‘Full-mouth crowns are not a treatment option’: Prosthodontist warns against irreversible smile …

Patients seeking a dramatic “smile makeover” should not automatically be steered towards having large numbers of natural teeth prepared for crowns, a senior Pakistani prosthodontist has warned, drawing a sharp distinction between properly indicated full-mouth rehabilitation and elective crowning of teeth simply to transform a smile. Speaking on the Dental News Podcast, Dr Sameer Quraeshi, Head of the Department of Prosthodontics and Vice Principal at Fatima Jinnah Dental College (FJDC), delivered one of the episode’s strongest clinical and ethical messages: full-mouth crown-and-bridge treatment is not, by itself, a treatment option. His warning centres on a simple but consequential reality — once natural tooth structure has been removed for an irreversible restorative procedure, it cannot simply be put back. “Full mouth is not a treatment option in itself, ” Dr Quraeshi said during the discussion, adding that dentists must consider whether a more conservative approach is possible before committing patients to extensive crown-and-bridge work. The comments are particularly significant in an era of highly visual cosmetic dentistry, social-media smile transformations and growing patient demand for rapid aesthetic results. But Dr Quraeshi’s message was not that all full-mouth rehabilitation is inappropriate. Instead, he laid out a much more important distinction — one that patients and dentists may need to understand before irreversible treatment begins. A ‘smile makeover’ is not the same as crowning an entire mouth Dr Quraeshi challenged the idea that covering multiple teeth with crowns should become a routine route to a new smile. During the podcast, he said he had seen patients who had undergone multiple crown-and-bridge procedures as part of what had been described as a smile makeover. His concern was not simply the number of restorations involved, but whether the biological and prosthodontic justification for such extensive treatment existed in the first place. He stressed that dentists have options, criteria and conservative approaches available to them and should ask why an irreversible procedure is being proposed before proceeding. That distinction is central to his argument. According to Dr Quraeshi, full-mouth rehabilitation may have a legitimate role where the clinician needs to address specific parameters — including a need to alter occlusal vertical dimension (OVD), adopt a reorganised approach or make a justified change to the patient’s occlusion. What he objected to was treating extensive crown preparation as an aesthetic procedure in itself. “The smile makeover concept is totally different from filling up the entire mouth with crowns, ” he said. Once a natural tooth is prepared, there is no simple way back Perhaps the most consequential part of Dr Quraeshi’s warning concerned what happens after a patient commits to extensive tooth preparation. Crowns are restorations with their own clinical lifespan. They may serve patients successfully for years, but they do not restore the tooth to its untouched natural state. Dr Quraeshi cautioned that the younger a patient is when multiple natural teeth are converted into restored teeth, the longer the restorative journey that patient may subsequently face. He told the podcast that crowns may remain functional for 10, 15 or 20 years, while later in the conversation noting that he has encountered restorations lasting considerably longer, including crowns surviving for 20, 25 and even 40 years. Their longevity, however, depends on factors such as planning, execution, adaptation and the surrounding clinical environment. His larger point was not that crowns are inherently problematic. It was that a restoration having the potential to last many years is not, on its own, a reason to remove natural tooth structure where treatment is not justified. For younger patients in particular, he warned against unnecessarily converting natural teeth into artificial restorations simply to achieve an aesthetic result. The money question — and an unusually candid warning Dr Quraeshi was also unusually direct about the financial dimension of extensive restorative dentistry. He acknowledged that full-mouth crown-and-bridge procedures can generate income for a practice, but said financial return should not become the reason for carrying out irreversible treatment. With more than 25 years in the field, Dr Quraeshi urged clinicians not to undertake full-mouth cases simply for the sake of doing them. He illustrated the issue with the case of a patient who told him that another dentist had advised crowns because the patient’s teeth could otherwise develop cavities. Dr Quraeshi rejected that rationale as a treatment indication and criticised the practice of selling unnecessary treatment. That comment ties directly into another theme running through his Dental News conversation: dentists should educate patients rather than sell procedures to them. Earlier in the episode, while discussing implants and treatment choices, Dr Quraeshi said patients should be informed about the available options and allowed to understand their choices. Communication and empathy, he argued, are essential to developing patient trust and a sustainable clinical practice. Trying simply to sell treatment, he said, can eventually backfire. His first treatment-planning question: What if we do nothing? The warning against indiscriminate crowns becomes clearer when placed alongside Dr Quraeshi’s broader philosophy of treatment planning. Recalling what he learned during his postgraduate education at the University of Manchester, he said one of the first rules taught to him was to begin with “no treatment” — and then require the clinician to justify why an intervention is actually necessary. In other words, instead of beginning with what treatment can I provide? , the clinician first has to establish why treatment should be carried out at all. Dr Quraeshi said dentists should develop a systematic approach to determine whether a proposed treatment or replacement is truly required before constructing a definitive plan. That principle becomes especially important when the planned intervention is irreversible. Occlusion is the issue patients may never hear about — but dentists cannot ignoreAesthetic appearance was only one part of Dr Quraeshi’s warning. His discussion repeatedly returned to occlusion — the way the upper and lower teeth function and contact — as a fundamental consideration in prosthodontic treatment. Before discussing full-mouth cases, he went as far as saying that if there were one subject he would emphasise, dentists need to learn occlusion. He questioned what occlusal principles clinicians are following when undertaking extensive rehabilitation and why a patient’s existing occlusion is being changed. Later in the podcast, he also challenged the common practice of simply placing articulating paper after fitting a crown and grinding away contact marks until a patient says the bite feels comfortable. Dr Quraeshi said the patient’s occlusion should instead be understood and recorded before treatment so that the new restoration can be integrated appropriately. Simply reducing a crown until discomfort disappears can leave it in infraocclusion rather than correctly resolving the underlying problem. For patients considering multiple crowns, that makes the stakes considerably higher: once treatment extends across several teeth, errors in planning are no longer confined to a single restoration. Not every root-canal-treated tooth automatically needs a crown either Dr Quraeshi’s push for case-by-case decision-making continued when the podcast moved into common dental myths. Asked whether every tooth that has undergone root canal treatment needs a crown, his initial answer was no. He said the decision depends on factors including how much tooth structure remains, the integrity of the marginal ridges, the size of the restoration and the tooth’s risk of fracture. Where too little sound tooth structure remains or stresses are high, a crown may indeed be indicated. He also clarified that crowns are required in many root-canal-treated teeth because such teeth commonly arrive with large, deep cavities and have already lost significant structure. But putting every root-canal-treated tooth automatically into a crown, he said, is not an appropriate blanket approach. The qualification is important: Dr Quraeshi is not arguing against crowns. He is arguing against crowns without adequate indication. So when is extensive crown-and-bridge treatment justified? That may be the most important takeaway from the conversation. Dr Quraeshi did not dismiss properly planned full-mouth rehabilitation. His comments specifically leave room for complex cases where extensive intervention is clinically justified — including circumstances requiring changes to OVD, reorganisation of the occlusion or other parameters demanding comprehensive rehabilitation. What he rejected was the transformation of that complex prosthodontic treatment into a routine cosmetic shortcut. For clinicians, his message is to ask the difficult questions before touching a tooth: Why is this procedure required? What is happening to the patient’s occlusion? Is an irreversible intervention justified? And is there a more conservative option? For patients, the implication is equally important. A dramatic before-and-after photograph may show the final appearance of a smile, but it cannot show how much natural tooth structure was removed to achieve it — or what restorative care those teeth may require over the decades that follow. And that is precisely why Dr Quraeshi believes the distinction between a genuine smile makeover and unnecessary full-mouth crowning needs to be understood. More than crowns: Dr Sameer Quraeshi opens up on the Dental News Podcast The full conversation goes considerably beyond cosmetic dentistry. In the episode, Dr Sameer Quraeshi — Head of the Department of Prosthodontics and Vice Principal at Fatima Jinnah Dental College — discusses his journey through dentistry and postgraduate education, MDS versus FCPS, shortcomings in undergraduate clinical training, simulation-based learning, occlusion, digital dentistry and intraoral scanning, implant treatment planning, patient anxiety, postoperative pain, continuing education and the relationship between dentists and dental technicians. His professional role and academic background are introduced at the beginning of the programme. The discussion on full-mouth crowns is therefore only one part of a wider conversation about how dentists are trained, how clinical decisions are made and where modern dentistry must resist allowing technology, aesthetics or commercial pressures to overtake biological principles. WATCH THE FULL PODCAST What really separates a necessary dental procedure from overtreatment? Why does Dr Sameer Quraeshi believe dentists must master occlusion? Is digital dentistry replacing conventional techniques? And does MDS or FCPS really make the better specialist? Watch the complete Dental News Podcast with Dr Sameer Quraeshi on the official Dental News Pakistan YouTube channel for the full conversation. ▶️ WATCH THE FULL EPISODE: CLICK HERE

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