Full Mouth Rehabilitation with Zirconia Crowns in New Delhi: A Severe Tooth Wear Case Study

CASE STUDY X– FULL MOUTH REHABILITATION WITH ZIRCONIA CROWNS IN NEW DELHI: A SEVERE TOOTH WEAR CASE STUDY

 

Introduction

A 64-year-old male patient visited Smile Delhi – The Dental Clinic, New Friends Colony, New Delhi, with multiple dental concerns that had developed gradually over several years. He presented with severely worn teeth, noticeable gaps between teeth, broken crowns from previous root canal treatments, and a collapsed bite, which affected both his appearance and chewing ability.

After a comprehensive clinical examination and radiographic assessment, the patient was diagnosed with advanced tooth wear associated with loss of vertical dimension (collapsed bite). A customized full mouth rehabilitation was planned using all-ceramic zirconia crowns, selective root canal treatments, extractions of non-restorable teeth, bite raising, and a custom night guard to protect the final restorations.

The treatment successfully restored the patient’s bite function, facial support, comfort, and smile aesthetics.

Patient Background

The patient had a history of extensive dental treatment, including several root canal-treated teeth restored with crowns. Over time, many of these restorations had fractured, and the remaining natural teeth had become severely worn down.

His primary concerns included:

• Difficulty chewing food comfortably
• Increasing sensitivity in some teeth
• Gaps developing between worn teeth
• Broken crowns affecting appearance and function
• A feeling that his bite had “collapsed” or become shorter

He was looking for a long-term solution that would restore both function and aesthetics rather than replacing only the broken crowns individually.

Initial Assessment & Diagnosis

A detailed clinical examination was performed along with full-mouth X-rays to evaluate the condition of the teeth, existing root canal treatments, supporting bone, and occlusion.

Clinical findings

• Severe generalized attrition (tooth wear) affecting both upper and lower teeth
• Multiple fractured crowns on previously root canal-treated teeth
• Loss of vertical dimension of occlusion (VDO) resulting in a collapsed bite
• Spacing and irregular contact between teeth
• Compromised chewing efficiency
• Poor occlusal stability

Radiographic findings

• Upper right second molar showed pathology requiring root canal treatment
• Upper right canine required endodontic therapy
• Lower left second molar required root canal treatment
• Upper right first molar and upper left second premolar were found to be non-restorable and indicated for extraction

Final diagnosis

• Generalized severe tooth wear with collapsed bite
• Failed restorations and fractured crowns
• Loss of occlusal stability
• Multiple teeth requiring endodontic treatment
• Need for full mouth occlusal rehabilitation with bite raising

Treatment Plan

The rehabilitation was planned in carefully sequenced stages to ensure patient comfort, functional adaptation, and long-term stability.

Proposed treatment

1. Root canal treatment for:

• Upper right canine
• Upper right second molar
• Lower left second molar

1. Extraction of:

• Upper right first molar
• Upper left second premolar

1. Full mouth rehabilitation with all-ceramic zirconia crowns
2. Bite raising (increase in vertical dimension) to restore proper occlusal height and facial support
3. Temporary crowns at the proposed raised bite to allow neuromuscular adaptation
4. Final zirconia restorations after successful adjustment to the new bite
5. Custom night guard to protect the restorations from excessive forces and possible grinding habits

The patient was informed that gradual adaptation to the new bite height was essential before proceeding with the final permanent restorations.

 

Treatment Process

8 January 2024 – Endodontic and extraction phase

The first stage focused on eliminating infection and removing non-restorable teeth.

Procedures performed

• Root canal treatment for the upper right second molar
• Root canal treatment for the lower left second molar
• Extraction of the upper right first molar

This created a stable foundation for the restorative phase.

10 January 2024 – Preparation phase

During the second appointment, the teeth were prepared for full mouth rehabilitation.

Procedures performed

• Crown preparation and impressions from:
  • Upper right second molar to upper left second molar
  • Lower right second molar to lower left first molar
• Extraction of the upper left second premolar
• Root canal treatment of the upper right canine

The impressions were sent for fabrication of provisional restorations designed at the planned bite-raised vertical dimension.

13 January 2024 – Temporary bite raising phase

Custom temporary crowns were placed at the new increased vertical dimension.

This was a critical step because the patient had lived with a collapsed bite for many years. The provisional restorations allowed the dental team to evaluate:

• Comfort of the jaw joints
• Muscle adaptation
• Speech changes
• Chewing efficiency
• Aesthetic appearance
• Tolerance to the increased bite height

The patient was monitored closely and given time to adapt to the new occlusal relationship before proceeding to the final restorations.

6 February 2024 – Final impression stage

After confirming that the patient had successfully adapted to the raised bite, final precision impressions were made for the permanent restorations.

Special attention was given to:

• Occlusal accuracy
• Bite registration
• Marginal fit
• Aesthetic tooth proportions
• Functional guidance during jaw movements

15 February 2024 – Final zirconia crown delivery

The definitive all-ceramic zirconia crowns were fabricated and permanently cemented.

Why zirconia was chosen

• Excellent strength and durability
• Suitable for full mouth rehabilitation cases
• Highly aesthetic with a natural tooth-like appearance
• Resistant to wear and fracture
• Provides long-term functional stability under heavy chewing forces

The occlusion was carefully adjusted to ensure balanced contacts and smooth jaw movements.

23 February 2024 – Night guard records

Following several review visits and minor occlusal refinements, impressions for a custom night guard were taken to protect the new restorations.

27 February 2024 – Night guard delivery

A custom-fabricated night guard was delivered with instructions for nightly use to minimize excessive occlusal forces and help maintain the longevity of the rehabilitation.

15 March 2024 – Final follow-up

A comprehensive follow-up examination confirmed:

• Stable occlusion
• Comfortable chewing function
• Healthy supporting tissues
• Proper adaptation to the raised vertical dimension
• Good patient satisfaction with both function and appearance

 

Results & Outcome

The full mouth rehabilitation produced a significant functional and aesthetic transformation.

Functional improvements

• Restoration of proper bite height
• Improved chewing efficiency
• Better distribution of biting forces
• Elimination of discomfort caused by fractured and worn teeth
• Enhanced jaw stability during function

Aesthetic improvements

• Fuller, more natural-looking teeth
• Closure of unattractive gaps created by severe wear
• Improved smile proportions
• Better facial support due to restoration of vertical dimension

The patient adapted well to the new bite and reported that eating became far more comfortable and efficient than before treatment.

Before & After Image Placeholders

Before

After

 

Dentist’s Insight

This case was particularly challenging because it involved severe generalized tooth wear combined with a collapsed vertical dimension and multiple failing restorations. Simply replacing the broken crowns would not have solved the underlying functional problem.

The most important aspect of this rehabilitation was the careful bite-raising phase using temporary crowns. Allowing the patient sufficient time to adapt before fabricating the final zirconia restorations helped ensure long-term comfort, stability, and predictable results.

For patients with advanced tooth wear, a comprehensive occlusal evaluation is essential before beginning restorative treatment.

Conclusion

Severely worn teeth and a collapsed bite can affect much more than appearance—they can compromise chewing function, comfort, speech, and overall quality of life. This case demonstrates how a carefully planned full mouth rehabilitation with all-ceramic zirconia crowns, root canal therapy, bite raising, and protective night guard therapy can successfully restore both function and confidence.

If you have worn teeth, broken crowns, gaps, or difficulty chewing, a personalized full mouth rehabilitation from a dentist in Delhi may help restore your smile and oral function.

Book a consultation today at Smile Delhi – The Dental Clinic, New Friends Colony, New Delhi, and learn how a customized treatment plan can help you achieve a healthier, more comfortable, and natural-looking smile.