Have your teeth worn shorter over the years?
Wear is a bite problem before it is a cosmetic one, and rebuilding the teeth without establishing where the bite should sit hands the same forces a new set of surfaces to destroy. Send us a photo of your teeth and we will tell you what is causing the wear, what restoring it would involve, and what it would cost.
- A call within two hours during office hours.
- A written cost from us, before you commit to anything.
- No obligation. Many patients take weeks to decide. That is normal.
What this case cost
$669/month
144 payments at 9.99% APR, on approved credit.
Total: $56,000 for crown lengthening, provisional restorations and twenty-eight individual ceramic units.
How full-mouth reconstruction works, and what it costs today →
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Treatment Plan by Dr. Mehdizadeh
- Assessment of the worn dentition and of the vertical dimension lost to attrition.
- Crown lengthening to expose sound tooth structure for the restorations to engage.
- Provisional restorations in both arches, worn long enough to test the restored bite.
- Twenty-eight individual ceramic restorations, fourteen in each arch.
The Patient's Journey
This patient had worn his teeth down through severe bruxism. Bruxism is the involuntary grinding and clenching that most people do in their sleep, and that a few do with this much force. The attrition ran across his whole dentition rather than concentrating on the front teeth. Several upper incisors had shortened until they sat almost level with the gingival margin. He was embarrassed by them. He wanted a smile he could be confident about for a career change he had already decided on.
Wear of this severity is a bite problem before it is a cosmetic one. The teeth are short because the opposing arch has been abrading them for years, and lengthening them without first establishing where the bite should sit simply hands the same destructive forces a new set of surfaces to remove.
Understanding the Challenge
We had to solve two separate problems before our laboratory made any ceramic. The first was structural. A restoration needs a collar of sound tooth structure to grip, called a ferrule, and teeth worn nearly to the gingival margin do not present one. Without a ferrule only adhesive holds a restoration, against a patient whose own grinding had already destroyed his enamel, which is a poor arrangement. There was no room to prepare these teeth, because the preparation would have consumed everything that remained.
The second problem was the vertical dimension, meaning the height at which the jaws close when the teeth meet. Decades of attrition had lowered his, and the restorations had to reopen it. Reopening the vertical dimension is not simply a matter of building the teeth taller. The muscles and the temporomandibular joints have accommodated the collapsed position over years, and they have to tolerate the new one before we commit it to ceramic. A vertical dimension the patient cannot function at produces muscle pain, joint symptoms and fractured restorations, in roughly that order.
Expose sound tooth structure for the restorations to engage. Reopen the vertical dimension lost to attrition. Prove the new bite in provisionals before committing it to ceramic. Restore twenty-eight teeth as individual units. Complete treatment within two months.
How We Approached Treatment
Crown lengthening came first: Dr. Mehdizadeh repositioned the gum line around the worn teeth so that sound tooth structure stood clear of it, giving the restorations the ferrule those teeth did not have. Without it there is nothing for the ceramic to hold, which is why this step comes before the provisionals rather than alongside them.
We then placed provisional restorations across both arches at the intended vertical dimension. This step converts a proposed occlusion into a tested one. He wore the provisionals and ate on them, and we assessed the restored bite in function rather than on an articulator alone. We began the definitive work only once his musculature and joints had accommodated the new position without complaint.
Our laboratory then made twenty-eight individual ceramic restorations, fourteen in each arch, as a combination of inlays and crowns according to how much structure each tooth had retained.
The Result
The reconstruction restored the appearance of the dentition and the vertical dimension it had lost, and he functions on the new bite. The worn edges are gone, the anterior teeth have proportions appropriate to his face rather than the stumps attrition had left, and the teeth are no longer the first thing anyone notices about him.
The reconstruction has not cured the grinding itself, because bruxism is a habit of the muscles rather than a problem with the teeth, and no restoration alters it. What changes is what absorbs the force. Ceramic is considerably harder than the enamel it replaced, and a night guard protects the restorations during the hours when the grinding actually occurs.
Frequently Asked Questions About Full Mouth Reconstruction for Worn Teeth
What causes teeth to wear down this severely?
Bruxism, the involuntary grinding and clenching that occurs mostly during sleep. It is a neuromuscular habit rather than a dental one. Over years the opposing arches abrade one another, shortening the teeth and lowering the height at which the jaws close.
What is crown lengthening and why was it needed first?
We remove gingival tissue and recontour the underlying bone to expose more of the natural tooth. Teeth worn almost to the gingival margin present no collar of sound structure for a restoration to grip, and preparing them without lengthening first would consume what little remained.
What is vertical dimension?
The height at which the jaws close when the teeth meet. Years of attrition lower it, and a reconstruction of worn teeth has to reopen it. The muscles and the temporomandibular joints have accommodated the collapsed position, so we test the new one before making it final.
Why were provisional restorations worn before the ceramic was made?
Because we prove a restored bite in function rather than assuming it. The provisionals hold the intended vertical dimension while the musculature and joints accommodate it. Committing twenty-eight ceramic units to an untested position risks muscle pain, joint symptoms and fractured restorations.
What is the difference between an inlay and a crown here?
An inlay restores the biting surface and sits within the remaining walls of the tooth. A crown covers the tooth entirely. Which one a tooth received depended on how much sound structure it had retained, so we used the more conservative option wherever the tooth allowed it.
Will the grinding damage the new restorations?
Restoring the teeth does not cure the habit. Ceramic is considerably harder than the enamel it replaced, and a night guard absorbs the force during sleep when the grinding occurs. Wearing it is the single most useful thing you can do.
How long does a full mouth reconstruction take?
This case ran two months from the crown lengthening to the final restorations. The interval depends on how long we need to assess the provisionals in function and on how much healing the surgery requires before preparation can begin.
Is a full mouth reconstruction painful?
We carry out the surgical phase under local anesthetic, and IV sedation, administered by Dr. Mehdizadeh, is available in this office if you prefer it. Discomfort afterwards is comparable to other periodontal surgery, and ordinary analgesia controls it.
How much does a full mouth reconstruction cost?
This case was $56,000, covering crown lengthening, provisional restorations and twenty-eight individual ceramic units. $669/month: 144 payments at 9.99% APR, on approved credit.
