Advanced Adhesive Approach to Support a Minimally Invasive Full Mouth Rehabilitation.

Objective: Patients who exhibit severe loss of tooth structure are challenging to rehabilitate. Conventional treatment of these patients may require adjunctive procedures of surgical crown lengthening, elective endodontic therapy and placement of posts and cores to retain full coverage crowns as part of a full mouth rehabilitation. Minimally invasive approaches to treatment of these patients provides opportunity to conserve tooth structure and to reduce adjunctive procedures by using an advanced adhesive approach to retain all ceramic partial coverage restorations as part of a full mouth rehabilitation.

Clinical considerations: The use of an advanced adhesive approach to perform a full mouth reconstruction restoring occlusal vertical dimension (OVD) is described. This approach emphasizes preserving healthy tooth structure, maximizing restoration adhesion to enamel and dentin, maintaining pulpal vitality and minimizing adjunctive dental procedures. The preparation design focuses on being defect-oriented to remove only diseased or undermined tooth structure. The all ceramic restorations are additive, where indicated, to further aid in preserving tooth structure. An advanced adhesive approach using an immediate dentin seal and resin coating over exposed dentin and composite resin cement under rubber dam isolation is used to lute the restorations. The restorations are fabricated using micro-layered lithium disilicate ceramic to maximize the esthetic appearance of the rehabilitation where needed.

Conclusion: An advanced adhesive approach to full mouth rehabilitation should be considered as a treatment option for patients exhibiting tooth surface loss as an alternative to conventional full coverage restorations when clinical parameters allow.