|Year : 2016 | Volume
| Issue : 3 | Page : 103-106
Multidisciplinary approach to full mouth rehabilitation
Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
|Date of Web Publication||28-Nov-2016|
Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj
Source of Support: None, Conflict of Interest: None
A 25-year-old Saudi male reported with pain, swelling in gums, multiple caries, and loss of teeth as a result of caries. A thorough workup and multidisciplinary approach helped to deliver patient with good smile, relief from pain, and gum swellings. Use of radiographs which included orthopantomogram, full mouth series of X-rays, and 4R system for complete analysis of patient gave satisfactory result and brought a smile back to patients face.
Keywords: Caries experience, full mouth rehabilitation, multidisciplinary approach, poor oral hygiene
|How to cite this article:|
Aljeaidi Z. Multidisciplinary approach to full mouth rehabilitation. J Dent Res Rev 2016;3:103-6
| Introduction|| |
Dental esthetics is of prime importance for young adults as it positively influences their self-confidence, social life, and overall well-being. New advances in the field of dentistry have contributed to better smiles worldwide. Severely debilitated oral conditions which involve the majority of teeth, demand for more comprehensive and multidisciplinary treatment. ,
Dental neglect in terms of daily oral hygiene practices, access to oral health services, dietary habits of the patient and attitude toward oral health are associated with poor oral hygiene status, caries experience, and periodontal disease. Dental caries can lead to the loss of teeth, pulp pathologies and loss of esthetics. Awareness on oral health amongst the patients has a direct relation to esthetic appeal of the patient. 
Patients diagnosed with multiple teeth pathologies need a multidisciplinary approach for the treatment as well. This case report presents a multidisciplinary approach where dental specialties worked together to create a perfect smile for the patient.
| Case Report|| |
A 25-year-old Saudi male reported with pain in teeth, swelling in the upper gums, and black colored teeth. Patient desired to restore his teeth and smile. Pain and swelling started a year ago. The patient had undergone extraction of 12, 28, and 36 5 years ago, Ketac-Fill with 47 a year ago and composite filling on the buccal surface of 26 a year ago. He had no specific or relevant medical history. The patient was thoroughly assessed with his diet history, which revealed high sugar consumption and between meal snacking. The patient had no history of brushing teeth, use of interdental aids or mouthwash which accounted to poor oral hygiene. The patient had a history of pipe smoking once a day. On intraoral examination, carious lesions were revealed with teeth number 17, 16, 15, 14, 13, 11, 21, 22, 23, 24, 25, 26, 27, 38, 37, 35, 34, 33, 41, 43, 44, 45, 46, 47. Generalized mild redness of the marginal gingiva and interdental papillae with no periodontal pockets were observed as shown in [Figure 1]. High plaque scores were recorded. Smile profiling and thorough examination of occlusion were done. The patient presented with loss of esthetics; diastema, missing 12 and black color stains on anterior teeth due to caries. Occlusion showed cross bite in mandibular left region, missing 36, mesial tilting of 37, and supraeruption of 15. There were no temporomandibular joint abnormalities detected. On soft tissue examination, nicotinic stomatitis was seen in palate area which can be attributed to his pipe smoking habit. Pretreatment photographs, diagnostic cast model workups, necessary radiographs which included orthopantomogram and full mouth series of X-rays were taken as shown in [Figure 2]. 4R system for complete analysis of patient [Table 1] was followed. The patient had 24 carious teeth, 7 teeth with pulp pathologies, 2 missing teeth, and generalized plaque-induced gingivitis [Figure 1]. The patient had poor oral hygiene, high sugar consumption, and smoking habit as major risk factors. Written patient consent was obtained before the start of treatment.
Treatment plan sequence
The following treatment objectives were followed:
- To motivate the patient
- To improve his oral hygiene and dietary patterns
- To educate the patient and enforce his knowledge about oral health and create dental awareness
- To eliminate pathology
- To treat caries
- To restore function
- To improve esthetics.
The treatment was planned in five phases [Table 2]:
Oral hygiene instruction which included a recommendation for the use of toothpaste and brush with the proper brushing technique was advised, scaling was done to remove all plaque, calculus, and staining. Diet analysis following dietary advice to reduce sugar intake and stop in between meal snacking was recommended. Smile profiling was also done to create the best possible smile for the patient. Diagnostic cast wax model workups were carried out.
Composite restorations with 16, 15, 13, 11, 21, 24, 25, 26, 27, 38, 37, 34, 33, 41, 43, 44 and endodontic treatment with post and core of teeth: 17, 14, 22, 23, 35, 45, and 46 were done. Cavity liners with direct posterior composite restorations were used for the restoration of posterior teeth using silorane-based composite. Split incremental horizontal layering technique was followed for posterior composite restoration. Metal matrices and wooden wedges were used for proximal caries restoration. Cast post and cores were placed following the root canal treatments of 17, 14, 22, 23, 35, 45 except 46 in which we used prefabricated post and core.
Surgery; crown lengthening of teeth 14, 22, 23 and implant with a soft tissue graft to replace 12 was carried out.
Prosthodontic treatment: implant loading with 12, crown with 22, 23, 14, and 17 were done. Occlusal adjustments were done to achieve good occlusion.
Posttreatment photographs were taken [Figure 3]. The patient was recalled after 3 months and then after 6 months to assess the overall status.
| Discussion|| |
Poor oral hygiene and high plaque score are reported to have shown strong association with dental caries experience and periodontal disease. , A thorough case workup with diagnostic casts, X-rays, and 4R system can provide encouraging results. Dental diseases are multifactorial, so they need a comprehensive approach involving restorative, esthetic, periodontal and prosthetic care to achieve satisfactory results. 
The black staining of the patient was mainly due to dental caries; esthetic restorations were placed to give a pleasing appeal. Pulp therapies relieved the patient of pain, oral hygiene conditions, and problems. Direct posterior composites were used with cavity liners, resin-modified glass ionomer (RMGI) liners appear to perform better than flowable composites because of their physical properties. In addition, placing the self-adhesive RMGIs liner on the areas of deep dentin can protect this sensitive dentin from the strong conditioners and decrease postoperative sensitivity.  Metal matrices with wooden wedges were used to perform better than the transparent matrices.  Split incremental horizontal layering technique was used, placing posterior composite resin in moderate to large Class I occlusal cavities offering several advantages over currently available techniques in addition to minimizing the detrimental effects of polymerization shrinkage stresses on the adhesive interface and cavity walls.  Silorane-based composite resin presented with lower quantity of adhering streptococci. This low adhesion potential of the silorane-based composite can potentially improve the longevity of direct fillings and thereby reduce recurrent caries.  Prefabricated posts with amalgam as the core building material in posterior were used as reported. Amalgam cores had the lowest failure rate following composite resin cores. All teeth restored with crowns over GI core build-up failed. ,
Anterior tooth 12 was replaced by an implant with soft tissue graft which will enhance the longevity of the implant.  Smile designing in such situations is a challenging task and requires the expertise of multiple disciplines and meticulous treatment planning. Since occlusal rehabilitation is a key to long-term success of the restorations and oral health, occlusal adjustments in both temporary and final restoration are important.  By the end of the treatment, the patient was aware of oral hygiene practices, had a satisfactory smile and restored esthetic area had brought back lost confidence in the patient.
| Conclusion|| |
The planning and management of the patient set an example of the multidisciplinary approach in treating patients. A detailed case history and use of appropriate diagnostic tools in assessing the case yield to satisfactory results. Evidence-based use of composite material and technique, post and core material, implant technique has enhanced the clinical outcome. Followed by adequate oral health awareness for the sustained result and proper maintenance of the oral health were advised. A healthy esthetic smile has made a huge difference to the life of this young individual.
Learning points/take home message
- Meticulous planning which is evidence based can lead to desirable clinical outcomes
- Multidisciplinary approach will give better understanding to the patients oral status
- Sustained oral hygiene practices are key to better oral health
- Esthetic restorations and smile designing when precisely done are rewarding.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]