Case Study
This case documents the treatment of a 72-year-old female patient presenting with severely worn dentition and an overclo · Dr. Rodney Andrus
This case documents the treatment of a 72-year-old female patient presenting with severely worn dentition and an overclosed, collapsed bite. The patient sought care for both functional restoration and aesthetic improvement, expressing dissatisfaction with the appearance of her chipped teeth. Through full mouth reconstruction using zirconia crowns, the patient achieved restored vertical dimension, improved aesthetics, and long-term functional success.
The patient was a 72-year-old female who presented with extensive dental wear and significant aesthetic concerns. She was referred by her general dentist for evaluation and treatment planning. The patient was facing a geographic relocation and required a treatment approach that could be completed efficiently within a limited timeframe and with minimal healing requirements.
The patient stated, "I hate the way my teeth look. I want a bright white smile. It's embarrassing to walk around with the chipped teeth." Her primary concerns centered on both the cosmetic appearance of her worn and damaged dentition and her desire for a brighter, more youthful smile.
Clinical examination revealed extremely worn dentition throughout the mouth. The patient exhibited an overclosed, collapsed bite resulting from the significant loss of tooth structure over time. This loss of vertical dimension affected both the functional and aesthetic aspects of her dentition and contributed to the compromised appearance that motivated her to seek treatment.
The patient had previously considered orthodontics combined with Le Fort I surgery to address her dental concerns. This surgical approach would have involved orthognathic surgery to reposition the maxilla and orthodontic treatment to align the dentition. However, given her lifestyle circumstances, timeline constraints, and the nature of her condition, alternative treatment approaches were evaluated.
The patient elected to proceed with full mouth reconstruction using zirconia crowns. This treatment plan was selected because it aligned well with her lifestyle needs and practical constraints. She was preparing to move out of state and required a treatment approach that could be completed within a few appointments without extensive healing time. The reconstruction approach eliminated the need for orthodontics and surgery while still addressing her chief complaint and restoring proper vertical dimension and aesthetics.
Treatment began with comprehensive diagnostic records, including mounted diagnostic casts and a diagnostic wax-up to establish the appropriate vertical dimension and plan the final restoration design. Cast post and core buildups were fabricated where needed to provide adequate foundation for the final restorations. Endodontic treatment was performed on teeth requiring root canal therapy prior to crown placement.
Provisional restorations were fabricated and placed to allow the patient to function at the planned vertical dimension before committing to final restorations. This transitional phase confirmed that the planned increase in vertical dimension was comfortable and functional for the patient. Following successful adaptation to the provisionals, the final zirconia crowns were fabricated and delivered to complete the full mouth reconstruction.
The final restorations utilized Ivoclar Prime transitional zirconia material. These zirconia crowns were fabricated as monolithic restorations without porcelain layering, providing strength and durability while achieving the aesthetic result the patient desired. The choice of monolithic zirconia offered the advantage of reduced material thickness requirements and excellent wear resistance.
The primary challenge encountered during treatment involved managing patient behavior related to dementia. This required adapted communication strategies and additional attention to ensuring patient comfort and cooperation throughout the treatment appointments. The clinical team had to balance the technical demands of the reconstruction with the need for clear, patient-centered communication and flexibility in appointment management.
The patient experienced no complications during or after treatment. At four-year follow-up, she reported very good comfort and function with her restorations. She expressed high satisfaction with both the functional restoration of her bite and the aesthetic improvement she had sought. The reconstruction successfully restored her vertical dimension, eliminated the worn and chipped appearance that had caused her embarrassment, and provided the bright smile she desired.
This case demonstrates the value of referring complex full mouth reconstruction cases to a prosthodontist, particularly when treating patients with severely worn dentition and collapsed vertical dimension. An important principle illustrated here is treating the patient, not just the teeth. This patient presented with behavioral challenges related to dementia that required accommodation and understanding throughout treatment.
Additionally, the case highlights the importance of providing what the patient needs clinically, not simply what she requests. While the patient initially considered more invasive surgical and orthodontic approaches, a thorough evaluation revealed that full mouth reconstruction could achieve her aesthetic and functional goals more efficiently and appropriately given her circumstances. General dentists with extensive experience in opening vertical dimension may be able to manage similar cases, but prosthodontic consultation can be valuable when patient complexity, medical considerations, or extensive restorative needs are present.
Worn teeth & collapsed bite
Timeline constraints
Chief complaint & behavior
Severe tooth wear can result from various factors including bruxism (grinding), erosion from acidic foods or drinks, abrasion from aggressive brushing, or simply decades of normal function. Over time, this wear can lead to loss of vertical dimension and a collapsed bite, affecting both appearance and function.
The timeline for full mouth reconstruction varies based on the complexity of the case and individual treatment needs. In this case, treatment was designed to be completed within a few appointments to accommodate the patient's relocation schedule. After diagnostic planning and any necessary preparatory procedures like endodontics, provisional restorations are placed first, followed by final restorations once the patient adapts to the new bite.
Zirconia crowns offer excellent strength and durability, particularly in monolithic form without porcelain layering. They can provide very good aesthetics while being highly resistant to wear and fracture. For full mouth reconstruction cases involving restoration of vertical dimension, zirconia provides the structural reliability needed for long-term success.
Vertical dimension refers to the height of the lower face when the teeth are in contact. When teeth wear down significantly over time, this dimension decreases, leading to an overclosed, collapsed bite. Restoring proper vertical dimension improves facial aesthetics, jaw function, and bite relationships while providing space for durable restorations.
No, surgery is not always required for treating severely worn dentition. While some cases may benefit from orthognathic surgery combined with orthodontics, many patients can achieve excellent functional and aesthetic results through restorative approaches like full mouth reconstruction. The appropriate treatment depends on the specific nature of the wear, the patient's goals, and their overall circumstances.
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