Specialty & Implant Care
Full Mouth Reconstruction
When years of grinding, wear, decay, or old dental work have caught up with an entire mouth, the answer is not another patch. It is a plan that treats the whole bite as one system.
Treated by
Dr. Jonathan Berkowitz, DMD
Residency-trained Prosthodontist
- University of Michigan prosthodontic residency
- Ten years attending prosthodontist, Northport VA
- Implants placed and restored in-house
How mouths reach this point
Almost nobody arrives here suddenly. Full mouth reconstruction is generally the result of two or three decades of small problems compounding — a crown here, a root canal there, a filling replaced three times, each done in isolation and each perfectly reasonable at the time.
Eventually a pattern emerges. Teeth look noticeably shorter than they used to. Front teeth chip for no obvious reason. Old crowns come loose repeatedly. The jaw aches in the morning. Something feels off about the bite but no single tooth is the culprit. Sometimes patients describe their face as having collapsed slightly, which is not imagination — as back teeth wear down, the lower face genuinely loses height.
The common causes are long-term grinding and clenching, acid erosion from reflux or diet, extensive decay, advanced gum disease, or simply decades of dentistry that was never planned as a whole. Frequently it is several of these at once.
Why treating one tooth at a time stops working
Individual dentistry works well when the underlying bite is sound. Once it is not, treating teeth one at a time becomes a losing exercise — crowns keep fracturing, restorations keep failing, and the patient reasonably concludes that the dentistry is at fault when the real problem is the forces acting on it.
Full mouth reconstruction takes the opposite approach. Before any tooth is touched, we establish where the bite should sit: the correct vertical height between the jaws, the correct position for the jaw joints, and the correct relationship between the upper and lower teeth. Every restoration is then built to that plan.
This is the core of prosthodontic training. Three years of residency are devoted substantially to occlusion — how teeth meet, how force distributes, and why restorations fail when that is wrong. It is the difference between rebuilding a mouth and repeatedly repairing one.
What the treatment involves
No two reconstructions are alike, which is why an honest description resists a checklist. A given case may combine crowns and onlays to restore worn teeth, implants to replace missing ones, bridges to span gaps, gum treatment to establish a healthy foundation, veneers where the concern is primarily esthetic, and a nightguard to protect the finished result.
What matters is the sequence. Disease is brought under control first — active decay and gum disease treated before anything is rebuilt. The new bite position is then tested in temporary restorations you wear for weeks or months, so that any problem is found while it is still easy to change. Only when the temporaries are comfortable and functioning correctly are the final restorations made.
That temporary phase is the single most important safeguard in the process, and it is also the step most often skipped in practices without specialty training. Skipping it is how patients end up with a mouth full of beautiful permanent crowns that never feel right.
Timeline and cost
A full reconstruction typically takes between six months and eighteen months. Cases involving implants or extensive grafting sit at the longer end, since the bone needs time regardless of how efficiently the rest proceeds.
Cost varies more widely here than in any other treatment we offer, because the scope varies so widely. In Manhattan, comprehensive reconstruction generally falls between $30,000 and $90,000. A case involving fifteen crowns is a substantially different undertaking from one involving twenty-eight units plus six implants and gum surgery.
You will receive a written, phased treatment plan with costs itemized by stage. Many patients spread treatment across two or three years for financial reasons, and where that is clinically safe we will structure the plan around it — sequencing the work so the most urgent problems are addressed first and nothing deteriorates while you wait.
How we approach a reconstruction
The planning phase is deliberately slow. Getting the diagnosis right is what determines whether the finished result lasts twenty years or five.
- 1
Comprehensive examination
A full set of records: photographs, digital scans, 3D imaging, bite registration, and an assessment of the jaw joints and muscles. We examine every tooth individually and the bite as a whole.
- 2
Diagnosis and planning
Your models are mounted so the bite can be studied outside the mouth, and the new position is designed there first. You then see a proposed plan, in stages, with costs.
- 3
Stabilizing the foundation
Active decay and gum disease are treated, and teeth that cannot be saved are removed. Nothing is rebuilt on an unhealthy foundation.
- 4
Implants and grafting, where needed
Implants are placed and given time to integrate. This is usually the longest phase and runs in parallel with the temporary restorations.
- 5
The temporary phase
You wear temporary restorations built to the proposed new bite for several weeks or months. This is where we confirm it is comfortable, functional, and looks right — and adjust it while adjusting is still easy.
- 6
Final restorations
Once the temporaries have proven themselves, the final crowns, bridges, and implant restorations are fabricated to match what has already been tested, fitted, and refined.
- 7
Protection and maintenance
Most reconstructions finish with a custom nightguard. Regular hygiene visits and periodic bite checks protect the investment for the long term.
Questions
Things people ask
If your question is not here, call the office. Nobody will pressure you into booking.
Call 212-874-1700Is this mostly cosmetic?
No, though the appearance almost always improves substantially. Full mouth reconstruction is functional treatment — the goal is a bite that works, distributes force properly, and stops destroying itself.
The esthetic improvement follows from restoring teeth to their correct proportions and rebuilding lost facial height. Patients frequently say they look years younger afterward, but that is a consequence of the functional work rather than its purpose.
Will I be without teeth at any point?
No. Temporary restorations are in place throughout the entire process. There is no stage where you are without teeth, and the temporaries are made to look presentable because you may be wearing them for months.
Can I do this in stages to spread the cost?
Very often, yes, and many patients do. The important condition is that the sequencing has to be clinically sound — some steps depend on others being complete, and the overall bite plan has to be established at the start even if the work is delivered over several years.
We will map out a phased plan showing what should be done first, what can safely wait, and what each phase costs.
How long will the work last?
Well-executed reconstruction, properly maintained, commonly lasts fifteen to twenty-five years and often longer. The variables that matter most are how well the bite was planned, whether you wear the nightguard, and whether you keep up with hygiene visits.
The cases that fail early almost always fail for one of two reasons: the underlying bite was never corrected, or the grinding that caused the original damage was never addressed.
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Most people considering implants or major reconstruction have been thinking about it for a long time. A conversation costs nothing and there is never any pressure.
40 West 86th Street, Suite 1C · New York, NY 10024