Customizing Every Step of a Full Mouth Reconstruction

Dr. Casagrande: Many of my patients require more than just a single crown or even a area of crowns. They, in fact, many times have destroyed all of their teeth on both the upper and lower jaw. Whenever patients have damage to both jaws of teeth, it is imperative that they have what is called full-mouth reconstruction. You cannot fix a case that has significant damage on both jaws by only doing one jaw at a time. Therefore, full-mouth reconstructions require more expertise and therefore are just, by nature, are much more difficult. However, if the cause of the damage to the teeth is not discovered, then why will this reconstruction last, when the last one did not? Or why will this be worth the money I'm going to spend to have this reconstruction done? In our office, we always do a reconstruction three times. We take models of the existing teeth, at the existing bite. And everything we plan to do to the patient, we do on those models in the laboratory, in wax. We bring that back and we show the patient and their family members. We look at photos, we look at measurements and aesthetics and proportions on the face, and we determine if those wax-up modifications make sense. Then we proceed to what is called provisional temporaries. In other words, we make those same crowns now out of polished, high-quality acrylic. And those restorations are placed in the patient's mouth and worn, if you will, test driven. If you're not comfortable with your provisionals, you're not going to be comfortable with your long-term, permanent porcelain restorations. Therefore, we work out any issues of aesthetics, function with the temporaries, before proceeding to the finished ceramic restorations. And then finally, we make the all-porcelain restorations, one arch at a time, completed to give a final result that the patient is very happy with, and that is extremely appropriate from a functional point of view.