Diagnosis and Reconstruction Technic in Full Mouth Rehabilitation

Abstract

O n e of the primary objectives of good dentistry is the maintenance of healthy teeth and their supporting structures. A great impediment to achiev­ ing this goal is malocclusion, which is responsible for the loss of teeth through trauma. It is also responsible for the resorption of the bony support ridges under both partial and full dentures. There are three ways of overcoming this handicap of malocclusion and securing a functional occlusal balance: by ortho­ dontia, by grinding to eliminate the trauma caused by cusp interference, and by full mouth reconstruction. In this paper, we are chiefly interested in the discussion of the last of these methods; namely, full mouth reconstruction as it pertains to the securing of a functional occlusal balance. To understand the problems involved in complete rehabilitation of the masti­ cating mechanism, one requires a thorough knowledge of the associated dental sciences of anatomy, physiology, histology, biology and physics. The causes of the various conditions which are present must be recognized, as must be the limitation in the use of the three methods of treatment mentioned above. In order to secure the best results it is frequently necessary to combine ortho­ dontics and grinding in cases in which full mouth reconstruction is being under­ taken. Full mouth reconstruction may be em­ ployed ( i ) when the patient has lost vertical dimension, (2) in cases in which restorative work is necessary although vertical dimension has not been lost, and (3) for purely cosmetic reasons. There are definite symptoms of lost vertical dimension, objective and subjective. The objective symptoms are plainly visible; teeth show attritional wear, there is a marked change in facial expressions upon swallowing, a sagittal displacement of the mandible in closure is apparent, or . there may be found a deep overbite of the anterior teeth. The subjective symptoms are pain or soreness in the mandibular joint, crack­ ing noise in the joint, dizziness (fre­ quently after eating), localized head­ aches, subluxation of the mandibular joint, and a burning sensation of the sides of the tongue. One of the chief causes of failure of so-called “bite open­ ing” technics has been due to a disregard of the importance of maintaining a normal freeway space. “Freeway space” is a term which defines the space that exists between the teeth when the jaw is at the physiologic rest position. Niswonger1*2 first recognized that this physiologic rest position was constant throughout life. Thompson and Brodie3 have confirmed his findings. Thompson4 examined many cases in which the verti­ cal dimension had been increased by means of full dentures but no allowance