Pre-treatment: Two photographs taken at the initial consultation demonstrate severe generalised tooth wear and substantial loss of natural tooth structure.

Treatment delivery: The delivery-stage photograph documents the conservative and individualised preparation designs used before the definitive restorations were delivered to the mandibular right teeth.

Post-treatment: Two photographs taken at the four-year follow-up demonstrate the frontal and oblique smile views.

This complex full-mouth rehabilitation addressed severe generalised tooth wear through a carefully planned, tooth-preserving restorative approach.

Laser reshaping of the gingival margins (laser gingivectomy) was performed where clinically indicated, increasing the visible clinical crown height by approximately 1 mm in selected areas.

Following detailed assessment of the patient’s bite, remaining tooth structure and available restorative space, the vertical dimension was carefully increased by approximately 3 mm anteriorly and 1.5 mm posteriorly. The bite was reorganised at a stable and reproducible jaw position.

The planned changes were assessed with provisional restorations for at least one month. During this phase, the patient’s comfort, function, adaptation and bite stability were reviewed before proceeding with definitive treatment.

Preparation design was individualised according to the condition and structural requirements of each tooth. Full circumferential crown preparation was not routinely used throughout the dentition. Instead, treatment incorporated a combination of veneers, partial-coverage and three-quarter preparations, and selected full-coverage crowns.

Palatal or lingual coverage was incorporated where required for function, restorative space and protection of the remaining tooth structure. This approach allowed healthy natural tooth structure to be preserved wherever clinically appropriate.

The delivery-stage photograph provides direct clinical documentation of this approach. The mandibular right teeth, visible on the left side of the photograph, had been conservatively and individually prepared, but their definitive restorations had not yet been delivered. The photograph therefore allows the limited extent and tooth-specific variation of the preparations to be observed.

All definitive ceramic restorations were fabricated using layered IPS e.max.

No teeth were extracted as part of the rehabilitation. One tooth required root canal treatment and was subsequently restored with a cast post and core before receiving its definitive layered IPS e.max crown. No other teeth required root canal treatment during the rehabilitation.

The assessment, treatment planning, laser gingivectomy, root canal treatment, cast post-and-core restoration, tooth preparations, provisional phase and delivery of the definitive restorations were completed by Dr Pooneh Shahab.

Meet Dr Pooneh Shahab