Dentist: Dr. Matthew Higginson
Location: The Gardens Dental Practice
Patient: 70-year-old male presenting with severe tooth wear and failing dentition
The patient presented with extensive tooth wear that had progressively compromised both the function and appearance of his dentition.
Significant loss of tooth structure had resulted in a reduced vertical dimension of occlusion, reduced facial support and a long-standing adapted mandibular position. Multiple teeth also had a poor long-term prognosis, creating the need for a comprehensive full mouth treatment approach.
The primary objective was to establish a stable, fixed solution while restoring appropriate facial proportions, function and smile aesthetics.
Clinical presentation
At initial assessment, the patient presented with:
- Severe tooth wear affecting both arches
- Significant loss of vertical dimension
- Reduced facial support
- A long-standing adapted bite position
- Multiple failing teeth with a poor long-term prognosis
A comprehensive assessment was completed using CBCT imaging, digital scans and facial analysis to evaluate the existing dentition and establish the requirements for treatment.
Following assessment, the case was planned using the GuidedSMILE workflow.
Digital planning and workflow
The case was planned digitally from the intended restorative outcome, allowing tooth position, occlusion and implant placement to be considered together before surgery.
Particular attention was given to restoring the lost vertical dimension and establishing an appropriate relationship between the upper and lower arches.
Planning in centric relation provided a reference for repositioning the mandible and establishing the proposed occlusal relationship for the new restorations.
The digital plan was used to:
- Establish the proposed tooth position
- Restore vertical dimension
- Improve facial support
- Plan implant positioning
- Create the foundation for immediate fixed provisional restorations
This restorative-driven approach allowed the proposed final outcome to guide the surgical phase of treatment.
Guided surgery and immediate provisionalisation
Treatment was completed using guided implant surgery.
The surgical phase presented a number of challenges, including very dense bone and large tooth roots requiring careful extraction.
A small oro-antral communication was identified in the upper left premolar region during treatment and was managed and closed at the surgical appointment.
One lower implant also demonstrated less favourable primary stability and angulation. As a result, this implant was not incorporated into the immediate prosthetic support.
Despite these clinical considerations, fixed provisional restorations were successfully delivered following surgery.
Healing phase
The immediate restorations provided the patient with fixed teeth throughout the healing and osseointegration period.
Shortly after treatment, the patient embarked on a three-month cruise. The fixed provisional restorations allowed him to maintain function and continue eating and socialising during the healing phase without the need for a removable prosthesis.
Following his return, healing and implant integration were assessed before progressing to the definitive restorative stage.
Final records and zirconia restorations
Once healing had been confirmed, a new set of detailed digital records was obtained for the definitive restorations.
These records were used to develop the final zirconia bridges, with the design refined around the functional and aesthetic requirements established during treatment.
The definitive restorations were developed to optimise:
- Smile aesthetics
- Tooth proportions
- Facial support
- Speech
- Function
- Long-term durability
The final zirconia bridges restored the significant loss of tooth structure and vertical dimension while providing a fixed solution across both arches.
Outcome
The completed rehabilitation provided a substantial change in both function and appearance.
The patient progressed from severely worn and failing dentition with a significantly reduced vertical dimension to fixed zirconia implant restorations designed around his new occlusal and aesthetic requirements.
Following treatment, the patient reported significant improvements in his ability to function comfortably and in his confidence when smiling.
Before
After
Matthew Higginson’s review and reflections
“ This case required careful restorative planning to re-establish the patient’s vertical dimension, function and facial support. GuidedSMILE allowed us to work backwards from the intended final outcome, providing a structured and predictable approach throughout treatment. Once again, the Quoris3D team did a fantastic job with this case. It’s a privilege to work with you all.
