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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: Hello, I am very happy to try to help you for this one.  I have to tell you that this is extremely complicated but I'll do my best to help you.  I am not exactly sure what you mean in the number 2 that you told me, I think  you mean that you have a small space between some of your front teeth.  That could probably be closed quickly with a simple removable appliance.  This is very difficult to answer without seeing you.  The pressure on the lips is telling me one of two or three things, one is that the vertical dimension is off perhaps too shallow, secondly it seems to say that there is a possibility that the porcelain on the anterior teeth is too bulky which is pushing the lips slightly.  In the mouth it does not take very much to make us notice subtle changes and I'm sure you are feeling this.  When you said that your muscles seemed loose that is what gave me the clue that your vertical dimension ( how open or closed your mouth is) is too shallow. One has to be very careful to not make it too high because that causes many problems so I don't know if I'd try to change that but if you do it will require some remakes of some of the posterior crowns.  If you raise the back tooth by 1 millimeter then it raises the front 3 millimeters so it does not take much to make this happen. As far as which teeth to be redone upper or lower, that is a decision to be made by your clinician, I tend to do the lower because the tend to be a bit more stable but that's just my opinion.  I truly hope this helps you.  The space between your teeth in front bothers me a little and as far as reducing that with braces or an appliance will only work if you have room to bring those teeth back a little, if you don't then the anterior crowns need to be remade.  Remember I am giving you all this advice without seeing you but this is the best I can do with the information you've provided.  I wish you well and I'm sure you can be made comfortable.

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

QUESTION: thanx sir,
you understood the most of it verry well ..
number 2) is that i want to feel more pressure on my premolars and the bite was shifted from premolars to molars by grinding high points on teeth by unprofessional dentist .. thats the cause ..
so now i am planing on replacing either lower 4 premolars or uppers ....
right now i did consulted a dentist and he applied resin filling meterial to temporary raise height of premolars to see if it helps and it really did .... all i am confused is to get raised upper pre molars or lowers cuz they do change facial muscles and its shape ... thats what i have noticed and going through right now ....
anyway thanx a lot for your help sir..

ANSWER: I think that your dentist did a great job of using  the resin.  I suggest you place some temporarily on uppers then lowers and see which makes you feel and look best.  Then you can decide the final restorations.  It makes no difference functionally so at this point it's aesthetics and I think you can experiment a little using temporary measures.

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

QUESTION: really thanks a ton for your information...
still i have one major doubt that i really want to ask you . uppers and lowers dont matter functionally but i dont have a strong chin and its not in straight shape with my nose(viewing from side angle). .(hope u get it)its a lil bit backwards than nose position. (cute baby face type maybe) ..  so in order to make it right like getting strong chin bone and jawline and making chin in straight positin with my nose are lowers gonna help me or uppers . thats all i wanna ask you at last..   
dentists here cant tell me all this .. only you can help me out ..
thanx again!

Unfortunately neither of the will help that situation, to actually move the lower jaw forward your bite needs to be closed and you've gone the other way and opened it. From what you've told me this is the right approach for you to make your muscles and teeth work properly together and keep you the most comfortable.  I think a suggestion I might have for you to explore is a chin implant, and this can be done in the vestibule (the area between the gum and lip) just in front of the front teeth.  This can be done with little trauma, pretty good healing and little scaring. Nothing would be visible and only you and your dentist or surgeon would know.  It might give you the result for which you're looking.

Dr. Karmen


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Thomas Karmen


All general dentistry questions, especially those related to fixed prosthetics. Endodontics, Periodontics, and implants, minor oral surgery I can't answer much about othodontics nor advanced treatment of carcinoma nor deep tissue surgery nor osseous surgery such as jaw reduction or advancement.


DDS In general practice and consulting with having done some lecturing for local dental societies.

ADA and Florida Dental Association and Iowa Dental association

DDS degree

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