Full Mouth rehabilitation - Endo-Perio Prostho interferface.

This very pleasant patient presented to us with a very old upper

crown and bridgework, which had started to recede and looked unsightly. It had caused severe attrition on the lower anterior teeth, with a few teeth

almost worn down to gingival level.


The patient’s GDP had advised extraction of those teeth and the

patient wanted a second opinion. We did a wax-up and a mock-up in

the mouth to see if what we were planning was achievable. To

improve sufficient crown height we did surgical crown lengthening

on lower anterior teeth using a surgical stent given to a periodontal

colleague.


The patient was then referred to the endodontist for elective root

canals on all the four lower anterior teeth. Once root canal was

completed all the teeth were prepared and the placed in temporaries

to assess the occlusion and aesthetics to ensure patient was happy

with result.


Once everything was stable we did definitive impressions for the

final prosthesis and the patient was restored with an increased OVD

with porcelain bonded crown and bridgework on the upper and

lower teeth.


BEFORE











































Wax Up and Mockup - For patient information and consent






Lower anterior teeth were surgically crown lengthened , as there was insufficient teeth structure to have a crown placed on it . A stent was given to the periodontal colleague ( from a different wax up ) to help them with knowling the expected crown margin , and they remove sufficient bone to around 3mm below the planned crown margin.
















Post crown lengthening - 4 weeks












Tooth Preparations and impressions



















































Post Operative Result
































The Lower Left premolars were virgin teeth so were left to Dhal on the temporaries and in 3 months teeth were in contact, if it did come into occlusion, then the plan was to have a non-prep onlay on the LL4 and a bridge from eth LL5 - the LL7.


Patient was delighted with the result , so was I !!