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This article presents a detailed clinical case of full-mouth rehabilitation using the principles of Bioesthetic Dentistry, with a focus on managing severe anterior wear and occlusal instability. The case illustrates how restoring biologic function through proper joint positioning, muscle balance, and conservative restorative design leads to long-term oral health and patient satisfaction. Through thoughtful planning and minimal intervention, the treatment restored both function and esthetics while preserving natural tooth structure.
Clinical Presentation and Initial Findings
The patient, a middle-aged woman, presented with advanced anterior wear, chipping, joint discomfort, and a collapsed bite. She expressed concerns about her appearance and discomfort when chewing. Clinical evaluation revealed a loss of anterior guidance, significant attrition, and joint instability. The esthetic impact included reduced incisal display, flattened tooth anatomy, and signs of facial aging due to vertical dimension loss.
Rather than addressing isolated symptoms, the clinician conducted a full bioesthetic evaluation, viewing the patient’s condition as part of a larger systemic breakdown. The treatment approach prioritized functional rehabilitation of the entire masticatory system, guided by biologic models of healthy, unworn dentitions.
Stabilizing the System with Splint Therapy
Diagnosis began with a mounted model analysis and centric relation bite registration. A MAGO (maxillary anterior guided orthotic) splint was fabricated and worn for several weeks to deprogram the muscles and allow the joints to seat naturally. During this phase, the patient experienced symptom relief and increased awareness of her bite dysfunction.
Successful splint therapy confirmed the therapeutic position of the mandible, which then became the reference for planning the restorative phase. This biologic position served as the stable foundation for determining vertical dimension, tooth form, and occlusal relationships moving forward.
Designing Functional and Esthetic Outcomes
With the joints and muscles stabilized, the clinician used diagnostic wax-ups to simulate the biologic form. The wax-up restored anterior guidance, posterior support, and vertical dimension—all informed by naturally ideal tooth shapes and occlusal schemes. Special attention was given to esthetics, with considerations for incisal display, smile arc, and facial harmony.
The wax-up guided temporization and allowed the patient to preview her future smile. This phase also provided an opportunity to make adjustments based on function and esthetic feedback before final restorations were created.
Conservative Restorative Strategy
The final restorative plan focused on additive techniques. Due to the degree of wear, little additional reduction was necessary. Veneers and bonded onlays were used to rebuild the worn dentition while preserving enamel wherever possible. Material selection included lithium disilicate for strength and esthetics, providing a balance between translucency and durability.
The case was completed in stages, allowing for careful control of occlusion and bonding protocols. The result was a biologically harmonious occlusion designed to prevent future breakdown, support joint health, and provide long-term stability.
Post-Treatment Results and Patient Satisfaction
The patient’s facial profile and smile were rejuvenated by the restored vertical dimension and proper anterior tooth length. Functionally, she reported resolution of TMJ symptoms, improved chewing comfort, and newfound awareness of her system’s health. The final restorations looked natural and functioned without the muscle tension or breakdown that characterized her pre-treatment condition.
Photos and radiographs confirmed the integrity of the restorations and their integration into a stable occlusal environment. The case demonstrates how a biologically centered approach can yield superior outcomes with minimal intervention.
Key Clinical Takeaways
- Advanced anterior wear and joint symptoms are often systemic issues, not isolated cosmetic concerns.
- Splint therapy deprograms muscles and reveals a true, repeatable biologic position for planning treatment.
- Diagnostic wax-ups based on biologic models ensure occlusal harmony and esthetic precision.
- Conservative, additive restorative techniques reduce trauma and preserve enamel.
- Staged rehabilitation improves control, accuracy, and long-term outcomes.
- Bioesthetic Dentistry provides a predictable and minimally invasive approach to full-mouth rehabilitation.
This article exemplifies how Bioesthetic Dentistry can transform complex cases with a biologically grounded, conservative approach. By prioritizing function, joint health, and natural form, clinicians can provide lasting solutions that restore both oral health and patient confidence.
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