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Dentistry/full mouth rehab....


i had full mouth rehab with 28 crowns leaving wisdom teeth in order to raise my vertical height of teeth ..   treatment was completed ok.. after sometime i felt some (1 or 2) high points .. bt the dentist did my entire right side upper and lower mostly pre molars not molars ... and sir now i am facing problems below -

1)pressure on lips while sitting idle or speaking ..
2)i feel like getting a high point touch in front of my teeth due to which i feel a gap and its causing stress (feeling restless)
3)muscles that were strong are now loose (well thats what i have noticed)
all i want is that i donot face the above problems..
main question is -
So if i was to change some crowns (premolars maybe?) which ones should i go for lower ones or upper ones ?      does having an option in upper and lower ones effect the face muscles or its same for upper and lower ?

please help me on this one .. ihave felt a lot of effects in upper upper or lower raise of teeth .. so am confused ..
looking forward to ur reply.

ANSWER: Ho Om and thanks for your question.

Very sorry to hear about your situation, especially with all the work that has been done to improve your oral health and function to date.  Full-oral rehabs are not treatment modalities to be taken lightly or under-estimated for their inherent complexities.  In my opinion, unless the clinician is adequately trained and experienced in the procedure, full oral rehabs should rather be left to specialist prosthodontists.  As you rightly say and mention experiencing yourself post-operatively, ensuring the exact vertical dimension of the jaw and the proper relationship between the upper and lower jaw, during function and at rest, is of paramount importance to maintain "facial homeostasis" or optimal facial balance.  That is balance between all facial muscles, between the hard structures, all the soft supporting tissues and all these units in balance with each other as well.  The effect of imbalance is the identification of signs and symptoms of either undue strain or laxness in one or more facial area.  And its not unreasonable to expect that, given the extent of work carried out during a full-oral rehab and the cost, most patients expect the end result to be flawless.  And here in lies a fundamental problem...

1. Man is trying to re-create a system and/or improve on it by doing the full-oral rehab by using the available information to do so.  The truth is, there is a great deal about occlusion, jaw relations, the TMJ or the jaw joint for example, that remains a mystery to this day.  Given that the occlusal patterns and patterns of jaw functions are unique to each one of us, each oral-rehab is as unique as the next one is and although we have guidelines to use, sometimes the golden rules just miss the preciseness that is needed in order to achieve perfection.  Remember too, that the clinician and the lab are trying to re-create a complex 3D functionality such as the mouth by the series of impressions and molds taken of your mouth and ascertaining the most ideal jaw relationship for you, which would usually change from before the treatment because there is a specific reason why the full-oral rehab was advised to you originally and having the treatment would make those corrections which are needed to improve your oral health.  This is why it is so important to make sure that patients have the right level of expectation before the treatment is started so that patients are aware that there will be a period of adaptation to adjust to the "alterations" or occlusal corrections built in to the full-oral rehab.

The best thing that I can advise you to do, is to return to the clinician who completed the work and discuss these problem with them in a calm, logical and open-minded fashion.  It makes no sense to randomly start redoing crowns in a bid to alleviate the problem, without the problem and the cause first being identified and diagnosed.  Of course you are entitled to get a second opinion on the matter, in which I would suggest that you consult a specialist prosthodontist for this task.

I hope this helps and I wish you a speedy and uneventful resolution of this matter and that you once again have the quality of life that you so deserve, take care.

Kind regards
Dr Craig Peck

---------- FOLLOW-UP ----------

QUESTION: thanks for the info sir,
but i did consulted him right after the problem but he is ignoring it every time no matter what i say .. and i know that i do have a problem that has been due to reduction of my pre molars ..

the other thing is that my lower anterior teeth were more visibe ( aesthetically only with no functional problem )so i did told him to just reduce half a mm the four of my lower anteriors leaving canines .... but as the thing goes he did my canines alil bit, my all pre molars(more from right side) and lower anteriors as well .. i am ok with anteriors but    THE PROBLEM is that now i have to forcely close my mouth /lips ... that was not there earlier .. speaking is effected and stress is there when i donot get my premolars toched easily ..  
the dentists here do not provide much info .. so i will be really happy if you help me out on the following problems -

1. right now my facial muscles are loose a lil bit ..
2. upper and lower lips get forced into each other while closing mouth..
3. speaking also is effected somehow..
SO i planned with a dentist to redo my lower premolars .. it is ovious that the lower vertical would be raised compared to upper premolars .. what effect would it bring to me .. i do not want to aesthetically ruin my face ..
dont know if doing lower premolars would bring my lower jaw forward or back ward or what other iffects are there..

only you can help me out here . hope you are understanding the condition i am facing ..
thanks again

Hi again Om

As I am sure you imagine the difficulty I have in giving you any definitive answers without the privilege of a lot more vital information and being able to examine you clinically.  Dentistry is pretty much a hands-on science and the one who will be better equipped to answer your questions, is a specialist prosthodontist.  I suggest that you make an appointment with one in your area and get to the bottom of your problems.  Should there be any remakes needed, the specialist can liaise with your original dentist to sort out any logistical problems.  Sadly, I cannot offer you anymore information without your entire case notes, X-rays, study models, articulated models, etc.  I hope that you understand my predicament, but I wish you all the best further and trust that this problem will soon be a thing of the past for you.

Kind regards
Dr Craig Peck

PS:  Please could you rate my responses to your questions, I feel that's little enough to ask.  Many thanks


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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)


I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.


I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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