Full Mouth Reconstruction
Upper worn teeth restored with zirconia crowns.
Before & After
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Case Study
This case documents the treatment of a 58-year-old male patient who presented with significant tooth wear, missing teeth · Dr. Rodney Andrus
This case documents the treatment of a 58-year-old male patient who presented with significant tooth wear, missing teeth, and loss of vertical dimension. Through a phased treatment approach involving orthodontics and full upper arch zirconia reconstruction, the patient achieved improved esthetics, increased tooth display, and restored function that has been maintained for seven years.
Patient GB was a 58-year-old male who sought treatment at St. George Center For Specialized Dentistry. He had experienced progressive wear and deterioration of his upper dentition and was concerned about both the appearance and structural integrity of his teeth. The patient had a technical background and placed high value on thorough treatment planning and coordinated care between specialties.
The patient's primary concern was that his upper teeth looked "uneven, dull, and old." He was motivated to improve both the esthetic appearance and function of his upper arch.
Clinical examination and diagnostic records revealed missing and damaged teeth with large restorations throughout the upper arch. The patient exhibited significant tooth wear and loss of vertical dimension of occlusion. These findings indicated that the existing dentition was compromised and would continue to deteriorate without comprehensive intervention.
The primary treatment option considered was full upper arch zirconia crowns to address the structural and esthetic concerns. For the lower arch, two approaches were evaluated: full arch restorations or a more conservative approach utilizing orthodontics to idealize the lower dentition.
The treatment plan consisted of full upper arch zirconia crowns placed at an increased vertical dimension of occlusion. This approach was designed to address the compromised upper back broken teeth while providing increased tooth display and a brighter appearance. The patient and Dr. Andrus agreed on a more conservative approach for the lower teeth, utilizing orthodontics rather than full lower arch restorations. This decision allowed for the possibility of future restorative work on the lower arch if the teeth deteriorated over time, while immediately addressing the more severely compromised upper dentition.
Treatment began with comprehensive diagnostic records including mounted diagnostic casts and a diagnostic wax-up simulation. This planning phase allowed for visualization of the proposed treatment outcome and served as a blueprint for the restorative work. Provisional restorations were fabricated and delivered to test the treatment concept, verify the proposed vertical dimension increase, and allow the patient to adapt to the new occlusal scheme.
The treatment sequence was carefully coordinated with other specialists. An oral surgeon performed necessary extractions and implant placement to replace missing teeth and provide support for the final restoration. Concurrently, an orthodontist managed the alignment and positioning of the lower teeth to create an ideal opposing dentition for the upper reconstruction.
Following completion of the surgical healing period and orthodontic treatment, the final zirconia restorations were cemented to complete the upper reconstruction at the planned increased vertical dimension.
The final restorations were fabricated using 4Y zirconia. This material provided the strength necessary for full arch reconstruction while offering acceptable esthetics for the patient's goals.
Following completion of treatment, the patient experienced noncompliance with wear of his lower retainer. This resulted in some minor relapse of his orthodontic treatment. While this complication did not require retreatment, it illustrates the importance of patient compliance with retention protocols, particularly in cases where prevention and maintenance depend on continued use of appliances.
The patient reported good comfort and function after seven years of clinical service. The reconstruction has proven durable and has met the patient's functional and esthetic expectations over an extended follow-up period. Despite the minor orthodontic relapse due to retainer noncompliance, the overall treatment result has remained stable and satisfactory to the patient.
This case demonstrates an important principle in treatment planning for full mouth reconstruction: not all compromised teeth require immediate restoration. When some teeth have minimal tooth structure or the damage is not severe, portions of a comprehensive treatment plan can be phased over time to maintain a conservative approach. This staged treatment strategy offers two significant advantages.
First, it preserves tooth structure and delays definitive restoration of teeth that may have years of remaining service life, allowing the patient to defer treatment costs and potentially benefit from advances in dental materials and techniques. Second, phasing treatment can make comprehensive care accessible to patients with only moderate financial resources who might otherwise delay all treatment due to cost constraints. By prioritizing the most compromised areas first, patients can achieve significant functional and esthetic improvements while planning for future phases as needed and as finances allow.
Before & After
Full Mouth Reconstruction
Upper worn teeth restored with zirconia crowns.
Increasing the vertical dimension of occlusion means restoring the height of the bite that has been lost due to tooth wear over time. When teeth wear down significantly, the distance between the upper and lower jaws decreases. By carefully increasing this dimension during reconstruction, we can restore proper function, improve facial esthetics, and create more visible tooth display when smiling.
Provisional restorations serve as a testing phase for the treatment plan. They allow the patient to adapt to the new bite height and tooth positions before the final restorations are made. This concept testing phase ensures that the patient is comfortable with the planned changes and allows for any necessary adjustments before committing to the permanent zirconia crowns.
The patient and Dr. Andrus agreed on a more conservative approach for the lower arch. Since the lower teeth were not as severely compromised as the upper teeth, orthodontics could idealize their position without removing tooth structure for crowns. This conservative approach preserved natural tooth structure and allowed for the option of future restorations only if the lower teeth deteriorate over time.
Yes, when appropriate, comprehensive treatment can be phased over time. If some teeth have minimal damage or can remain functional, treating the most compromised areas first allows patients to achieve significant improvements while planning for future phases as finances allow. This approach makes comprehensive care more accessible while still addressing urgent functional and esthetic concerns.
While individual results vary based on oral hygiene, occlusal forces, and other factors, this patient has experienced good comfort and function for seven years following treatment. Zirconia is a durable material well-suited for full arch reconstructions, and with proper care and maintenance, patients can expect long-term clinical service from their restorations. Some studies point to an expected longevity average of 10-15 years, but everyone knows that Dr Andrus' crowns are well above average!
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