Rebuilding a Completely Worn-Down Smile: Full Mouth Rehabilitation for Function and Aesthetics

Published in Journal of Indian Academy of Dental Specialist Researchers — June 2016. Co-authored by Sunil Kumar Mishra, Dr. B. Srinivas Rao, Ramesh Chowdhary, and Patil PS.

Over years and decades, teeth can gradually wear down to a fraction of their original height. This happens through attrition (tooth-against-tooth grinding), erosion (acid exposure from diet or reflux), abrasion (aggressive brushing or abrasive habits), or a combination of all three. The process is so gradual that many patients do not notice it until the damage is severe — their teeth have become short, flat, sensitive, and their face appears to have aged prematurely due to the loss of vertical height in the bite.

By the time a patient with severely worn dentition seeks treatment, the challenge is enormous. Every tooth in the mouth is affected. The bite has collapsed. The jaw joints have adapted to an incorrect position. And restoring everything requires rebuilding the entire mouth — not just one or two teeth, but every single surface that comes into contact when the patient bites and chews.

This case report documents how Dr. Srinivas systematically rebuilt a patient's entire dentition from a severely worn state to full function and aesthetics, utilizing dental implants where teeth are missing.

The Patient's Condition The patient presented with generalised severe tooth wear affecting both the upper and lower arches. Years of attrition had reduced the clinical crown height of nearly every tooth. Several teeth were worn down almost to the gum level. The patient's occlusal vertical dimension — the measurement of face height when the teeth are in contact — had significantly decreased, giving the face a collapsed, aged appearance with deepened facial folds and reduced lip support.

Functionally, the patient experienced difficulty chewing, intermittent jaw pain, and sensitivity across multiple teeth where the protective enamel had been completely worn away, exposing the softer underlying dentine.

The Treatment Challenge [Full mouth rehabilitation](/services/full-mouth-rehabilitation) in a severely worn dentition is one of the most complex procedures in all of prosthodontics. The clinician must simultaneously address multiple interconnected problems:

* Restoring the correct bite height: The collapsed vertical dimension must be re-established to the correct measurement — not too high (which causes muscle fatigue and jaw pain) and not too low (which fails to restore proper function and aesthetics). This requires precise calculations using a facebow, articulator-mounted study models, and careful clinical analysis. * Reorganising the bite: When teeth are severely worn, the bite relationship between the upper and lower teeth has changed. Simply adding material on top of the worn surfaces without correcting the overall bite would create an unstable result. The entire occlusal scheme — the way teeth meet and glide against each other during chewing — must be redesigned. * Managing all teeth simultaneously: Unlike a single crown or bridge case, full mouth rehabilitation involves preparing and restoring every tooth. The sequence in which teeth are treated, the provisional restorations used during the process, and the final coordination of all restorations must be delicately planned.

The Treatment Process 1. **Diagnostic phase**: Dr. Srinivas began with comprehensive records — full-mouth radiographs, clinical photographs, facial measurements, and study models mounted on a semi-adjustable articulator using a facebow transfer. This allowed the treatment to be planned and visualised on the articulator before any work was done in the patient's mouth. 2. **Determining the new bite height**: The correct occlusal vertical dimension was calculated using established clinical methods — measuring the patient's rest position and applying appropriate freeway space. An occlusal template was fabricated to serve as a guide for the new bite height. 3. **Interim prostheses**: Before committing to the final restorations, interim (temporary) prostheses were fabricated at the new, increased vertical dimension. The patient wore these provisional restorations for a trial period, during which Dr. Srinivas monitored comfort, jaw joint adaptation, muscle response, speech, and aesthetics. This is a critical step — it allows both the clinician and the patient to evaluate and adjust the new bite in real life before making it permanent. 4. **Final restorations**: Once the patient had adapted comfortably to the new vertical dimension and all functional and aesthetic parameters were confirmed, the definitive restorations were fabricated and cemented. Each crown was designed to contribute to a harmonious overall bite, with proper cusp-fossa relationships, canine guidance, and anterior disclusion — the precise biomechanical features that protect the restorations and jaw joints during function.

The Outcome The completed rehabilitation restored the patient's teeth to their proper height, form, and function. The facial profile improved noticeably with restored vertical height — the collapsed appearance reversed, lip support returned, and facial folds softened. Functionally, the patient could chew comfortably and the sensitivity resolved completely since all exposed dentine surfaces were now covered by protective restorations.

Most importantly, the patient regained a smile they had lost gradually over many years — a transformation that affected not just their oral health but their overall confidence and self-image.

What This Means for Patients If you have noticed your teeth getting shorter over the years, if your bite feels collapsed, if your face looks older than it should, or if multiple teeth are sensitive and worn flat — you may be a candidate for full mouth rehabilitation.

At Maxface Dental Clinic, Dr. Srinivas has extensive experience in managing complex worn dentition cases using the same systematic, evidence-based approach documented in this publication. The process takes time and planning, but the result is a complete transformation — not just of your teeth, but of the entire lower third of your face.

About the Publication Journal: Journal of Indian Academy of Dental Specialist Researchers

Published: June 2016

Type: Clinical Case Report

Read the original publication on ResearchGate.