A Case Study of Full Mouth Rehabilitation of Worn Dentition
Patient Background
Mr. Rajesh Verma, a 62-year-old retired banker, approached Dr. Jaydev Dental Clinic with concerns that had accumulated over years of untreated dental wear. He complained of shortened teeth, chewing difficulties, increased sensitivity, and a visibly aged facial appearance. Mr. Verma had become increasingly reserved in social settings, often covering his mouth while speaking or smiling due to the compromised aesthetics of his teeth.
A meticulous and soft-spoken gentleman, Mr. Verma expressed deep frustration over how his smile had aged him beyond his years. He hoped for a solution that could not only restore function but also bring back his confidence. Dr. Jaydev, known for his excellence in smile designing and microscopic endodontics, took on the case with a vision to restore both youth and functionality through a structured full mouth rehabilitation.
Symptoms
On clinical examination, Mr. Verma displayed:
- Severe generalized tooth attrition, especially in anterior teeth
- Collapsed vertical dimension leading to deep nasolabial folds and facial sagging
- Increased dentinal hypersensitivity, causing discomfort during meals
- Loss of posterior occlusal support, impairing chewing efficiency
Esthetic compromise with shortened, discolored teeth
These signs pointed towards long-term wear likely caused by a combination of bruxism and enamel erosion over time.
Diagnostic Method
- Clinical Evaluation: Identified worn dentition patterns, occlusal instability, and signs of muscle tenderness.
- Digital Smile Designing (DSD): Simulated the proposed smile transformation, enabling Mr. Verma to visualize his new look.
- 3D CBCT and Intraoral Imaging: Confirmed the presence of adequate bone support, ruled out pathology, and assisted in prosthetic planning.
- Occlusal Deprogramming: A deprogrammer was used over two weeks to relax the musculature and determine centric relation precisely.
- Facebow Transfer and Articulator Mounting: Helped accurately assess vertical dimension and develop the wax-up model.
This diagnostic workflow ensured precision at every phase of the full mouth rehabilitation.
Disease Diagnosed
Based on the diagnostic findings, Mr. Verma was diagnosed with:
- Advanced generalized attrition
- Posterior bite collapse with occlusal disharmony
- Secondary dentin hypersensitivity
- Mild muscular tenderness from occlusal imbalance
- Aged facial appearance due to vertical height loss
Treatment Plan and Post-Surgery Guidelines
Treatment Plan:
1. Occlusal Reprogramming and Wax-up Planning:
- Deprogramming was followed by a full-mouth diagnostic wax-up to determine the new vertical dimension of occlusion (VDO).
- Mock-ups were tried intraorally to test function and aesthetics.
- Monolithic zirconia crowns and bridges were fabricated for molars and premolars, offering strength and durability for functional load-bearing.
- Root canal therapy was performed on a few pulpal-involved teeth using advanced microscopic endodontics.
- Emax veneers were chosen for the upper and lower anteriors due to their superior translucency and natural appearance.
- The veneers restored tooth length, alignment, and shade, providing a youthful smile.
- Balanced occlusion was achieved with centric stops and canine guidance.
- Final polishing and aesthetic refinements were carried out.
Post-Treatment Guidelines:
Hygiene Protocol: Daily brushing with a soft toothbrush, non-abrasive toothpaste, and flossing.
Nightguard Use: A custom-fitted nightguard was provided to protect restorations from nocturnal bruxism.
Dietary Advice: Avoid hard foods like nuts and candy initially; follow a semi-soft diet during adaptation.
Scheduled Follow-Ups: At 1 week, 1 month, 3 months, and then bi-annually to monitor restoration integrity and oral health.
Outcome
The transformation was nothing short of remarkable. Mr. Verma’s youthful smile was restored, his bite was stable, and his sensitivity was gone. The patient reported a dramatic improvement in his ability to chew and enjoy food. More importantly, he regained the confidence to smile freely in public and interact socially without inhibition.
Dr. Jaydev remarked,
“Full mouth rehabilitation is not just about restoring teeth; it’s about restoring lives. Mr. Verma’s case exemplifies how precision dentistry can enhance both function and self-worth.”