Pre-treatment
Post-treatment
A 54-year-old male patient presented with a severely collapsed occlusion, multiple missing posterior teeth, and heavily worn anterior dentition due to untreated periodontitis and years of neglect. The case involved a full interdisciplinary rehabilitation combining periodontal therapy, implant surgery, and full-arch prosthetics over 18 months.
Clinical Findings
Generalised chronic periodontitis (stage III, grade C). Multiple missing posterior teeth (16, 17, 26, 27, 36, 46). Severely worn anterior teeth with loss of 4 mm vertical dimension. Deep bite. Existing restorations failing. BOP >60%. Multiple grade II furcation involvements on remaining molars.
Occlusal Analysis
Collapsed occlusal scheme with deep anterior bite. Curve of Spee grossly exaggerated. No posterior support. Fremitus on upper anterior teeth. Occlusal vertical dimension reduced approximately 4 mm from estimated ideal.
Comprehensive periodontal treatment to establish a stable, healthy foundation before any prosthetic work.
Procedures
Clinical Photos
Notes
Patient responded excellently to Phase I therapy. BOP reduced from 62% to 14% at re-evaluation. Residual 5–6 mm pockets on 16 and 26 scheduled for surgical management in Phase II.
Full rehabilitation completed across 18 months. Vertical dimension raised by 4 mm. Patient reports 100% satisfaction with aesthetics and function. 1-year follow-up confirms stable occlusion and healthy peri-implant tissues.
3-monthly periodontal maintenance with hygienist. Annual dental check-up including radiographic assessment. Nightguard fabricated and delivered at final visit to protect restorations from parafunctional loading.
Annual CBCT recommended for implant monitoring. Nightguard provided for bruxism management. 3-monthly periodontal maintenance programme.
Excellent case documentation. The treatment planning here is really solid.
This is a great reference case. Thanks for sharing the details.
Excellent case documentation. The treatment planning here is really solid.
How did you handle the occlusal scheme post-treatment?
Love the before/after comparison. What materials did you use for the final restoration?
What was the patient's chief complaint initially? The final result speaks for itself.
Great outcome! How long did osseointegration take before loading?
The radiographic follow-up would be great to see here.
Very clean technique. The margin placement is spot on.
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CBCT-guided implant placement with simultaneous guided bone regeneration where ridge deficiency was present.
Procedures
Notes
All 6 implants placed with primary stability >35 Ncm. ISQ values 72–78 (Osstell). Implant at 26 required additional GBR due to 3 mm buccal bone defect. Provisional PMMA bridge fitted immediately at 36 and 46 sites.
Diagnostic provisional phase to establish new vertical dimension, aesthetics, and occlusal scheme before final restorations.
Procedures
Notes
Patient adapted quickly to new VDO. No TMJ symptoms at 3-month review. Provisionals worn for 4 months to confirm stability before final impressions. Intraoral scanning with iTero Element 5D for digital impressions.
Delivery of final full-arch monolithic zirconia restorations on teeth and implants.
Procedures
Notes
All 22 units delivered in two appointments. Upper arch first, lower arch 2 weeks later to allow patient adaptation. Excellent fit confirmed with 0 gap on explorer assessment. Patient extremely satisfied with aesthetics.
