Case of the Month: Rethinking Full-Mouth Rehab in the Digital Age

Multidisciplinary Full-Mouth Rehabilitation with Digital Occlusal Design and Implant Restoration
By Dr. Arman Barfeie

Patient Profile
A 48-year-old male patient presented with a history of severe generalised tooth wear and functional discomfort. Chief complaints included aesthetic concerns, loss of vertical dimension, and impaired mastication. The patient was otherwise healthy, with no significant medical history and expressed strong motivation to rehabilitate both function and smile aesthetics.

Diagnosis
Comprehensive clinical and radiographic assessment confirmed advanced tooth surface loss, occlusal instability, and one missing posterior tooth (LR6). There were no active carious lesions, but the patient exhibited signs of parafunction, muscular tension, and an altered occlusal plane. Periodontal assessment revealed chronic inflammation and reduced support, requiring stabilisation prior to definitive restorative work.

Treatment Approach
A multidisciplinary treatment plan was developed in close collaboration with our periodontist, whose expert periodontal therapy created the stable foundation needed for long-term restorative success.

Digital Workflow & Functional Assessment

The rehabilitation was digitally driven from the outset:

• iTero Lumina was used to capture high-resolution digital impressions, arch relationships, and intraoral detail.

• ModjawLive digital jaw tracking enabled real-time capture of dynamic mandibular movements, critical in designing a functionally accurate occlusal scheme.
• Leaf gauge was used to establish a reliable centric relation and assess vertical dimension changes.
• AMG provisional resin was used to fabricate long-term provisionals, allowing thorough assessment of aesthetics, phonetics, and functional adaptation prior to final restorations.

Surgical Phase

To restore the edentulous LR6 site, an Osstem dental implant was placed following ridge assessment and digital planning. Healing was uneventful and implant integration was achieved without complication.

Definitive Restorations

Once periodontal and functional parameters were confirmed, definitive restorations were fabricated using Emax lithium disilicate ceramics, chosen for their strength, aesthetics, and minimal invasiveness. A total of 24 teeth were restored with a combination of crowns and veneers, all meticulously crafted by Yusef Karzon and his exceptional lab team.

Adjunctive Therapy

To support functional stability and manage parafunctional habits, masseter Botox was administered both pre-operatively and post-operatively. This helped reduce muscle hyperactivity during the diagnostic and transitional phases and contributed to a more balanced and relaxed occlusal environment post-rehabilitation.

Following completion of the definitive restorations, the patient was also provided with a custom bite-stabilising splint. This was designed to protect the restorations, support ongoing muscle balance, and provide long-term maintenance of the rehabilitated occlusion. These adjunctive measures played a key role in ensuring the longevity and comfort of the final outcome.

Treatment Duration & Follow-up
The entire process—from initial consultation through to final prosthetic delivery—was completed over a 9-month period. The patient was reviewed at regular intervals throughout, with special attention to occlusion, soft tissue health, and adaptation to restorations.

Outcome
The case resulted in a fully rehabilitated, stable occlusion and a highly aesthetic smile. The integration of digital technology, multidisciplinary coordination, and attention to occlusal function proved critical in achieving a successful long-term outcome. Patient satisfaction was exceptionally high, with improved confidence, comfort, and oral function.

Elevate Your Dental Practice with Personalised Mentorship

Discover the transformative Mentorship Programme at London Dental Arts, led by renowned prosthodontist Dr. Arman Barfeie. This exclusive one-to-one training offers hands-on experience in advanced procedures, including full-arch surgeries and 4D digital workflows. With limited spots available, seize the opportunity to gain invaluable insights and practical skills that can significantly enhance your clinical confidence and practice growth.

Learn more and apply today: londondentalarts.co.uk/mentorship-program