you choose a dentist with more experience, they will most likely charge you more. However, they're also more likely to provide you with a higher level of quality based on their extensive experience.
How much planning is required to determine your course of treatments will also affect the price of a full teeth reconstruction. The more planning required, the more expensive it will be. The current condition of your teeth is also a huge factor in determining the price. If your teeth are in reasonably good condition, less work is required. If, however, your gums and teeth are both quite damaged, more extensive work is needed, which will drive up the costs. The type of technology used and the types of restorations you require will also affect the final price of the reconstruction.
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