Full mouth rehabilitation.
A reconstruction is a treatment plan carried out over months. The restorations are the last part of it and the least likely place for it to go wrong.
Diagnose before designing
Establish what destroyed the dentition before deciding what to build. Attrition from parafunction, erosion from dietary or gastric acid, abrasion, caries, periodontal collapse — each has different implications and each continues after treatment if it is not addressed.
Restoring an eroded dentition without managing the acid source reproduces the same pattern around new restorations. Restoring a bruxing patient without protection transfers the fracture from teeth to ceramics.
This step determines whether the reconstruction lasts a decade or three years, and it is the one most often compressed.
Records the laboratory needs
A full photographic series, mounted study casts with a facebow record, complete radiographic assessment, and a periodontal chart. From those comes the diagnostic wax-up, which is the first physical statement of what the case is trying to achieve.
Everything afterwards is measured against the wax-up, which is why it is worth doing properly rather than approximately.
For a case being planned, a conversation with the laboratory at this stage is worth considerably more than written instruction later.
Vertical dimension
Where wear has been substantial, the space needed for restorations does not exist at the patient's current closure, and creating it by reduction alone would destroy what remains.
Increasing the vertical dimension creates space across the whole arch at once. It requires assessment of freeway space, existing muscular comfort and phonetics, and it has to be tested before it is committed to.
The provisional phase is where that testing happens. The articulator cannot predict adaptation.
Sequencing
Stabilize first — caries control, endodontics, periodontal therapy, extraction of teeth that cannot be saved. Building definitive restorations on an unstable foundation is the most expensive error available in this kind of case.
Then provisionalize, and let the provisional scheme prove itself over weeks or months. Then restore definitively, by which point very little should be uncertain.
Record the working provisionals and instruct the laboratory to reproduce them rather than the original wax-up. See planning a full mouth case.
Material strategy across the arch
It is rarely correct to use one material everywhere. Posterior units in a bruxing patient want strength; anterior units want optical performance; abutments under partial dentures want metal.
What matters is coherence. Adjacent units in different materials at the same nominal shade will not look identical, so material changes belong where they are least visible — typically at the canine or first premolar.
Decide the strategy across the whole case at the outset rather than tooth by tooth as each is prepared.
Be realistic with the patient
Time, cost, number of appointments and interim appearance all need stating plainly at the outset. Patients tolerate a long treatment they understood in advance; they do not tolerate one that keeps extending.
It is also worth being explicit that a reconstruction is maintenance-dependent. These cases need review, the splint worn, and components repaired or replaced over their life.
A patient who understands that from the start becomes a partner in maintaining the work. One who believed it was finished at delivery does not.
Staging with the laboratory
A reconstruction moves between practice and laboratory repeatedly — wax-up, provisional fabrication, provisional adjustment recorded, framework try-ins, definitive restorations, often in segments.
Sequence the whole case at the outset rather than appointment by appointment, so the patient gets a realistic picture of the number of visits and the period involved.
Restoring in segments, so a stable occlusal reference always remains, is frequently safer than restoring a whole arch in one step — particularly where the vertical dimension is being changed.
Protecting the result
If parafunction caused the original destruction, restoring the teeth has not treated it. A nightly occlusal splint is usually the single most cost-effective element of the plan.
Present it as part of the treatment from the beginning — built into the fee, the consent discussion and the review schedule. See occlusal splints.
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Digital scans and conventional impressions are both accepted. Cases move by UPS and Purolator, and Fairmont works with practices throughout British Columbia and across Canada.