12. Comprehensive Full Mouth Rehabilitation: Restoring Vertical Dimension and Occlusal Stability

Case Summary

A female patient in her 50s presented with a severely compromised dentition. The primary clinical findings included:

• Posterior Bite Collapse: Significant loss of posterior support leading to a reduction in Vertical Dimension of Occlusion (VDO).

• Anterior Flaring: Due to the lack of posterior stops, excessive occlusal forces were transferred to the anterior segment, resulting in pathological labial drifting (flaring) and increased tooth mobility.

• Recurrent Caries: Extensive secondary caries were noted under old, ill-fitting prostheses.

• Alveolar Bone Deficiency: Severe bone resorption in the posterior regions, complicating the foundation for restorative work.

OPG - BEFORE

INTRA ORAL - BEFORE

Treatment Objectives

• VDO Elevation: To recover the lost vertical dimension and create space for definitive restorations.

• Occlusal Reconstruction: To establish stable posterior support and a sustainable occlusal scheme.

• Anterior Realignment: To correct the anterior flaring by providing proper overjet and overbite, thereby reducing tooth mobility.

• Structural Integrity: To eliminate secondary caries and replace failing prostheses with high-precision restorations.

• Foundation Reinforcement: To perform guided bone regeneration (GBR) to support strategic implant placement in the posterior regions.

INTRA ORAL - AFTER

Treatment Approach

1. Initial Phase: Removal of non-restorable prostheses and management of extensive secondary caries. Periodontal therapy was conducted to stabilize the supporting tissues.

2. Surgical Phase: Extensive bone grafting was performed in the posterior segments to address alveolar bone loss, followed by the placement of dental implants to provide a firm foundation for the new occlusion.

3. Prosthetic Phase (VDO Management): The patient’s VDO was systematically elevated. Temporary restorations were utilized to verify the patient's adaptation to the new vertical height and to stabilize the newly established centric relation.

4. Final Restoration: Once occlusal stability was confirmed, definitive anterior re-prosthodontics and implant-supported posterior bridges were delivered. Particular attention was paid to establishing an ideal overjet/overbite relationship to prevent future flaring and ensure long-term sustainability.