Restoration in patients with severely worn dentures is a challenging case as every case is unique from one another. There is a great apprehension involved in reconstructing debilitated dentition due to widely divergent views concerning the choice of an appropriate occlusal scheme for successful full mouth rehabilitation.
The objective of full mouth rehabilitation is not only the reconstruction and restoration of the worn out dentition but also the maintenance of the health of the entire stomatognathic system. Complete mouth rehabilitation should re-establish a state of functional as well as biological efficiency where teeth and their periodontal structures, the muscles of mastication, and temporomandibular joint (TMJ) mechanisms all function together in synchronous harmony. Proper evaluation followed by definitive diagnosis is mandatory as the etiology of severe occlusal tooth wear is multifactorial and variable. Careful assessment of the patient’s diet, eating habits and gastric disorders, along with the present state of occlusion is essential for appropriate treatment planning.
Various classifications have been proposed to classify patients requiring full mouth rehabilitation. However, the classification most widely adopted is the one given by Turner and Missirlian.
The patient closest speaking space is not less than 1 mm and the interocclusal space is always more than 4 mm and has some loss of facial contour and drooping at the corners of the mouth. All tooth of one arch must be prepared in one sitting for the final decision is taken. This increases in VDO less abrupt and allows better control of esthetics.
Patients typically have a long history of gradual wear caused by bruxism, oral habits, or environmental factors but the continuous eruption maintains the occlusal vertical dimension (OVD). It might be challenging to achieve resistance and retention form as shorter crown length, and gingivoplasty needed in few cases. Enameloplasty of opposite posterior teeth may provide some space for the restorative material.
There is excessive wear of anterior teeth for an extended period, and there is minimum wear of the posterior teeth. Centric occlusion and centric relation are coincidental with the closest speaking space of 1 mm and an interocclusal distance around 2 to 3 mm. In such cases, vertical space must be acquired from restorative materials. This is accomplished by orthodontic movement, restorative repositioning, surgical repositioning of segments, and programmed OVD modification.
After evaluating and classifying the patient’s existing clinical situation but before beginning the reconstruction procedure, the clinician must decide upon the occlusal approach and choose an appropriate occlusal scheme.