PHILOSOPHIES OF FULL MOUTH REHABILITATION

INTRODUCTION:
-What is full mouth rehabilitation and what is full mouth occlusal rehabilitation-
is it the same??
Occlusal rehabilitation procedure involves restoring the dentate or a partially
dentate mouth with the restorations and treatment that would restore the entire
occlusion back to the normal state of comfort.
- Definitions
INDICATIONS OF FULL MOUTH OCCLUSAL REHABILITATION:
CONTRA-INDICATIONS OF FULL MOUTH OCCLUSAL
REHABILITATION: No pathology – no treatment
GOALS/AIMS OF FULL MOUTH OCCLUSAL REHABILITATION: To
provide an orderly pattern of occlusal contact and articulation that will optimize
oral function, occlusal stability and esthetics.
OBJECTIVES OF FULL MOUTH OCCLUSAL REHABILITATION:
how do you achieve these goals/aims.
ETIOLOGICAL FACTORS LEADING TO FULL MOUTH OCCLUSAL
REHABILITATION: Congenital Anomalies-Disturbance in structure of teeth,
Occlusal diseases-Teeth & their supporting structures, Temporomandibular
disorders
VERTICALDIMENSION& INTEROCCLUSAL SPACE:
Can Vertical Dimension Be Altered?
Increasing Occlusal Vertical Dimension –Why ,When & How
 Category 1: Excessive wear with Loss Of Occlusal Dimension
 Category 2:Excessive wear without loss of VDO but with space available
 Category 3:Excessive wear without loss of VDO but limited space.
Possible clinical concerns on changing VD 
How Long should we wait after increasing the VDO?
OCCLUSAL SPLINTS: Definition, types, functions, principles, period of
wear
DEPROGRAMMING OF THE MUSCLES: methods for deprogramming of
the muscles.Directly Fabricated Anterior Deprogramming Device.(The Pankey
Jig, the Best-bite Appliance, The Lucia Jig, Leaf Guage)
CENTRIC RELATION & METHOD TO RECORD CENTRIC
RELATION:
PHILOSOPHIES OF OCCLUSAL REHABILITATION:
 PANKEY-MANN-SCHYULER PHILOSOPHY
The philosophy has had as its goal the fulfilment of the following principles of
occlusion as advocated by Schuyler:
1. A static coordinated occlusal contact of the maximum number of teeth
when the mandible is in centric relation.
2. An anterior guidance that is in harmony with function in lateral eccentric
position on the working side.
3. Disclusion by the anterior guidance of all posterior teeth in protrusion.
4. Disclusion of all nonworking inclines in lateral excursions
5. Group function of the working side inclines in lateral excursions.
Proper sequence advocated by PANKEYMANN-SCHYULER philosophy:
Part1:Examination,diagnosis,treatment planning and prognosis. Part-
2:Harmonization of the anterior guidance for best possible esthetics,
function and comfort.
Part-3: Selection of an acceptable occlusal plane and restoration of the
lower posterior occlusion in harmony with the anterior guidance in a
manner that will not interfere with condylar guidance.
Part-4: Restoration of the upper posterior occlusion in harmony with the
anterior guidance and condylar guidance
ADVANTAGES-
1. Possible to diagnose and plan treatment for the entire rehabilitation
before a single tooth is prepared.
2. Well organised and a logical procedure.
3. Never a need for preparing or rebuilding more than eight teeth at a
time.
4. Divides the rehabilitation into separate series of appointments.
5. Functionally generated path and centric relation are taken on the
occlusal surface of the teeth to be rebuilt at the exact vertical
dimension.
6. All posterior occlusal contours are programmed by and are in
harmony with anterior and condylar guidance.
 7. There is no need for time consuming techniques and complicated
equipment.
8. Laboratory procedures are simple and controlled to an extremely fine
degree by the dentist.
 HOBO’S TWIN TABLE PHILOSOPHY
The twin-stage procedure was developed by Hobo and Takayama in 1989.
They derived a kinematic formula to calculate anterior guidance from
condylar path.
Factors that determine disclusion:
1. Angle of hinge rotation
2. Cusp shape factor Angle of hinge rotation Posterior disclusion occurs
when anterior guidance is steeper than condylar guidance. The mandible
rotates around the intercondylar axis during eccentric movements when
anterior guidance is steeper than condylar guidance. The fact that
compensates for the difference in steepness is the angle of hinge rotation.
Cusp shape factor
When slopes of posterior cusps are parallel to condylar path inclination and
anterior guidance is parallel to condylar guidance, the opposing cusps slide
during protrusive movement without discluding, despite the degree of
steepness. If anterior guidance is steeper than condylar path, the posterior
teeth disclude. However, if the cuspal inclination of molars is parallel to
anterior guidance, there is no posterior disclusion even though anterior
guidance is steeper than the condylar path. The posterior teeth disclude only
when the cusp inclination of the molar is parallel to the condylar path and
anterior guidance is steeper than condylar path.
Basic concept of twin stage procedure
To provide disclusion, the cusp angle should be shallower than the condylar
path. Since anterior teeth help produce disclusion, when waxing of the
occlusal morphology is done, to produce shallow cusp angle, the anterior
portion of the working cast becomes an obstacle. Therefore, a cast with a
removable anterior segment is fabricated. The occlusal morphology of the
posterior teeth without anterior segment is produced so that the cusp angle is
coincident with the standard value of effective cusp angle. This is referred to
as“condition I‟. Secondly, the anterior morphology of the anterior segment
is produced to provide anterior guidance with standard amount of disclusion.
This is referred to as “condition II‟. The application of the two conditions
 described to fabricate the cusp angle and anterior guidance are termed as
“Twin Stage Procedure‟.
The twin-stage procedure is contraindicated in the following cases:
 Abnormal curve of Spee
 Abnormal curve of Wilson
 Abnormally rotated tooth
 Abnormally inclined tooth.
 FUNCTIONALLY GENERATED PATH
Classically, the FGP occlusion has been described as “3D static expression of
dynamic tooth movement,” since exact occlusal pathways of posterior teeth are
captured three-dimensionally in the functional wax. The technique was
introduced by Meyer  almost 70 years ago, which he termed as the “chew-in”
technique, and since then various researchers have refined the procedure. Over
the years, the technique has been known by various names such as “functional
chew-in technique,” “functional bite technique,” “generated path technique,”
and “cuspal tracing technique.” The FGP is highly versatile and has been
employed with equal efficacy in fabrication of relatively simple restorations
such as a single crown, or more complex full mouth reconstructions. It has also
been used in developing occlusion for complete and partial dentures and dental
implant restorations. The functionally generated path technique is to be
followed after the anterior guidance has been harmonized according to the
patient‟sesthetic and functional requirements and after the lower posterior
contours has been harmonized to the anterior guidance.
 FULL MOUTH SIMULTANEOUS TECHNIQUE
It involves full arch preparations, impression, provisional restorations and
mastercasts.
Advantages:
Flexibility in developing:
 Occlusal plane
 Occlusal scheme
 Embrasure
 Crown and esthetics
Disadvantages:
 Arduous unpredictable patient visit
 Full arch anaesthesia
  Multiple occlusal records
 Possible loss of vertical dimension of occlusion.
 QUADRANT/SEGMENT TECHNIQUE
It involves completing one quadrant before beginning another.

Advantages:
Preparation and final impression of selected teeth at one time will lead to-
 Maintenance of vertical dimension
 Quadrant anaesthesia
 Shorter predictable appointments
Disadvantages:
Restriction of achieving ideal occlusion when altering
 Vertical dimension
 Occlusal plane
 Embrasure development
Functionally generated path technique can be used when restoring one
quadrant at a time.
 SEGMENTED SIMULTANEOUS
Is combination of the desired characteristics of the full mouth simultaneous
rehabilitation and the programmed quadrant approach into a single
reconstructive technique.
Teeth are prepared and temporary restorations are fabricated chair side
segment by segment during several appointments. The patient’s vertical
dimensions of occlusion are maintained by using unprepared teeth or
provisional restorations as occlusal vertical stops.

TO CONCLUDE…
After reviewing the various philosophies of full mouth rehabilitation, I can
be concluded that it is best to achieve posterior disocclusion in full mouth
rehabilitation to avoid harmful lateral forces as was suggested by Hobo.
Although, the concept of gnathology provides stable long-term results due to
mutually protected occlusion and tripod contacts, in some patients, freedom
in occlusion may be required and therefore the PMS concept cannot be out
 rightly dismissed. Indeed, some of the PMS concepts such as establishing an
acceptable occlusal plane prior to occlusal rehabilitation are incorporated
into everyday occlusal practice. Furthermore, as the tripod contacts are very
difficult to equilibrate it is recommended that cusp-to-fossa contacts be
achieved in the reconstructed occlusion.