Traditionally full mouth restoration means that the patient must go through the process of having all of their teeth prepped for crowns. Not only is this very expensive, making the reality of full mouth rehabilitation cost prohibitive, but it is extremely invasive.
Dr. Hal Stewart, Dr. Craig Herre, and Dan O’Rourke, CDT, founding partners of the Texas Center for Occlusal Studies, have dedicated themselves to teaching dentists the sound biologic principles of occlusion. They have developed technical procedures to restore and rehabilitate full mouth cases using minimally invasive techniques that are predictable, stable, and affordable for the average patient. This philosophy and technique is called BioRejuvenation Dentistry. The following case by Dr. Hal Stewart illustrates a typical BioRejuvenation Dentistry case.
Patient Chief Complaint
Gregg’s chief concern was the noticeable wear of his teeth and his premature facial aging. Gregg had been to several dentists in the San Diego area and all treatment plans consisted of full mouth crowns. While Gregg was not completely opposed to this, he had a desire to seek treatment that might salvage his teeth versus grinding them down. Gregg, who lives in San Diego, found Dr. Stewart via the internet when he searched ‘conservative full mouth rehabilitation’.
At Gregg’s initial consultation, Dr. Stewart explained that he could predictably and successfully treat his tooth wear by addressing his whole system and not just his teeth. Dr. Stewart explained that by centering his TMJ it would relax Gregg’s facial and neck muscles at the ideal position required to restore his bite and smile. This made perfect sense to Gregg as he had always thought that his problem lay deeper than just his teeth. Plus, the fact that Dr. Stewart could treat this minimally invasively made it even more appealing to him.
The examination revealed generalized attrition of all of Gregg’s teeth resulting in a decreased vertical dimension of occlusion and a more aged look. He was suffering from facial muscle tension and regular headaches. Gregg had a few old crowns and an old lower right bridge which were in need of replacement. Other than these restorations, his remaining teeth had no caries or restorations in them.
Physical therapy of Gregg’s TMJ was initiated with Condylar Centering Orthotic (C2O) therapy. This is a maxillary hard acrylic orthotic that creates a biologic anterior proprioceptive guiding environment in the stomatognathic system. It was regularly and methodically adjusted on a weekly basis utilizing dead soft shims. The condylar repositioning was tracked with a MCD Instrument (ad2usa.com) to verify complete seating of the condyles. When the C2O therapy was completed and verification of the seated condyles was made, a hinge-axis recording was taken along with a final centric open bite. This allowed for accurate vertical dimension restoration of the occlusion. A final DX wax-up was completed with excellent centric stops and anterior guidance.
By utilizing adhesive composite rejuvenation techniques as taught by the faculty at The Texas Center for Occlusal Studies, the wax up was predictably and carefully duplicated in the mouth to within 10 microns of accuracy creating a harmonious anterior proprioceptive guided chewing system at the improved vertical dimension of occlusion. The composite used was G-aenial Universal Flow (GC America). This is a unique highly filled nanohybrid flowable composite with excellent wear resistance and polishability.
Preservation of natural tooth structure is critically important and every clinician should consider this when creating any treatment plan whether it is for one tooth or for full mouth rehabilitation, as is the case here. One of the most outstanding features of this type of treatment is that, with the exception of three old crowns and his lower right bridge needing replacement, Gregg’s mouth was restored with absolutely no tooth structure being ground down or permanently altered.
Dr. Stewart has been rejuvenating mouths in this manner since 2001, and he has many cases that are still going strong with little to no maintenance required over the years. This is one of the features of the BioRejuvenation Dentistry treatment that Gregg, and many other patients, find so appealing.
The final results are not only functional but extremely esthetic. Note the changes not only in the teeth themselves but in the face and eyes of the patient. By restoring the occlusion to a stable condylar position in centric relation and at a restored vertical dimension, not only do the teeth look great but the facial muscles as well as the muscles of mastication are relaxed and functioning harmoniously with one another. The occlusion is ideal so the pressure on the teeth is minimal resulting in long-term stability and esthetics. Gregg feels great and he loves the way his smile and entire face have been transformed. This is typical of the results that we see at The Texas Center. Equally as important is that this result was accomplished while preserving 100% of Gregg’s natural tooth structure and at a fraction of the cost of a full mouth case with all crowns.