Full Mouth Reconstruction - by John Utama

7/25/2019 Full Mouth Reconstruction - by John Utama

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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 highestquality 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 astate, 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!


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Below is another case with grossly broken down teeth.


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In this case, there are also multiple missing teeth, gradually changing the

bite. The destructive process has been occurring throughout the patientslife, who is now in his late 50s. As discussed

on the

about metab, 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
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mind can be most resilient in ignoring the bodys cries for help by

exhibiting the above mentioned symptoms, the body ultimately has thefinal 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.


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Photographs (profile and inside the mouth) just like xrays, photos are

medical records. We look at the patients profile to assess both functionand aesthetics.

Impressions (mould) of the teeth study models are constructed to assess

the biteSleep study If sleep disordered breathing is suspected, a sleep studyis

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.
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Waxed mock-up models are then carefully constructed as shown in thephotos below.


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The wax build-up on the models also tidies up the teeth to their optimalaesthetics 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.


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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 thenwear 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. Apredetermined 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.


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

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

Another subsequent

one, two or more appointments can be made for moreadjustments. 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.


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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 personswell-being

as a whole.

Fees vary from $20,000.00 to $50,000.00 depending on the complexity of

each individual case.


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John Utama BDS MBA

Robina Town DentalDentists @Capri

Gold Coast Australia

www.thewholedentist.com

[email protected]

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Full Mouth Reconstruction - by John Utama