Complex oral rehabilitation

What is complex oral rehabilitation?

It is treatment in which several teeth are affected at once, and each cannot be treated separately from the others. The goal is a stable system: functional, aesthetic and healthy in the long term.

Cases usually start from wear, erosion, fractures, tooth loss, multiple old restorations or a bite that has changed over time.

When is a complex rehabilitation needed?

When problems can no longer be solved tooth by tooth without taking the bite and the rest of the arch into account.

• Advanced tooth wear, with shortened or sensitive teeth.
• Suspected loss of vertical dimension of occlusion.
• Multiple missing teeth or partial edentulism.
• Many old restorations, crowns with poor margins, work that needs redoing.
• A bite changed by other treatment, migrated teeth, chewing difficulties.

What is tooth wear, and when does it stop being only a cosmetic issue?

Tooth wear is the progressive loss of tooth structure from causes other than decay. It becomes a medical issue when it affects function, causes sensitivity or reaches the dentine.

• Attrition comes from tooth-to-tooth contact, for example in bruxism.
• Abrasion comes from an external agent, such as forceful brushing or certain habits.
• Erosion is the dissolving of enamel by acids, from diet or from gastro-oesophageal reflux.

Usually the causes combine. Exposed dentine wears faster than enamel, so the process accelerates. I treat the causes before restoring teeth, because a restoration placed over an active cause will wear again. More detail in the article Tooth wear: when it stops being a cosmetic issue.

What is the vertical dimension of occlusion?

It is the distance between the upper and lower jaw when the teeth are in maximum contact. Wear can shorten the crowns, but the body often compensates by moving the teeth, so the vertical dimension is not necessarily reduced.

I do not change it by reflex. The decision follows an analysis with photographs, measurements and study models, and any increase is tested reversibly first, with a mock-up or a splint. If the patient adapts well, we move on to the definitive work.

What do I restore teeth with: composite, onlays, crowns or table-tops?

I choose the least invasive option that solves the problem predictably. There is no single option for every case, and a rehabilitation can combine several.

• Direct composite, additive. Preserves tooth structure, is repairable and often reversible.
• Onlays, overlays or "table-tops". Adhesive restorations that cover the chewing surface, in ceramic or composite. Used when resistance to heavy forces is needed with limited preparation.
• Veneers. For the visible fronts of the front teeth, when enamel allows bonding. Details on the page about dental veneers.
• Crowns. When the tooth no longer has enough support for a partial adhesive restoration.

When do implants come into the plan?

When teeth are missing or when some teeth can no longer be kept. The position of the implant is set by the final restoration, not the other way round, so planning starts with the shape of the teeth and then the implant.

The surgical part is planned together with the clinician who carries it out, and the whole plan is agreed before the first intervention.

Why is orthodontic treatment sometimes needed first?

Orthodontics can move teeth into positions that allow more conservative restorations: it creates space, straightens tooth axes or redistributes space for correct proportions.

Without this stage we would have to remove more enamel or compromise the shape. The extra time is worth it if it avoids more invasive work. See also post-orthodontic rehabilitation.

How does a complex case unfold?

1. Diagnosis

   Photographs, radiographs, occlusal examination, scan or impressions, assessment of the gums and the jaw joints.

2. Controlling the causes

   Treating decay and gum disease, assessing bruxism and, when relevant, referring to other specialities (for example for reflux).

3. Planning and diagnostic wax-up

   The shape and position of the teeth are planned from the start across the whole arch.

4. Reversible phase

   Mock-up, splint or temporary restorations to test shape, comfort and function.

5. Definitive restorations

   In stages, often area by area, in the order set by the plan.

6. Protection and maintenance

   A night guard, professional hygiene and regular check-ups.

What are the limits of a complex rehabilitation?

Not every case can be solved conservatively, and sometimes compromises must be accepted. Treatment takes time, often months, and needs several appointments.

The result also depends on the patient: hygiene, wearing the night guard, attending check-ups. I do not promise a result identical to other cases, because every situation is different.