Rehabilitation

A wax-up is a three-dimensional model of the final shape. I use it to see how much space the teeth need to reach the desired proportions before adding any material.

Ideally the plan is discussed with the orthodontist during treatment, so that space is distributed for restorations. The wax-up is then transferred into the mouth with a reversible mock-up, and for composite work it serves as a guide through a silicone key.

After the teeth have stabilised and the retention has been decided. Restorations during fixed braces are limited to minor details, agreed with the orthodontist.

I do not remove or change a retainer without the orthodontist's agreement. Restorations adapt to the retainer, not the other way round.

Retention stays important after restorations. Teeth have a tendency to move throughout life, and restorations do not stop that.

A retainer can be fixed, bonded to the inside of the teeth, or removable, usually a clear tray worn at night. The orthodontist chooses with the patient, and the restoration plan takes it into account.

From the most conservative to the most extensive:

• Orthodontic finishing adjustments, when the problem is position.
• Minimal reshaping of enamel, when the correction is very small.
• Direct additive composite, for small gaps and small teeth.
• Ceramic veneers, when stability and precise control of shape and colour are wanted.
• More extensive restorations, in cases with wear or heavily modified shape. See complex oral rehabilitation.

When tooth position can be improved more conservatively with orthodontics, when the gums are inflamed, or when the retention period has not finished. Rushing restorations before the teeth have stabilised can lead to work that has to be redone.

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 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.

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.

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 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.

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.

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.