An Outline For Full-Mouth Reconstruction
Gary Alex, DMD

  1. Treat issues requiring immediate attention (pain, infection, broken teeth, etc).
     
     
     
     
  2. Perform comprehensive examination and work-up (consult with specialists as required).
  3. Fabricate diagnostic wax-up (we bill patient the cost of the wax-up).
  4. Present case to patient.
  5. Extract hopeless teeth.
  6. Prepare teeth as treatment planned and fabricate provisionals using templates made from wax-up (alternative is to have laboratory fabricate provisionals).
  7. Periodontal treatment/surgery as required (while the patient is in provisionals that can be removed for access).
  8. Following healing from any periodontal treatment, reassess the teeth and supporting structures and modify treatment plan if necessary.
  9. Create final preparations and impressions. Fabricate second set of provisionals or modify first set as required.
  10. Carefully evaluate provisionals for esthetics, function, comfort, and stability. Make sure joints and supporting structures are also stable and comfortable. Work the case out in provisionals!
  11. Send various photographs and solid model of the provisionals to the laboratory to use as a guide in fabrication of restorations.
  12. Schedule various try-in appointments depending on the specific nature of the case. Place finished case once it is approved by both patient and dentist.

While there are many different schools of thought on how to sequence a full-mouth reconstruction, I like to first determine where I want the incisal edge position of #8 and #9 to be. This is crucial for esthetics and phonetics. I then determine where I want the lower incisal edges to be. The incisal edge position of the lower anterior teeth helps determine the lingual contours of the upper anterior teeth. I like to then set up an “ideal” lower incisal and occlusal plane and match the upper to this. It is extremely important to have properly positioned and contoured lower incisal edges and a correct incisal and occlusal plane established. Almost all my full-mouth cases are built in centric relation.

Disclaimer: This piece is meant to serve as a forum for members to share practice tips. Information that appears in this forum represents the personal experience of the author and does not imply endorsement by the jCD or AACD.