creating a treatment plan

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BY

Keith Kelley, DDS SENIOR SECTIONAL EDITOR

updated March 12, 2015

Source: http://www.docshop.com/education/dental/general-dentistry/full-reconstruction/planning

Full mouth reconstruction is a process of combining two or more dentaltreatments to restore the health, balance, and functionality of a patient'ssmile. Because no two patients' needs are exactly the same, extensiveplanning and preparation is essential. This always involves an in-depthconsultation to determine the patient's needs and goals, deciding on thetype and number of prosthodontics needed, and scheduling the phasesof treatment.

Though we all know that healthy teeth and gums are important, it can

Creating a Treatment Plan

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be easy to take a healthy smile for granted. But when one or more teethare lost, or the gums and teeth become compromised by trauma ordecay, quality of life can take a rapid downturn as functions likechewing and speaking become inefficient and painful.

Fortunately, modern dentistry is capable of restoring smiles sufferingwith virtually any degree of compromise. Innovations like dentalimplants are a milestone treatment that make restorations like denturesas stable as natural teeth. Meanwhile, advancements in the quality andappearance of dental porcelain have made other restorations likecrowns and dental bridges incredibly strong and indistinguishable fromnatural teeth. Modern dental practices can restore both excellent healthand flattering aesthetics to practically any smile.

Whether you are beginning to experience pain and other complicationsas a result of a compromised smile, or if you have been suffering withoral health issues for a long time, it is never too soon to speak with yourdentist about planning a full mouth reconstruction. This process cannotrebuild your smile overnight, but with careful planning and patience, youcan expect to eventually achieve a smile that is balanced, attractive, andfree of disease and decay. Starting a new chapter of healthy smiles inyour life begins with choosing an excellent dentist.

Enlisting an ExpertIf you have a healthy smile that has suddenly been compromised byinjury or trauma, there is a good chance that you regularly see a trusteddentist for checkups, and he or she can either help plan a full mouthreconstruction, or refer you to another doctor who specializes incomprehensive restorative procedures. On the other hand, if you havebeen suffering for a long time with gum disease, missing teeth, andother conditions, you may not have an established relationship with adentist.

Today, the Internet has made it incredibly easy to compare doctors inyour area without ever leaving your home. Search for doctors whoprovide full mouth reconstruction either entirely by themselves or incooperation with other area specialists. Take time to read testimonialsand look through their before and after photos of full mouth



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reconstruction patients. If you have friends or family members whohave undergone a full mouth reconstruction or other lesscomprehensive restorative procedures, ask for recommendations.

Once you have chosen a dentist and scheduled a consultation, makecertain that the doctor listens to your goals, patiently answers all ofyour questions, and takes plenty of time to conduct a thoroughassessment of your oral health.

The Consultation: Specifying Your Needsand GoalsMost of the time, I feel that there is only one best course of treatmentfor a patient, and that is arrived at only after a really thoroughexamination and evaluation involving a lot of listening.

I find that during most full mouth reconstruction consultations, patientsalready know about half of the treatments they will need. They knowthey will need something to replace missing teeth, or they know theirgums are swollen and painful, and will likely require some medicationor periodontal treatment. Over the course of about an hour and a half,we talk, perform an evaluation of the state of the patient's oral health,collect x-rays, and sometimes take computerized tomography (CT)scans.

Your dentist must take care toevaluate the whole picture andunderstand what led to thecurrent conditions. Somecontributing factors may not beso obvious, such as teethgrinding or acid reflux.Some important questions thatmust be answered during thisconsultation include:

Has the jaw bone experienced any atrophy as a result of tooth loss orother conditions?

I find that during most fullmouth reconstructionconsultations, patientsalready know about half ofthe treatments they willneed



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Are malocclusion, dental wear, or other factors disrupting the balanceof the bite, placing undue strain on the muscles and tendons thatgovern the movement of the jaw? This can be indicative oftemporomandibular joint (TMJ) disorder, and can have a majorinfluence on your course of treatment.

Is gum disease affecting the patient? Are gum grafting, antibiotics, orother treatments necessary?

Are there any suspect lesions or other signs of adverse oral healthconditions?

Does the patient have any health issues such as diabetes orautoimmune disease affecting oral health?

Will referrals be necessary to address all pending health issues?

It is also very important to determine any changes in lifestyle or dietnecessary to facilitate a successful full mouth reconstruction. I counselmy patients about smoking. By now, everyone is well aware of the manyhealth hazards of smoking, and it becomes an issue when we're doingcomplex reconstruction with dental implants. Smoking really tends todecrease oxygen availability for healing tissues.

A diet that involves large amounts of sugar also requires specialmeasures. If the patient does not want to cut out sugary foods such asenergy drinks, I tell them to have a drink of water afterwards to cleanaway the sugar, and to take extra care in brushing and flossing daily. Ioften recommend home fluoride treatments, vitamins, and other simpleways to generally facilitate improved oral health in preparation for thetreatment, and to maintain the results of the treatment after it iscompleted.

Scope of TreatmentOnce all of the patient's oral health needs have been identified, I canbegin determining which treatments will meet those needs, and theorder in which they should be performed.



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A full mouth reconstruction can require a simple treatment scope, or aplan combining several extensive treatments. A successful full mouthreconstruction must begin at the foundation of the smile: the jaw andthe gums. Treatments often used to restore the jaw and gums include:

Bone Grafting: If a patient has been missing teeth for an extendedperiod of time, the jaw bone may have begun to atrophy, or shrink. Inthe absence of tooth roots, the body will begin to resorb the bonecells surrounding the tooth socket. In order to support therestorations needed to replace the missing tooth and rebuild the bite,the dentist may recommend a bone graft This involves transplantingeither donor tissue or the patient's own bone tissue (usuallyharvested from the hip) to restore lost bone mass.Tooth Extraction: Teeth that are too decayed to be salvaged througha root canal or cavity treatment must be extracted in order to set thestage for full mouth reconstruction.Root Planing and Scaling: Plaque bacteria can accumulate below thegum line on the tooth roots, endangering the health of the tooth, jaw,and gums. Root planing and scaling is a process of removing bacteriafrom the tooth roots, and smoothing rough dental surfaces below thegum line to make the teeth less prone to bacteria accumulation.Gum grafting: Advanced gum disease can cause the gums to recede,compromising the foundation of your smile and exposing tooth roots.Gum grafting is a process of replacing recessed gum tissue,sometimes with tissue harvested from the roof of the mouth.Antibiotics: If the gums have become inflamed as a result of infection,antibiotics can help the body fight the infection and restore the healthof the gums.

Most full mouth reconstruction procedures require some treatment ofthe teeth. If the jaw and gums are healthy, or if they have been fullyrestored during an earlier phase of full mouth reconstruction, yourdentist and any necessary specialists can move forward with dentalrestoration. These treatments can include:

Tooth-colored Fillings: Composite resin fillings can restore teethfollowing cavity treatment. If a patient had one or more silveramalgam fillings placed in the past, he or she may have experiencedsome chipping or cracking around the fillings. In this case, the patientmay only require new composite fillings, which can replace the metalfillings while concealing the chips and cracks, providing renewedsupport.Root Canal: If tooth decay has advanced beyond the outer surface ofa tooth and reached the pulp (the blood vessels and nerve endings in



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the center of the tooth), the healthy outer structure can be salvagedwith a root canal. This procedure involves removing the infected pulpfrom within the tooth and roots, replacing it with an inert substance,sealing the tooth, and usually restoring it with a crown.Crowns and Bridges: Crowns and bridges are custom replacementteeth. Crowns are most often used to cover a tooth followingtreatment for decay or trauma, while bridges (also called partialdentures) replace missing teeth. They can be created from a varietyof materials that provide both a natural appearance and exceptionaldurability. Crowns and bridges can draw support from existing teethor dental implants.Dental Implants: Dental implants are small titanium posts that aresurgically implanted in the jaw to replace tooth roots and providesupport for your restorations. Implants virtually eliminate the risk ofrestorations slipping, and halt the atrophy of the jaw bone that canoccur in the absence of tooth roots.Dentures: Dentures are designed to replace an entire dental arch onthe upper jaw, lower jaw, or both. They can be held in place with amild adhesive, or designed to attach to dental implants.

Depending upon the patient's goals, cosmetic treatments may beincluded in a full mouth reconstruction. Often, by addressing thepractical needs of the smile, you can't help but experience a cosmeticupgrade. However, some patients choose to undergo cosmetictreatments as part of full mouth reconstruction in order to betteraccentuate the aesthetic value of their smile. These can include:

Teeth Whitening: Specially formulated whitening solutions caneliminate deep dental stains caused by dark-colored foods and drinks,tobacco, genetics, and other factors.Porcelain Veneers: These thin porcelain shells attach to the frontsurfaces of teeth to conceal minor imperfections like chips, cracks,inconsistent shaping, and slight misalignment. In some cases,veneers can actually create small changes in the way the teeth meet,improving the balance of the bite.

Providing the patient with excellent functionality and aesthetics canrequire a careful review of the patient's lifestyle to ensure long-lastingresults. Bruce J. Wilderman, D.D.S. is a cosmetic and restorativedentist practicing in the Philadelphia area. Dr. Wilderman explains:

"I always want to know if a patient is the kind of person who iscommitted to long-term whitening maintenance. If not, we have tocarefully choose the shade of our final restorations. If they are



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committed to long-term maintenance, we can choose a lighter shade. Ioften ask the patient how good they are with taking their dailymedications. Are they diligent about taking meds that must be takenthree to four times daily? If they have trouble with that, they probablywon't do their whitening maintenance on a regular schedule. We wantthe shade we pick for our restorations to blend with the natural teethover the long term."

Phasing Full Mouth ReconstructionTreatmentsThe phases of full mouth reconstruction begin with your initialconsultation and diagnosis, followed by periodontal treatments, dentalrestoration, and aftercare. Several treatments associated with fullmouth reconstruction require multiple visits and healing time:

Bone grafts can require 3 months or more to heal.

Gum grafts can take one to two weeks to heal.

Antibiotic treatment can take about two weeks.

Dental implants require at least two surgeries, with three to sixmonths of healing time in between.

Dentures, crowns, bridges, and porcelain veneers usually require atleast two appointments over the course of two to three weeks.

Aftercare can be ongoing. For example, if you grind your teeth, you maybe prescribed an orthotic, or splint, that will act as a buffer that willprevent damage to your teeth or your restorations.

Sedation: Helping You through LengthyTreatmentsSome treatments involved in your full mouth reconstruction may require



lengthy sessions in the dentist's chair. This is especially true of bonegrafting and dental implant surgery involving placement of multipleimplants. If you have conditions such as arthritis that make ituncomfortable to sit for long periods of time, or suffer with extremesensitivity to dental treatment or anxiety, you may want to ask yourdentist about administering sedation during lengthy treatments. Today,most dental offices offer nitrous oxide, oral conscious sedation, and IVsedation options.

Budgeting for Full Mouth ReconstructionBecause of the practical nature of many of the treatments involved in afull mouth reconstruction procedure, your insurance policy may covermost of the cost, if not the entire cost. Unfortunately, most insurancecompanies consider extremely beneficial treatments such as dentalimplants to be elective, and will not provide coverage for this phase oftreatment.

While dental implants do require what many consider to be a substantialinvestment, it is important to consider the benefits they provide, such asbeing able to eat, speak, and laugh without worrying that your denturesor other restorations will slip out of place. Meanwhile, because dentalimplants preserve jaw bone mass, you can save yourself the time andexpense of returning to the dentist to have dentures refitted as thedimensions of your mouth change.

If any part of your full mouth reconstruction treatment plan is notcovered by insurance, most practices work with third-party financingcompanies, or offer their own financing options.

Stopping the Stop-gaps: Helping ThomasAchieve a Complete, Healthy SmileMy patient Thomas had been suffering with broken teeth, advancedtooth decay, and restorations that had become worn, damaged, andunsightly over time.



"I knew I had to do something," he said. "I just wasn't sure I wanted togo the full extent. But as I started looking into my options, I realized thatjust addressing one problem at a time would be like putting a band-aidon it. I'm 72, and when you get to this point in your life, you don't knowif you want to invest the money in extensive dental treatment. But thefact is that I wish I had done it sooner. Leading up to my treatment, Iprobably put more emphasis on the cost than I should have. Thebenefits I'm experiencing far outweigh the cost."

For many years, Thomas had been visiting a dentist who was using oldtechniques and technology, and he was interested in finding out how amodern approach might help him to finally achieve a comfortable, fullyfunctional smile. During our initial consultation, I conducted a fullexamination of his oral health, and provided him with suggestions onhow we could help him rebuild his smile.

"I'm the kind of person who really wants to know about the process,"Thomas said. "I'm not going to just sit there and say, yeah, okay, I don'tcare. Dr. Kelley explained the procedures in full detail, and it helped meto have confidence in the treatment. That was important to me."

Together, we determined a phased treatment plan that spanned aboutthree months. This included a root canal, replacements for his metalfillings, and new dental crowns. Two years later, Thomas says his fullmouth reconstruction treatment continues to provides benefits.

"My bite just feels right," Thomas said. "I'm not self-conscious abouthow my smile looks. It just gives me peace of mind knowing that I havea good smile, and I don't have to worry about piecing out treatmentsanymore."

For many years, Thomas had beenvisiting a dentist who was using oldtechniques and technology



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Relief, Rejuvenation, and Renewed Self-confidence: Plan on It

A full mouth reconstruction can make a tremendous difference in yourhealth as well as your self-esteem. However, the success of thiscomprehensive treatment depends greatly upon your cooperation withyour dentist in planning a scope of treatment that addresses all youroral health needs while fitting your schedule and your budget.

By taking ample time to choose an excellent dentist, arriving at yourconsultation prepared to discuss your restorative and aesthetic goals,and committing to a scope of treatment that makes no compromises inthe interest of time or expense, you can experience life-changingbenefits. If you are suffering with a compromised state of oral healththat you feel is hopeless, I encourage you to research dentists in yourarea and schedule a consultation. Achieving a healthy and beautifulsmile may be a more realistic goal than you think.

References & Resources

Source: http://www.docshop.com/education/dental/general-dentistry/full-reconstruction/planning

Author: Keith Kelley, DDS

Publisher: DocShop

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http://www.drkeithkelley.com/



creating a treatment plan

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