Severe tooth wear can present a complex restorative challenge, particularly when loss of tooth structure is accompanied by reduced occlusal vertical dimension, altered function, sensitivity, and aesthetic concerns. In these situations, full-mouth restoration requires more than simply replacing damaged teeth. The clinician must first understand the underlying causes and establish a predictable treatment sequence.
A comprehensive assessment should include periodontal health, remaining tooth structure, occlusion, vertical dimension, parafunctional habits, aesthetics, temporomandibular considerations, and the patient's expectations. Diagnostic photographs, radiographs, study models or digital scans, and diagnostic wax-ups can help establish a clearer restorative plan.
One important consideration is whether the patient's existing vertical dimension should be maintained or carefully modified. Increasing the vertical dimension without adequate diagnostic planning can create functional and restorative complications. A provisional phase may therefore be useful in selected cases to evaluate aesthetics, phonetics, function, patient adaptation, and occlusal stability before definitive restorations are fabricated.
Material selection is another important factor. Depending on the clinical situation, clinicians may consider different ceramic, composite, or hybrid restorative approaches. The choice should be based on remaining tooth structure, occlusal forces, aesthetics, available space, repairability, and long-term maintenance rather than material preference alone.
Digital dentistry can also contribute to the workflow. Intraoral scanning, digital articulation, facial photography, CBCT where clinically indicated, and CAD/CAM planning may improve communication between the clinician, laboratory, and patient. However, digital tools should support sound diagnosis rather than replace clinical judgement.
Long-term maintenance is equally important. Patients with significant tooth wear may have ongoing risk factors such as bruxism, dietary erosion, inadequate oral hygiene, or other behavioural factors. These should be addressed as part of the treatment plan rather than after definitive restoration has already been completed.
For clinicians managing advanced tooth wear and bite collapse, what factors do you consider most important when deciding the treatment sequence? Do you prefer a provisional approach to test a new vertical dimension before definitive full-mouth rehabilitation, and how do you assess long-term stability?