Full Mouth Rehabilitation – How to Protect Your Esthetics by Dr. Paul Lee

64 year old male, single dad,  presented and wanted to restore his smile. He had excessive and destructive wear of more than  3+mm of incisal length. He had no pain and TMJ presented with no issue, with an edge to edge occlusal scheme pre-operatively, he would be classified as a very heavy destroyer.

After deprogramming, we took records for the fabrication of a wax up that would improve overjet and overbite relationship and achieve class I bite. This required a Full Mouth Rehabilitation and followed the Clinical Mastery Series protocol taught in Ultimate Occlusion Level 2 and Full Mouth Rehabilitation Live Patient Programs.

Patient was ultimately restored with e.Max Press MTBL2 ingot with a minimal cutback. Even with an ideal occlusal scheme, this patient required night time protection due to the parafunctional clenching and grinding in order to preserve the porcelain. This requires managing your patients expectation. When you encounter this severe wear and attrition, providing guidance to your patient that includes verbiage that says, “I can re-design and provide man made enamel to restore your teeth and get them to a comfortable more balanced position. Enamel is the strongest substance in the human body — so if you destroyed what God gave, the porcelain will also be at risk long term without proper protection. In your case that is a nighttime piece of plastic that will save you thousands in upkeep.” When you have this discussion prior to restoring the patients dentition, then the ownership of a chip or fracture is on the patient. It is a commitment that requires their intervention and the pre-framing that your treatment will require upkeep.

 

As a CMS Faculty member, I feel very confident in the process and system that gets patients back to health and my ability to provide it. And this pearl in managing patients expectations has been an important part of my treatment protocol.

Case by CMS Faculty Dr. Paul Lee