Preprosthetic Orthodontic Intervention for Management of a Partially Edentulous Patient with Generalized Wear and Malocclusion

Prosthodontic management of patients with generalized wear of dentition has been well documented in the literature. Although prosthodontic treatment is designed to correct minor malocclusion and interdental spacing, patients with severe malocclusion accompanied by generalized wear may require preprosthetic orthodontic intervention. Few articles have described the comprehensive treatment of adult orthodontic patients with severe wear of teeth. This article describes the multidisciplinary management of an adult patient with multiple missing posterior teeth, malocclusion, and severe wear of anterior teeth. Preprosthetic orthodontic treatment was planned using occlusograms, visualized treatment objective, and sectioned diagnostic waxing for movement of teeth, according to the prosthodontic treatment plan. Temporary anchorage devices were used to accomplish complex orthodontic tooth movements. The definitive treatment included reestablishing appropriate esthetics, and occlusion and restoration of the entire maxillary arch and posterior mandibular dentition with metal ceramic and full gold restorations. At a 2.5-year follow-up, positions of teeth and integrity of the restorations remained stable. Importance of preprosthetic orthodontic treatment and challenges in management of complex esthetic and functional rehabilitations are discussed in this article.