PRINCIPLES OF

FULL MOUTH
REHABILITATION
 INTRODUCTION

The prevention of any oral disease, including caries and periodontal disease is
highly desirable.

Todays oral rehabilitation offers many options. There are basically two
concurrent types of outcomes used in clinical trials:

1)Longevity and survival(survival of teeth, implants, restorations)

2)Psychosocial parameters(treatment satisfaction ,quality of life)

Tooth loss has been identified as a chronic condition by WHO.

The main goal of palliative treatment is symptom relief.

Modern oral rehabilitation provides relief from pain and other symptom:
integrates the psychological, social and spiritual aspects of care and will
ultimately enhance quality of life.

With all the restorative options and within a patient-centered approach,

we need to provide patients with information that includes input on the
expected symptom relief to come after oral rehabilitation.

Patient-centered treatment approach is the foundation of successful oral

rehabilitation outcome.

Full mouth rehabilitation entails the performance of all the procedures

necessary to produce healthy, esthetic, well functioning, and self-maintaining
masticatory mechanism.
REASONS FOR FULL MOUTH REHABILITATION

The most common reason for doing full mouth rehabilitation is to obtain and
maintain the health of periodontal tissues.

Clinical periodontal findings are correlated with radiographs to determine the

extent and character of any disease findings must then be correlated to function
of the mouth in examining the function of the mouth, many factors must be
considered.

In conjunction with malfunction, we must consider oral habits that could have
a bearing on the condition present. These may include such things as bruxism.
lip-chewing, thread-biting, tongue habits.

Temporomandibular joint disturbance is another reason for full mouth

rehabilitation. This may be difficult to diagnose, and great care must be taken
to determine the etiological factors involved.

Still another reason for full mouth rehabilitation is the need for extensive
dentistry. In such cases, some teeth are missing, others are worn down, and
there are old fillings that need replacing. Usually, the patients have little
periodontal involvement and no joint symptoms. These are the easiest cases to
treat, and the beginner should limit his or her full mouth rehabilitation to them.

The modern practice of renewing and reorganizing (he teeth by prostheses

began with the idea of' raising the bite" to rectify closure resulting from
excessive wear of the occlusal surfaces. Later, such closure was associated with
hearing loss, noted by Costen. This view, though later questioned, served to
stimulate interest increasing the length of the patients own teeth and thus in
increasing the vertical dimension.
In correcting articular disturbances, the best procedure came to be the retention
of the remaining natural teeth in so far as this was possible. To accomplish this,
these teeth were rebuilt to harmonize with the movements of the joints in order
to protect them from further injury.

It should be kept in mind that although the operations of all mouth

rehabilitation procedures are performed on tooth units, they have one basic
objective: the equalization of the forces directed against the supporting
structures. Any disharmony at the occlusal or incisal aspects of a tooth will
direct forces against these malaligned surfaces and thus subject the supporting
structure to traumatic injuries. Similarly, any impairment of buccal or lingual
harmony will be reflected in injury to the gingival tissue and subsequently to
the deeper tissues involved in supporting the tooth. The proximal contact
anatomy is also vital in maintaining the health of the underlying soft tissue.
Poor contact relationships encourage food impaction with resultant periodontal
tissue loss.

FUNCTIONAL ASPECTS OF COMPLETE MOUTH

REHABILITATION

A BIOLOGIC AND FUNCTIONAL approach to restorative dentistry is

essential for the satisfactory performance and fulfillment of those requisites
basic to Prosthodontics. Accordingly, the masticatory organ must be considered
as a functional consolidated unit, with proper attention being directed to all the
elements that comprise this unit. All functional factors are interrelated, and
proper regard for each aspect is essential, if the restoration and maintenance of
the health of the entire functioning mechanism is to be a realization.
Consequently, a comprehensive study and practical approach must be directed
toward the interrelation of the teeth and their supporting periodontal structures,
the myofunctional aspects of mastication, the vertical dimension, freeway
space, centric relation, and centric occlusion.

The objective of complete mouth rehabilitation is the reconstruction,

restoration, and maintenance of the health of the entire oral mechanism. The
accomplishment of this goal requires an understanding and utilization of all
available dynamic potentials.

Complete mouth rehabilitation is a dynamic functional problem, and

embodies the correlation and integration of all component parts into one
functioning unit.

The aim therefore, must be reconstruction and rehabilitation of the whole

satisfying all the related factors.

Principles and basic laws:

There are two important and basic steps, which must be recognized in any
technique. These are

(1) A preliminary equilibration of the occlusion, and

(2) The establishment of the incisal guidance. The basic principles of occlusion
must be understood and observed, and definite objectives must be visualized
and achieved wherever possible.

The objectives of the preliminary occlusal equilibration are:

(I) To correlate . centric occlusion with the unstrained centric relation.

(2) To obtain the maximum distribution of occlusal stress in centric relation.

(3) To retain the vertical dimension of occlusion.

(4) To equalize the steepness of similar tooth inclines in order to distribute
eccentric occlusal stresses evenly.

(5) To establish smooth guidance tooth inclines.

(6) To reduce the steepness of inclines of guiding tooth surfaces so that occlusal
stresses may be more favourably applied to the supporting tissues.

(7) To retain the sharpness of cutting cusps.

(8) To increase number and size of food exits.

(9) To decrease the size of the occlusal contact surfaces.

SUMMARY:

1. The objectives of occlusal rehabilitation are optimum oral health,

functional efficiency, mouth comfort, and esthetics.

2. The posterior teeth maintain the vertical dimension while the anterior teeth
are being restored.

3. The anterior teeth maintain the occlusal vertical dimension while the
posterior teeth are being restored.

4. The incisal guide angle, the temporomandibular joints,and the

mandibular musculature register a functionally generated path.

5. The restorations exhibit a static occlusal contact of all teeth when the
mandible is in centric relation to the maxillae.

6. An area of centric occlusal contact is developed to provide freedom of

movement in a horizontal direction while the same vertical dimension is
maintained.
7. All centric movements, including the Bennet movement, can be exercised
without occlusal interferences.

8. Working side contacts are coordinated with the incisal guide contour while
the potentially damaging nonfunctioning side contacts are eliminated.