Prevalence of patients requiring full mouth rehabilitation classi(cid:977)ied based on turner and missirlian classi(cid:977)ication and choice of treatment outcome

To assess the prevalence of patients requiring full mouth rehabilitation based on the turner and missirlian classi(cid:977)ication and assess the choice of the treatment plan. The study was done in the institutional hospital setting of Saveetha Dental College, Chennai. Patients requiring Full mouth rehabilitation were assessed, data was obtained from (cid:977)iltering the college database to obtain 65 patients. The patients were classi(cid:977)ied by the Turner and Missirlian classi-(cid:977)ication based on their extent of rehabilitation required and the treatment protocol used for them was also assessed. The obtained data was tabulated using an Excel sheet and statistical analysis was performed using Pearson correlation. Prevalence of Category 1 Of turner and missirlian classi(cid:977)ica-tion was among patients above 60 years (36.8%), For category 2 it’s among patients between 50-60 years (33.3%), and category III (36.4%) showed sim-ilar results as class I in terms of prevalence. The treatment preferred was mostly tooth supported FMR, Category 1 (52.6%), Category II (47.2%), Category III (54.5%). Full mouth rehabilitation involves extensive rehabilitation of oral structures requiring a meticulous interdisciplinary approach. The study shows the increased requirement of full mouth rehabilitation among elderly patients. Research analysing the prevalence of patients in need for such rehabilitation could give us a ground report on the oral health status of a population, and could prove to be valuable literature which could become the fore-runner for research in analysing the treatment protocols.

Tooth wear, Full mouth rehabilitation, Turner and Missirlian Classi ication, Treatment protocols ABSTRACT To assess the prevalence of patients requiring full mouth rehabilitation based on the turner and missirlian classi ication and assess the choice of the treatment plan. The study was done in the institutional hospital setting of Saveetha Dental College, Chennai. Patients requiring Full mouth rehabilitation were assessed, data was obtained from iltering the college database to obtain 65 patients. The patients were classi ied by the Turner and Missirlian classiication based on their extent of rehabilitation required and the treatment protocol used for them was also assessed. The obtained data was tabulated using an Excel sheet and statistical analysis was performed using Pearson correlation. Prevalence of Category 1 Of turner and missirlian classi ication was among patients above 60 years (36.8%), For category 2 it's among patients between 50-60 years (33.3%), and category III (36.4%) showed similar results as class I in terms of prevalence. The treatment preferred was mostly tooth supported FMR, Category 1 (52.6%), Category II (47.2%), Category III (54.5%). Full mouth rehabilitation involves extensive rehabilitation of oral structures requiring a meticulous interdisciplinary approach. The study shows the increased requirement of full mouth rehabilitation among elderly patients. Research analysing the prevalence of patients in need for such rehabilitation could give us a ground report on the oral health status of a population, and could prove to be valuable literature which could become the forerunner for research in analysing the treatment protocols.

INTRODUCTION
The wear of teeth over the years in a gradual pace has been accepted as a part of physiologic wear. However, excessive wear can result in pulpal pathology (Ramamoorthi et al., 2015), occlusal disharmony, loss of functional occlusion and esthetic handicap (Smith, 1989;Turner and Missirlian, 1984). Patients presenting with such levels of loss of mineralized structure of the teeth require extensive rehabilitation (Song et al., 2010). The etiology for such rapid progression of wear could be because of, For the success of any treatment, it is important to understand the etiopathogenesis and eliminate the root cause (Rivera- Morales and Mohl, 1992). This is important to enhance the prognosis and to preserve as much tooth structure as possible (Jyothi et al., 2017;Smith, 1989). Once the etiology is established, it is important to understand what all needs to be replaced and if there is restorative space available for this. This involves the measurement of the vertical dimension, giving a better understanding of the amount of rehabilitation required (Atwood, 1958;Silverman, 1953). In the current study, we have used Turner and Missirlian classi ication to understand better the amount of rehabilitation required and the restorative space available.
2. Category-2: Excessive wear without loss of VDO but with space available.
3. Category-3: Excessive wear without loss of VDO but with limited space.
In a typical category-1 patient, the closest speaking space is more than 1 mm and the interocclusal space is more than 4 mm and associated with loss of facial contour. Patients belonging to category-2 usually have a long history of gradual wear caused by bruxism, oral habits, or environmental factors. Category -3 is characterized by closest speaking space of 1 mm and an available interocclusal distance of 2-3 mm. Orthodontic or surgical interventions may be required to establish the restorative space in such cases.
Primarily the existing literature on full mouth rehabilitation are protocols and case reports. Studies by Krishna MG (Krishna et al., 2005) Occlusal rehabilitation involves the restoration of functional and aesthetic integrity of the arch through adhesive restorations, crowns, bridges, implant supported the restoration and various kinds of the removable prosthesis (Ashok et al., 2014;Venugopalan et al., 2014). The selection of the treatment plan depends on the clinical scenario and can vary from patient to patient. There is very limited literature on the prevalence of patients in need for full mouth rehabilitation, which could give us an insight on dental awareness, general oral health and maintenance. Classifying them allows us to interpret the amount of rehabilitation required.
Thus, this study aims to analyse the prevalence of patients requiring Full Mouth Rehabilitation, assess the extent of rehabilitation required using Turner and Missirlian classi ication and to assess the choice of treatment protocol used.

MATERIALS AND METHODS
The study was designed to assess the prevalence of patients requiring full mouth rehabilitation and the treatment protocol used in their correction.
The study was designed to be a retrospective cross-sectional study done in Saveetha Dental College, Chennai. The study was performed during the months of March-April 2020. The study was approved by the ethical committee and all the guidelines pertaining to con identiality was maintained. 65 case sheets were iltered from the database of the college, which meticulously maintained the patient records, based on the need for full mouth rehabilitation. The patients were classi ied into three based on the Turner and Missirlian classi ication and the treatment plans for each of these patients were assessed. The obtained results were tabulated using Excel sheets. Descriptive statistics were performed to analyse the frequency and percentages.

RESULTS AND DISCUSSION
The study revealed that of all the patients requiring full mouth rehabilitation, most patients belonged to category 2 of Turner and Missirlian Classi ication (Figure 1). The graph shows that maximum patients were associated with category 2 of Turner and Missirlian classi ication.
It was also observed that the majority of the patients in each of the categories of Turner and Missirlian Classi ication belonged to the age group of 60 and above (Table 1). In terms of treatment options, Tooth supported rehabilitation was the most common (50%) (Figure 2). Tooth supported FMR was most commonly done. The association between the extent of rehabilitation assessed using the Turner and Missirlian classi ication and age group of the patients did not show any statistical signi icance (p>0.05). Similarly, there was no statistically signif-  The treatment preferred was mostly tooth supported FMR, in all the three categories, followed by ToothTissue supported rehabilitations. The association was not statistically signi icant

Figure 1: The frequency distribution of patients requiring full mouth rehabilitation based on Turner and Missirlian classi ication
icant association between the treatment provided and the extent of rehabilitation(p>0.05) ( Table 2).
From Figure 3, The X axis represents the different The primary goal of dentistry is to increase the lifespan and ef iciency of functioning of the human dentition. Occlusal rehabilitation involves restoring the esthetics and function of the entire dentition with the help of a combination of crowns, bridges, implant supported restorations and removable prosthesis (Dawson, 2007). In earlier times, patients requiring such extensive rehabilitation were tagged 'dental cripples' and underwent full mouth extraction followed by fabrication of complete denture (Goldman, 1952).
With the current advances in techniques and materials available, dentists are able to preserve as many teeth as possible (Figure 4). X axis represents the categories of turner and missirlian classi ication, and Y axis represents the percentage distribution of different age groups. It is inferred from the graph that among category 1 and category 3, most patients belonged to the age group of above 60 years(yellow). The current study evaluated the prevalence of patients requiring full mouth rehabilitation and classi ied them based on Turner and Miller classi ication. Of the total patients presenting with severe attrition and 36.4% belonged to category III, the worst affected. There have always been apprehensions surrounding the reconstruction of such debilitating dentitions due to the different views on the planning for a successful restoration (Schweitzer, 1981;Bronstein, 1954). The popular philosophies of treatment include those suggested by McCollum et al. (Kurth, 1954) proposing the bilateral balance, followed by Stuart and Stellard proposing the mutually protected occlusal scheme (Stuart and Stallard, 1960). The studies revealed that the patients above 50 were most commonly affected. This could be owing to the buildup of physiologic wear in addition to the loss of tooth structure due to deleterious habits, trauma or simply caries (Preston and Coale, 1982). The results of the study showed that category II showed the highest number of cases, which is slightly reassuring as they have better prognosis due to available interarch space (Lewis and Smith, 1973;Turner and Missirlian, 1984). Cases Reports by Song et al. (Brecker, 1959;Song et al., 2010), Bencharit S et al. (Bencharit et al., 2010), Ameri N, (Ameri et al., 2017), Kumar AV et al. (Kumar et al., 2012) showed various permutations and combinations of protocols and treatment options for full mouth rehabilitation.
The current study had the limitation that only the distribution of different grades of rehabilitation under the Turner -Missirlian classi ication and the frequency of the treatment option chosen was discussed (Brecker, 1959). No correlation was drawn between the choice of a particular treatment for a particular category due to the limited sample size.
Full mouth rehabilitation is a meticulous process of rehabilitation and further studies to assess the apt treatment plan for a particular grade of wear can make the process of treatment planning standardized and easier.

CONCLUSIONS
Full mouth rehabilitation involves a complex and meticulous rehabilitation of the human dentition requiring a variety of protocols and interdisciplinary interventions. The current study revealed an increasing prevalence of greater need of rehabilitation among the older age population, and the preference of tooth-supported rehabilitations to be more common. Presence of a set protocol for treatment planning based on the grades of rehabilitation required under a classi ication would ensure ease of communication, understanding and ef iciency of treatment planning. Hence further research with larger sample size is encouraged to best derive this relation.