Rebuilding confidence: A full-mouth rehabilitation

Clinically, he exhibited severe wear across his dentition, upper anterior spacing, gum disease, and a deep overbite, which contributed to further deterioration. His occlusion presented a Class 2 Division 2 incisal relationship, class 1 canines, class 2 molars, and mild lower crowding. Given the complexity of his case, a comprehensive treatment plan was required to restore both function and aesthetics while ensuring long-term stability. 

Treatment planning and phased approach 

Two possible treatment approaches were considered. The first was a direct restorative plan, which would involve opening his bite and rebuilding his teeth with crowns, veneers, and composite bonding. However, a more conservative approach was recommended, prioritising orthodontic repositioning to improve bite stability before proceeding with restorations. This method would limit unnecessary enamel reduction, improve occlusal function, and enhance the longevity of the final restorations. Given the extensive damage, a phased approach was essential to ensure gradual adaptation and prevent overloading of the new dentition. 

Phase 1: Periodontal treatment and orthodontic realignment 

Before initiating orthodontic work, the patient’s gum health needed stabilisation to provide a strong foundation for the planned restorations. Once his periodontal condition was controlled, orthodontic treatment began using Invisalign. The treatment was meticulously planned using digital scans and a wax-up setup to optimise tooth positioning while preserving as much natural enamel as possible. 

His teeth were progressively moved into ideal positions over 15 months, including two refinement phases. The lower anteriors were intruded to reduce the severity of his deep overbite, while occlusal adjustments ensured that his new bite would be both functional and comfortable. To test the new occlusal vertical dimension (OVD), semi-permanent composite build-ups were placed for six to 12 months. This allowed the patient to adapt to the changes gradually and provided an opportunity to refine the bite before committing to final restorations. The posterior bite was opened by 1mm, creating an anterior increase of 2-3mm, which provided the necessary space for future crowns. 

Phase 2: Occlusal stabilisation and implant placement

During the transitional phase, upper and lower B splints were provided to protect the teeth and prevent further damage. Additionally, Botox was administered to the masseter muscles to reduce excessive bite force and safeguard the restorations. 

Attention then shifted to restoring the missing upper right teeth. Due to significant bone loss, a sinus lift was performed before placing two Nobel Biocare implants in the UR5 and UR6 regions. This was carried out during the period of occlusal stability, allowing for a minimum healing time of six months. During this waiting period, the patient continued to use the semi-permanent composite build-ups, ensuring that his bite remained stable and functional before progressing to the final restorations. 

Phase 3: Final restorations and smile transformation 

The patient was ready for his final restorations after a continuous six-month period with no breakages or complications from the composite build-ups. The process was staged carefully to maintain occlusal balance and allow for controlled adaptation. 

The upper six anterior teeth were restored first with zirconia crowns, followed by the upper posterior restorations, including the implant crowns for UR5 and UR6, which were placed as screw-retained zirconia/ceramic metal crowns. The lower six anterior teeth were then restored, followed by the lower posteriors. This structured approach ensured that each phase was monitored and adjusted as needed, maintaining the integrity of the occlusion throughout. 

Once the final restorations were complete, a new set of upper and lower B splints was fabricated to help maintain long-term occlusal stability. The Botox masseteric treatment was continued to prevent excessive forces from damaging the restorations, ensuring the longevity of the results. 

Outcome: A life-changing transformation

The patient’s response to his new smile was remarkable. While he had already seen a preview of his transformed teeth during the transitional bonding phase, the final restorations far exceeded his expectations. His confidence soared, and he couldn’t stop smiling. The impact of his treatment extended beyond just dentistry. Shortly after completing his full-mouth rehabilitation, he decided to undergo a hair transplant to enhance his overall appearance. By the time of his final review appointment four months later, he had a renewed sense of self-esteem and had even found a new partner, something he directly attributed to his newfound confidence. 

Restoring function, aesthetics and confidence

This case exemplifies the power of a multidisciplinary approach in modern dentistry. We achieved a functionally sound and aesthetically transformative result by combining digital planning, orthodontic realignment, phased restorative treatment, and occlusal stabilisation techniques. Semi-permanent trial phases, Botox-assisted occlusal management and staged restorations ensured the treatment was carefully measured and predictable. 

Beyond the technical aspects, this case highlights the psychological impact of dental rehabilitation. The patient’s journey involved rebuilding his teeth and restoring his confidence and quality of life. His story is a testament to how modern dentistry can go beyond aesthetics, restoring smiles, self-assurance, and emotional well-being.