Staged Occlusal And Implant Reconstruction In Hereditary Opalescent Dentin

Hereditary opalescent dentin, an autosomal dominant disorder, causes progressive attrition and vertical dimension loss. This report describes a young patient with hereditary opalescent dentin and multiple periapical lesions, resulting in occlusal support loss and restricted restorative space. Functional-aesthetic rehabilitation was achieved through staged occlusal reconstruction with simultaneous implant restoration. A 26-year-old male presented with severe dental attrition and multiple periapical radiolucencies with root canal calcification. After extraction of non-restorable teeth, severely insufficient restorative space was observed. A comprehensive pre-restorative evaluation incorporating digital workflows guided a personalized protocol: 1) Removable prosthetic transitional phase comprised a removable occlusal splint elevated vertical dimension 5–8 mm in centric relation with concurrent implant placement. 2) A fixed splint and provisional implant crowns/bridges were implemented in fixed prosthetic transitional phase after temporomandibular joint (TMJ)/masticatory muscles/occlusion adaptation. 3) Definitive restoration phase was delivered after occlusal adaptation to establish stable, healthy occlusion. 4) Regular follow-up ensured long-term occlusal stability. The primary challenge was restoring a 5-8 mm functional space (posterior-anterior). Staged rehabilitation progressively adapted occlusion, masticatory muscles, and TMJ through reversible-to-irreversible transitions. Diagnostic transitional prostheses guided definitive restorations, while implanta were synergistically designed with residual dentition for occlusal load sharing. Long-term stability requires monitoring, particularly with 8 mm incisal vertical gain and limited bonding surfaces. For young patients with hereditary opalescent dentin and compromised dentition/occlusion, staged occlusal reconstruction with digital workflows minimizes risks, balancing functional, aesthetic, and musculoskeletal stability.