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Lower full mouth rehabilitation of a patient with reduced vertical dimension using Zicornia crowns restorations – A case report.

Full mouth rehabilitation  in dentistry refers to rebuilding teeth and supporting structures after decay and gum disease have been treated and stabilised. Full mouth rehabilitation is only required if your bite has collapsed and all of your teeth need to be rebuilt. In this case patient came with a complaint of his unesthetic upper right canine (cantilevered bridge)  #13 and #12.

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A closer look at the total dentition.

Patient wanted  to just change his upper right canine and lateral and lengthen the crowns of his upper teeth . However, after a  full mouth examination , we advised him against it since that would make his upper teeth look like that of  a horse ! Instead, we focused on rehabilitation of his lower teeth which have shown some extent of attrition , worn down and collapse of his face ( decrease in vertical dimension).

A careful examination revealed that there’s a midline shift to the right and worn off  of his lower teeth.
A careful examination revealed that there’s a midline shift to the right and worn off of his lower teeth.

There are different types of dental examinations that we will perform. Each one is tailored to individual patient’s needs. As a new patient to our practice, we did a comprehensive examination including a review of his medical history, digital radiographs and charting of his existing oral conditions, records such as intra-oral photographs and impressions of his teeth.

Treatment Plan

1. To increase occlusal vertical dimension ( face height)

Correct diagnosis and treatment planning are crucial. Even though this is rather a straight forward case, a diagnostic wax up is essential to allow conservative preparation and prototype fabrication and thus verifying any change in the occlusal scheme since we are going to change height of the lower teeth.

A thorough understanding of occlusion is essential for any rehabilitation case be, it functional or aesthetic. Changes in vertical dimension can allow for more conservative dental rehabilitation. In this case minimal preparation of the teeth was required, mainly the mesial and the distal aspect of the teeth without touching the occlusal and the lower incisal edges.

 Zicornia crowns were chosen in this case for its intrinsic and extrinsic properties. It also helps in increasing vertical dimension. of this case.

2. A better esthetics  and improving existing crowns .

A zirconia crown is a popular type of all-ceramic crown which is worn to improve the appearance of a tooth which has become stained or disfigured over the years. They are durable, easy to wear and long lasting. This all-ceramic crowns give you proven strength with unsurpassed beauty. The individually created crowns can be perfectly matched to your existing teeth so that no one can tell the difference.
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Initially I started with a full lower crowns and only changed his cantilevered bridge to fixed bridge of his front teeth on his right. Patient came back for review periodically, and recently he wanted me to veneer the 3 anterior teeth on the left as well.

Conclusion

The main aim of this treatment was achieved. This patient gets what he wanted , we managed to create esthetic and functional crowns and thereby develop mutually protected occlusion by generating an anterior guidance to disocclude posteriors, thereby generating group function/canine and premolar occlusion on working side and removing nonworking side interferences while increasing his vertical dimension.

3 more teeth were prepared on the upper left.
3 more teeth were prepared on the upper left.

Only a lower full-mouth rehabilitation with crowns on all the teeth were considered, as there was significant tooth wear of the anterior and posterior lower teeth and also there was loss of vertical dimension. So crowns were planned only for the lower teeth and upper incisors. Minimum preparation of crowns were required since lower teeth have adequate abutment height for the retention of the Zicornia crowns.

Aftercare of crown and bridge restorations

Teeth that have received crowns are never as strong as totally intact teeth and proper care should be taken to ensure that these teeth give you long trouble-free service.

It is important to remember that while crowns and bridges are strong restorations they are not indestructible. In general you should never try using your teeth in place of gadgets such as nutcrackers or bottle openers and this applies even more to your crowns and bridges. Very hard foods (like crabshells, ice and the like) should be avoided.  Patient was given custom-fit a nightguard (or occlusal splint) to protect the opposing teeth which were not crowned and to prevent chipping of the crowns.

Dr Kamsiah G Haider BDS, MDSc

A dentist , a continuous education junkie and inspiring other dentists to be a real dentist ! Who do you want to help you improve your smile if you are looking for a dentist? Dr. Kamsiah also known as Dr. Kam is cosmetic dentist with over 30 years experience . As a Master and Instructor of the Digital Smile Design , together with dental implantology , prosthodontics and orthodontics I have the experience and knowledge to handle the most complex cases in cosmetic dentistry. Oral reconstruction, rehabilitation with or without dental implants and conscious sedation dentistry all in one place. She earns her membership of the International Association for Orthodontist (iAOi) in 2014. She has been a Diplomate of the American Board of Prosthodontics and Implantology (ICOI) since 1997. She's into guided surgery and full mouth rehabilitation on failed dentition also known as teeth in a day with the help with digital dentistry. Something she's passionate about since embarking into private practice 23 years ago. Dr. Kamsiah was a full time lecturer at the University of Malaya and an Associate Professor at the International Islamic University and lectures on prosthetics , the All-on-Four concept and recently on the Digital Smile Design. Specialties: Prosthetic Dentistry, Dental Implants, Cosmetic Dentistry, Orthodontics, Invisalign, Bone-Screw Orthodontics, AO4, Teeth in one day.

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