The Dentiq Difference

Full Mouth Rehabilitation (FMR) Protocol — Scroll Down...

The Dentiq Difference

Full Mouth Rehabilitation Protocol

I. Diagnostics

At the first visit, hi-resolution photos, digital x-rays, a 3D CAT scan and a thorough clinical consultation will take place followed by expert explanation of the case diagnosis and treatment options. If indicated, pressure mapping and jaw tracking is administered to thoroughly assess occlusion mechanics. FMR (full mouth rehabilitation cases) and TMJ / TMD cases will follow the FMR protocol for establishing therapeutic occlusion, re-evaluation and long-term treatment administration which is case specific. At this visit, TMJ TENS, pressure mapping and impressions can be administered which will later be used to establish, and temporarily maintain therapeutic occlusion either with an orthotic or crown-build ups.

II. Establishing Therapeutic Occlusion (2 to 3 weeks later)

Before the vertical dimension is increased (also known as opening the bite), the patient receives a 60 minute TENS session to relax the masticatory muscles. This re-establishes the rest position of the mandible as a "point of reference" before adjustment of the therapeutic occlusion. Worn 24 hours a day, the orthotic appliance is removed only for cleaning the teeth while crown build-ups remain in place 24 hours a day. The orthotic or crown build-ups permit the jaws to come together in a muscularly healthy position, retraining the muscles to move along a more natural, muscularly oriented pathway into the new occlusion.

Increase Vertical Dimension: Crown build-ups (or the orthotic) may be used to open the bite and/or align the bite to the anatomically correct position prior to "prepping" the teeth for porcelain restorations (when indicated for FMR). Patients temporarily maintain this new therapeutic occlusion for the next 3 weeks to 3 months to ensure that this is indeed the anatomically correct position.

III. Adjustments / Re-Evaluation (3 to 4 weeks later):

At this point, we typically see patients for three to six adjustment visits. At each visit a TENS session is used to relax muscles preceding any necessary occlusion adjustment which is assessed by clinical symptomatolgy as well as pressure mapping and jaw tracking. TENS is utilized during the adjustment as described in visit 2 above. Following 3 weeks to 3 months of full-time therapeutic occlusion via an orthotic or crown-build-ups, patients return for a re-evaluation study to assess associated muscle function. This data assists in determining the effectiveness of the initial treatment to establish, and temporarily maintain therapeutic occlusion. Upon the completion of the re-evaluation study, the majority of our patients have achieved a level of improvement that warrants the consideration of long-term treatment options.

IV. FMR Smile Design

Dentiq Smile Design has pioneered a proprietary process that combines leading imaging, software and refinement technologies to evaluate color, shape, shade, symmetry, size and style with the artistic expressions of design masters (the master ceramist, the principal cosmetic dentist and of course, the patient). Every detail is incorporated into a digital smile design prior to casting to the temporary veneers (the prototypes). This stage of the protocol requires the master ceramist and the principal cosmetic dentist to submit their design recommendations independently. The patient can be as involved as they would like to be throughout every step of the smile design process. That said, we recommend letting the principal cosmetic dentist and master ceramist develop a design based on measurements, color contrasts, hue, chroma, translucency and applied principles. From this point, patients can typically better articulate design discretions that they would like incorporated into the next prototype for re-evaluation.

Golden Proportion

The physical components which make up the sense of beauty and attractiveness come down to balance and proportion. This natural law of beauty is known as Golden Proportion (or Golden Ratio). Golden Proportion is an essential element in need of understanding, in order to create the perfect smile. With that said, Dr. Johnson and the Master Ceramist incorporate the 7 natural laws of beauty in smile design. Golden Proportion assembles your new smile with the natural shape, size and contour to best fit your face and jaw function. Beautiful and timeless smiles must be proportionate and remain in harmony with your unique facial features in order to successfully emphasize your true beauty. The roots of this theory can be traced back to hypotheses used during the renaissance, in both art and science. It is a mathematical equation based on the principles of ratio and geometric proportion. This relationship best conveys the philosophy of perfect aesthetic composition, using ratio and dimensional connection. The application of Golden Proportion principles can be applied to the human face. Golden Proportion has been equally applied to the practice of Cosmetic Dentistry, and where consideration is made to essential components of the ‘perfect smile’. These principles of symmetry and balance are the critical ingredients in the development of a ‘beautiful’ face and smile.

V. Prototyping With Wax

Generally speaking, this is typically the second or third non-treatment visit for non-TMJ cases. For the TMJ FMR, this is typically the 7th visit. The Wax-Up is a prototype design that we use to establish a benchmark. The design is mounted on models that are used to assess the case mechanics (function). Depending on patient preference, we will either send hi-resolution pictures of the wax-up (to seek feedback from the patient which will be incorporate into the next prototype) or we ask the patient to come into the office for a hands-on review. All full mouth porcelain cases are entitled to unlimited prototype revisions with the understanding that case mechanics will never be compromised for case aesthetics - not to worry, 97% of the time, we can develop a prototype that is truly uncompromising. The patient should expect two weeks between prototype revisions. Unlimited revisions means that whether it's the first, second or tenth prototype, when you LOVE WHAT YOU SEE, it's time to schedule "The Prep" visit which typically takes place in two to six weeks.

VI. "The Prep"

This visit is the first treatment visit which is comfortably performed under a type of moderate, non-IV sedation (IV sedation is available too and is administered by a board certified Anesthesiologist). Minimal enamel is gently reduced to accommodate the new smile design, followed by master impressions (to make the final porcelain restorations) and the placement of the temporary veneers / crowns to create a seamless, naturally beautiful smile. If additional treatment is planned such as gum contouring, crown lengthening, dental implants or root canal therapy, this treatment typically takes place during this same visit.

VII. Re-Evaluation / Follow-Up

One week after "The Prep" visit re-evaluation takes place. During this visit, diagnostic imaging and pressure mapping takes place so that the principal cosmetic dentist and the patient can further assess and consult about the case mechanics and aesthetics. If further revisions are required, certain revisions can be made intra-orally during this visit while other, more drastic, revisions will be incorporated into "The Final" porcelain prototypes.

VIII. Prototyping With Porcelain

A small percent of patients request additional prototype revisions which are incorporated into porcelain units and mounted on a model for review. Similar to the first prototype, we can send hi-resolution pictures of the porcelain units or the patient can come into the office for a hands-on review. Any additional design revisions will be incorporate into another set of porcelain prototypes until they are approved for final design. Once the final design is approved, "The Final" treatment visit typically takes place four to six weeks later.

IX. "The Final"

This visit is the second treatment visit which is comfortably performed under a type of moderate, non-IV (or) IV sedation. During this visit, the temporary teeth will be removed to accommodate The Final porcelain restorations. Using a state-of-the art laser guided template, The Final porcelain restorations are placed with bespoke attention to each and every detail which completes the smile makeover. LOVE WHAT YOU SEE!

Porcelain Materials

Our exclusive porcelain protocols deliver uncompromising aesthetics and superlative strength, which makes e.Max® Porcelain (w/ micro-filled surface technology) virtually unbreakable. If dental implants are indicated, our office uses the SLActive® implant system, which is the only implant in the world that can be fully restored in 3 to 6 weeks.

X. Re-Evaluation / Follow-Up

One week after "The Final" treatment visit re-evaluation takes place. During this visit, additional diagnostic imaging and pressure mapping is administered. If the mechanics of the patients' bite (occlusion) are off by even 1/10 of a millimeter, the principal dentist will make a computer guided adjustment so that everything looks, feels and functions as designed. XI. Recare Depending on your oral hygiene habits and the porcelain restoration type, recare visits are typically three to four times a year. While recare visits are cost comparable to that of a regular cleaning, certain measures are taken in the recare process to ensure your smile makeover retains uncompromising, timeless aesthetics. When you do your treatment with us, you'll do it once and it will last a lifetime... so we honor our work for the life of the patient.

The Fine Print

The patient should complete, and maintain, all clinically necessary treatment; he or she should maintain their regularly scheduled recare visits (3 to 4 times a year); and, it should go without saying that the patient should be in good financial standing with our office. In the event of an accidental injury, or an extraordinary circumstance occurs that compromises the integrity of the treatment, the patient may be asked to cover the cloning costs per tooth, which is generally $200ea. Treatments that we can not honor include: non-implant secured bridges, mini-implants, dentures, orthodontics, composites (including bonding), fillings and root canal therapy.

Qualifying Cedentials: FMR (Full Mouth Rehabilitation)

There may be a handful of centers in the world that have the credentials, treatment technologies and specialized experience to perform a FMR (full mouth rehabilitation) case at a level in which you will love the outcome. For the patient that decides to have their treatment performed by another center, you should know that we are happy to help qualify their credentials and clinical capabilities required to meet your specific FMR needs. Alternatively, if you do this on your own accord, these are some of the topics you should address:

- Ask to see their "Full Mouth Rehabilitation" (FMR) Protocol in writing

- Ask about their experience in performing FMR cases and how often do they perform these cases

- Ask about how they perform occlusion diagnostic testing (bite paper, computed guided pressure mapping, emg)

- Ask about how they perform occlusion adjustments (bite paper, computed guided pressure mapping, emg)

- Ask about their process in establishing therapeutic occlusion and case mechanics

- Ask about their design philosophy in establishing naturally beautiful, full facial aesthetics

- Ask about the type of porcelain that's recommended for your case and why

- Ask about their porcelain supplier and master ceramist

- Ask about their refinement process

- Ask about "in writing" guarantees

- And of course, ask them to see pictures of their work highlighting full facial aesthetics 

An Overview Of The FMR Process

 * There needs to be a minimum of 2 to 4 weeks between each visit.

1. Establish Therapeutic Occlusion: TENS. Jaw tracking. Tek scan (pressure mapping). Increase vertical dimension (orthotic/ crown build-up)

2. The Prep: Crown lengthening & gingival contouring (if indicated). The porcelain prototypes are placed.

3. The Finals: The final porcelain restorations are placed.

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The Dentiq Difference

Full Mouth Restoration Protocol (Incorporating The SLActive™ Implant System & Crown Lengthening)

I. Diagnostics

At the first visit, hi-resolution photos, digital x-rays, a 3D CAT scan and a thorough clinical consultation will take place followed by expert explanation of the case diagnosis and treatment options. If indicated, pressure mapping and jaw tracking is administered to thoroughly assess occlusion mechanics. FMR (full mouth rehabilitation cases) and TMJ / TMD cases will follow the FMR protocol for establishing therapeutic occlusion, re-evaluation and long-term treatment administration which is case specific.

II. FMR Smile Design

Dentiq Smile Design has pioneered a proprietary process that combines leading imaging, software and refinement technologies to evaluate color, shape, shade, symmetry, size and style with the artistic expressions of design masters (the master ceramist, the principal cosmetic dentist and of course, the patient). Every detail is incorporated into a digital smile design prior to casting to the temporary veneers (the prototypes). This stage of the protocol requires the master ceramist and the principal cosmetic dentist to submit their design recommendations independently. The patient can be as involved as they would like to be throughout every step of the smile design process. That said, we recommend letting the principal cosmetic dentist and master ceramist develop a design based on measurements, color contrasts, hue, chroma, translucency and applied principles. From this point, patients can typically better articulate design discretions that they would like incorporated into the next prototype for re-evaluation.

Golden Proportion

The physical components which make up the sense of beauty and attractiveness come down to balance and proportion. This natural law of beauty is known as Golden Proportion (or Golden Ratio 1.6: 1). Golden Proportion is an essential element in need of understanding, in order to create the perfect smile. With that said, Dr. Johnson and the Master Ceramist incorporate the 7 natural laws of beauty in smile design. Golden Proportion assembles your new smile with the natural shape, size and contour to best fit your face and jaw function. Beautiful and timeless smiles must be proportionate and remain in harmony with your unique facial features in order to successfully emphasize your true beauty. The roots of this theory can be traced back to hypotheses used during the renaissance, in both art and science. It is a mathematical equation based on the principles of ratio and geometric proportion. This relationship best conveys the philosophy of perfect aesthetic composition, using ratio and dimensional connection. The application of Golden Proportion principles can be applied to the human face. Golden Proportion has been equally applied to the practice of Cosmetic Dentistry, and where consideration is made to essential components of the ‘perfect smile’. These principles of symmetry and balance are the critical ingredients in the development of a ‘beautiful’ face and smile.

III. Prototyping With Wax

Generally speaking, this is typically the second or third non-treatment visit for non-TMJ cases. The Wax-Up is a prototype design that we use to establish a benchmark. The design is mounted on models that are used to assess the case mechanics (function). Depending on patient preference, we will either send hi-resolution pictures of the wax-up (to seek feedback from the patient which will be incorporate into the next prototype) or we ask the patient to come into the office for a hands-on review. All full mouth porcelain cases are entitled to unlimited prototype revisions with the understanding that case mechanics will never be compromised for case aesthetics. If the patient is not 100% satisfied with the prototype design, revisions are incorporated into a new set of prototypes for review. The patient should expect two weeks between prototype revisions. Unlimited revisions means that whether it's the first, second or tenth prototype, when you LOVE WHAT YOU SEE, it's time to schedule "The Prep" visit which typically takes place in two to six weeks.

IV. "The Prep"

This visit is the first treatment visit which is comfortably performed under a type of moderate, non-IV sedation (light and deep IV sedation is available too and is administered by a board certified Anesthesiologist). Site preparations are performed so that Crown Lengthening, the SLActive™ Implant/s and bone grafting (if indicated) can be administered. Minimal enamel is gently reduced to accommodate the new smile design. If additional treatment is planned such as gum contouring, enamelplasty or root canal therapy, this treatment typically takes place during this same visit.

Crown lengthening is a procedure which is often used to enhance the smile line and modify gum symmetry. Although the teeth may already be the correct length, they can appear short when excessive gum tissue is present resulting in a ‘gummy’ smile. Cosmetic Crown lengthening involves reshaping the hard and soft tissues around the teeth to expose additional tooth structure thus improving smile aesthetics..

V. Re-Evaluation / Follow-Up

One week after "The Prep" visit re-evaluation takes place. During this visit, diagnostic imaging and pressure mapping takes place so that the principal cosmetic dentist and the patient can further assess and consult about the case mechanics and aesthetics. If further revisions are required, certain revisions can be made intra-orally during this visit while other, more dramatic, revisions will be incorporated into "The Final" porcelain prototypes.

VI. Prototyping With Porcelain

A small percent of patients request additional prototype revisions which are incorporated into porcelain units and mounted on a model for review. Similar to the first prototype, we can send hi-resolution pictures of the porcelain units or the patient can come into the office for a hands-on review. Any additional design revisions will be incorporate into another set of porcelain prototypes until they are approved for final design. Once the final design is approved, "The Final" treatment visit typically takes place four to six weeks later.

VII. Master Impressions

Four to five weeks after "The Prep" visit, the sites that received SLActive™ Implants and Crown Lengthening have had adequate time to heal so the temporary veneers / crowns are removed, followed by master impressions (to make the final porcelain restorations). A new set of prototypes will replace the old prototypes while the final porcelain restoration process takes place which requires three to four weeks.

VIII. "The Final"

This visit is the second and final treatment visit which is comfortably performed under a type of moderate, non-IV (or) IV sedation. During this visit, the prototypes will be removed to accommodate The Final porcelain restorations. Using a state-of-the art laser guided template, The Final porcelain restorations are placed with bespoke attention to each and every detail which completes the smile makeover. LOVE WHAT YOU SEE!

IX. Re-Evaluation / Follow-Up

One week after "The Final" treatment visit re-evaluation takes place. During this visit, additional diagnostic imaging and pressure mapping is administered. If the mechanics of the patients' bite (occlusion) are off by even 1/10 of a millimeter, the principal dentist will make a computer guided adjustment so that everything looks, feels and functions as designed. XI. Recare Depending on your oral hygiene habits and the porcelain restoration type, recare visits are typically three to four times a year. While recare visits are cost comparable to that of a regular cleaning, certain measures are taken in the recare process to ensure your smile makeover retains uncompromising, timeless aesthetics. When you do your treatment with us, you'll do it once and it will last a lifetime... so we honor our work for the life of the patient.

The Fine Print

The patient should complete, and maintain, all clinically necessary treatment; he or she should maintain their regularly scheduled recare visits (3 to 4 times a year); and, it should go without saying that the patient should be in good financial standing with our office. In the event of an accidental injury, or an extraordinary circumstance occurs that compromises the integrity of the treatment, the patient may be asked to cover the cloning costs per tooth, which is generally $200ea. Treatments that we can not honor include: non-implant secured bridges, mini-implants, dentures, orthodontics, composites (including bonding), fillings and root canal therapy.

 ABOUT US       VENEERS        3-VISITS                BEFORE & AFTER       CONTACT US

The Dentiq Difference

Full Mouth Rehabilitation (Incorporating Crown Lengthening & Implant/s) - 4 Stage Protocol

Pretreatment (Day 1) – Impressions

- TENS    

- Occlusion Analysis

- Pressure Map    

- Diagnostic Impressions   

- Treatment Time: 90 minutes    

- Recovery: NA  

Stage One (Day 14) – Establish Therapeutic Occlusion     

- Review Mechanics & Design     

- Occlusion Analysis    

- TENS    

- Jaw tracking    

- Tek scan (pressure mapping)    

- Increase vertical dimension w/ a fixed orthotic (crown build-ups)    

- Treatment Time: 4 hours    

- Recovery: NA  

Stage Two (Day 35) – The Prep     

- Crown lengthening, gingival contouring, dental implant/s (all treatment procedures are administered in this visit)    

- The porcelain prototypes are placed    

- Treatment Time: 8 to 12 hours    

- Recovery: 72 hours  

Stage Three (Day 63) – The Finals (Lowers & Molars)     

- Final gum revisions (if indicated)    

- The final porcelain restorations are placed (except where crown lengthening was performed and implant site/s)    

- Treatment Time: 8 to 12 hours    

- Recovery: 24 to 72 hours  

Stage Four (Day 91) – The Finals (Uppers)     

- The final porcelain restorations are placed 

- Treatment Time: 8 to 12 hours

- Recovery: 24 to 72 hours

The Dentiq Difference

Upper Arch Rehabilitation (Cross-Bite Correction Incorporating A Fixed Orthotic). Lower Arch Rehabilitation (Incorporating Implant/s) - 5 Stage Protocol.

Pretreatment (Day 1) – Impressions

- TENS    

- Occlusion Analysis

- Pressure Map    

- Diagnostic Impressions   

- Treatment Time: 90 minutes    

- Recovery: NA

Stage One (Day 21) – "The Prep" Establish Therapeutic Occlusion (Upper Arch Rehabilitation)     

- The porcelain prototypes are placed while restoring 1 to 4mm of vertical deminsion

- Fixed orthotic

- Pressure mapping

- Occlusion analysis

- Treatment Time: 8 to 12 hours    

- Recovery: 72 hours  

Stage Two (Day 35) – Re-Evaluate Therapeutic Occlusion 

- Review Mechanics & Design

- Occlusion Analysis    

- TENS    

- Jaw tracking    

- Tek scan (pressure mapping)    

- Treatment Time: 2 hours    

- Recovery: NA  

Stage Three (Day 63) – "The Finals" Maintain Therapuetic Occlusion With The Finals (Upper Arch)     

- The final porcelain restorations are placed 

- Treatment Time: 8 to 12 hours

- Recovery: 24 to 72 hours

Stage Four (Day 84) – "The Prep" Maintain Therapeutic Occlusion (Lower Arch Rehabilitation)     

- The porcelain prototypes are placed and implants (if indicated)

- Pressure mapping

- Occlusion analysis

- Treatment Time: 8 to 12 hours    

- Recovery: 72 hours  

Stage Five (Day 119) – "The Finals" Maintain Therapeutic Occlusion (Lower Arch Rehabilitation)     

- The final porcelain restorations are placed

- Pressure mapping

- Occlusion analysis

- Treatment Time: 8 to 12 hours

- Recovery: 24 to 72 hours