Initial situation

Preoperative views

Decreased VDO

Occlusal views

Severely worn lower dentition

Preoperative x-rays

Huge periapical infections and bone resorption

Starting the esthetic and functional plan
using wax-up

The vertical dimension of occlusion was increased and the centric relation was recorded using the bimanual manipulation.

Silicone indexes fabrication

The root canal treatments were merely initiated to allow pus grainage but were completed after tissue healing and maturation when the ferrure is regained to allow achieving better isolation and accomplishment of the restorative procedure.

Surgical crown lengthening to regain ferrule effect on the labial surface

Initial healing

Ferrule is back

After almost 6 months of follow-up, the canals got dry and obturated.

Fiber posts and composite build-ups

Mock-up fabrication

Mock-up in place as a trail

I like to do the try-in at this phase before giving the restorations the final contours and before being glazed because at this time any needed adjustment can be easily done, then the restoeartions are send back to the lab for finishing the fitting surface are sandblasted and ready for surface treatment and cementation.


At this time, I didn't like the shapes, sizes and details of the four upper anterior incisors and they were sent back to the lab for adjustments.


Surface treatment for final restorations
" layered lithium disilicated crowns "

Prolonged etching because the labial surface is almost cementum

Final cementation

Freshly cemented crowns waiting for more tissue healing

At this recall visit, excesses of the cement were removed and the teeth surfaces were well cleaned

The tooth 34 is going to be replaced because it is alittle bit out of occlusion

Lateral view

Final result .. 

After this phase of treatment, the patient was referred to complete restoration of the lower posterior areas by implants ...