Considerations In The Occlusal Reconstruction For Severe Tooth Wear Patients

Severe tooth wear patients often exhibit shortened anterior teeth, deep overbite, with or without condylar displacement. Successful treatment requires establishing a stable mandibular position with condylar centric relation, typically through stabilization splint therapy before the final restoration, though the ideal condylar position remains debated. Two representative cases were reported: Case 1, with severe tooth wear presented with posteriorly displaced condyles, has received approximately 3 months of stabilization splint therapy fabricated by conventional methods to achieve a stable mandibular position, ultimately resulting in significant anterior condylar displacement following the definitive reconstruction. Case 2, with severe tooth wear and normal condylar position, achieved a stable mandibular position within just 1 month of treatment using digitally-designed 3D-printed occlusal splints, while maintaining centric condylar position even after final restoration. The two cases showed significant differences in treatment duration and condylar positional changes. Cases with initial condylar displacement required a longer adaptation period, indicating the need for more extended neuromuscular compensatory adjustments. Notably, the final adapted condylar position may not conform to traditional "centric relation" standards. For cases with normal joint relationships, digital workflows demonstrated superior treatment efficiency. Condylar displacement prolongs the treatment duration of occlusal reconstruction. The key to successful treatment should prioritize functional stability of the mandible over strict adherence to anatomical standards of condylar position within the mandibular fossa. Digital technologies can effectively enhance treatment efficiency.