A 47-year-old woman with severe generalised tooth wear secondary to gastric reflux (GERD) and nocturnal bruxism. The patient had lost over 6 mm of vertical dimension with near-complete destruction of anterior guidance. Treatment combined VDO restoration, porcelain overlays, and implant-supported crowns for missing teeth, completed over 14 months.
Clinical Findings
Generalised severe erosive tooth wear (BEWE score 27 — very high risk). Near-complete loss of palatal enamel on upper anteriors. Cupping and cratering on posterior occlusal surfaces. Dentin hypersensitivity generalised. Missing: 16, 26, 36 (previously extracted). VDO reduced approximately 5.5 mm from estimated ideal. Existing amalgam restorations (7) — all failing. No periodontal disease. Healthy gingiva throughout.
Occlusal Analysis
Loss of posterior support 16, 26, 36. Reduced VDO confirmed via Pearson method and Willis analysis. Canine guidance absent — group function. Deep anterior overbite due to supraeruption of uppers. Articulator-mounted casts confirm 5.5 mm VDO deficit. T-Scan: uneven force distribution, premature contacts LR4/UR4.
Comprehensive records collection, digital planning, and patient communication before any intervention.
Procedures
Notes
Vertical dimension restored by 5.5 mm using an additive, minimally invasive approach. Anterior guidance re-established with canine-protected occlusion. All 28 units completed. Patient free of GERD symptoms (concurrent medical management). Nightguard compliance confirmed at all follow-ups. No chipping or complications at 2-year review.
3-monthly hygienist visits for first year, then 6-monthly. Annual full clinical and radiographic review. Nightguard replacement planned at 3 years. GERD monitoring — annual review with gastroenterologist.
2-year follow-up: all restorations intact. No debonding or chipping. Nightguard worn nightly — replaced at 18 months. Annual review planned. GERD well-controlled on proton pump inhibitors.
Impressive result! Did you use any digital workflow here?
This is a great reference case. Thanks for sharing the details.
Nice work on the soft tissue management. Often overlooked but makes such a difference.
Really educational case. The step-by-step breakdown helps a lot.
Nice work on the soft tissue management. Often overlooked but makes such a difference.
The pre-op planning clearly paid off. Excellent outcome.
Beautiful aesthetics. The shade matching is perfect.
Very clean technique. The margin placement is spot on.
Excellent case documentation. The treatment planning here is really solid.
Sign in as a dentist or clinic to like, save, and comment.
Patient Privacy
All cases are shared with patient consent. No personally identifiable information is included.
Patient was initially concerned about the treatment duration. The DSD mock-up was a pivotal moment — she approved the aesthetic outcome immediately and fully committed to the treatment plan. GERD management started simultaneously — essential to prevent re-erosion of new restorations.
Establishing and testing the new vertical dimension using composite additions and PMMA provisionals before committing to final restorations.
Procedures
Notes
Dahl approach worked beautifully — posterior teeth intruded and anteriors erupted slightly over 8 weeks to re-establish full occlusion at new VDO. No TMJ symptoms throughout. Patient wore provisionals for 4 full months to confirm comfort and aesthetics before proceeding to implant phase.
Placement of 3 implants at sites 16, 26, and 36 using CBCT-guided stents.
Procedures
Notes
Implant surgery uncomplicated. All sites had adequate bone volume based on CBCT — no grafting required. Patient reported minimal post-operative discomfort. Sutures removed at 10 days with clean healing. Implant crowns included in final restoration plan.
Preparation and delivery of posterior overlays and implant crowns.
Procedures
Notes
Additive overlay preparation required <0.5 mm reduction on cusps to seat overlays. Dentin was primed with G-Bond and restored with G-ænial Flow before cementation to replace missing dentin layer. Excellent marginal adaptation — 0 gap on explorer probing.
IPS e.max crowns on anterior teeth to restore aesthetics and anterior guidance.
Procedures
Notes
Achieving natural aesthetics in anterior sector with e.max LT required careful shade characterisation. External staining applied to the three upper anteriors to match individual tooth characteristics. Result described by patient as "more beautiful than my natural teeth ever were".
