Full-Mouth Restoration to Tackle Every Problem

The Patient's Journey

This patient arrived with several separate complaints. He had broken teeth toward the back of his mouth, he wanted a more comfortable bite, and there was decay that needed removing before anything else could be considered. He also wanted his smile improved, which is the complaint most patients lead with and which was, in his case, the last item on a longer list.

The photographs show the appearance problem clearly enough. The teeth were discolored, the proportions were uneven, and dark spaces interrupted the smile line. What the photographs do not show is the condition of the back teeth, which is where the treatment actually began.

Understanding the Challenge

Presented individually, these were three separate treatments with three separate timelines and three separate estimates. Treated that way they interfere with one another, because restorations at the front are made to meet the teeth at the back, and remaking the back afterwards means remaking the relationship the front restorations were built to.

There was also a sequencing constraint that no amount of planning removes. Two fractured teeth and one failed root canal had to be extracted, and the implants replacing them require approximately eight weeks in the bone before they can carry a restoration. Nothing at the front could be finished during that interval, because the finished bite depends on what the implant crowns will eventually contribute to it.

So the order was determined by healing rather than by preference. A plan that attempts to compress that interval does not produce a faster result. It produces an implant restored before it is ready.

How Dr. Mehdizadeh Approached Treatment

The assessment covered both arches and produced a written list of everything that required attention, including the problems he had not come in about. That list became the treatment plan, and the plan was agreed in its entirety before the first extraction, which is the difference between comprehensive treatment and a sequence of individual repairs arranged in whatever order the discomfort happens to arrive.

Two fractured teeth and the failed root canal were removed, and three implants were placed at those positions, two in the upper arch and one in the lower. Eight weeks of integration followed. During that interval the design work continued, because the proportions the finished restorations would take could be established from the records even while the implants healed.

Twenty restorations were then made as a single set: three implant crowns and seventeen porcelain veneers, eight veneers and two implant crowns in the upper arch, nine veneers and one implant crown in the lower. All of them were fabricated in e.max in the practice's own laboratory by its master ceramist.

Designing them together is what allowed the bite and the appearance to be corrected simultaneously. The implant crowns are not matched to finished veneers, and the veneers are not designed around finished crowns. Every unit was specified against the same completed plan.

The Result After Twelve Weeks

The broken teeth are replaced, the decay is gone, the proportions are even across both arches, and the bite is distributed across twenty restorations that were designed to share it. Eight appointments across twelve weeks covered the extractions, the implant placement, the integration period, the design and the final cementation of every unit.

There is no outstanding treatment on his list. He wears a retainer at night and maintains a routine recall schedule. Implants do not decay, but the bone and the tissue surrounding them can be lost, which is precisely what the regular examinations and cleanings are checking for.