Full-Mouth Rehabilitation Using Vertical Preparation Technique

A 69-year-old female patient presented to the clinic seeking improvement in both the appearance and function of her dentition. Her chief concerns included compromised esthetics, difficulty during mastication, and generalized discomfort associated with dentin hypersensitivity. The patient expressed a clear desire for a comprehensive oral rehabilitation that would restore function, improve occlusal stability, and deliver a natural and harmonious smile. Given the complexity of the case, a fully digital and biologically guided approach was selected to ensure predictability, precision, and long-term stability.

Clinical examination revealed malpositioned teeth, partial edentulism affecting the premolar and molar regions, generalized tooth discoloration, and signs of dentin hypersensitivity. The occlusal relationships were altered, and the smile line lacked harmony due to both tooth position and tissue irregularities. A comprehensive digital diagnostic protocol was implemented, including intraoral scanning, radiographic analysis, and cone beam computed tomography (CBCT). These records were digitally integrated to evaluate bone anatomy, remaining tooth structure, and occlusal dynamics.

A digital wax-up was created using a fully digital workflow with 3Shape® software, allowing visualization and validation of the proposed restorative outcome. This step was fundamental for assessing esthetic parameters, occlusal vertical dimension, and functional guidance prior to any irreversible procedures. Based on the diagnostic findings, a full-mouth rehabilitation was planned. The Biologically Oriented Preparation Technique (BOPT) was selected as the core restorative concept to guide soft tissue conditioning and emergence profile development on natural teeth.

The treatment phase began with biologically driven tooth preparations following the BOPT protocol. This approach allowed the prosthetic contours to guide gingival adaptation without a predefined finish line, promoting stable and healthy soft tissue architecture. 

The management of VDO was established using a Lucia jig, allowing determination and maintenance of the correct vertical dimension at the appropriate mandibular position prior to the provisional restorations. Provisional restorations played a crucial role in the treatment sequence. They were fabricated based on the digital wax-up and used to refine occlusion, phonetics, esthetics, and gingival contours. Crown lengthening was not required in this case, as the BOPT technique allowed for adequate emergence profiles and prosthetic margins without the need for surgical crown lengthening.

The provisional crowns were cemented using Kerr TempBond™ Clear, providing reliable retention while allowing easy retrievability during the evaluation and tissue maturation phase. Throughout this stage, occlusal adjustments and soft tissue conditioning were carefully monitored to achieve optimal functional and biological integration. 

Once stability and patient satisfaction were confirmed, the definitive restorations were fabricated in zirconia. Monolithic zirconia was selected for posterior regions to ensure strength and durability, while layered zirconia was used in the anterior zone to enhance esthetics. The restorations were segmented rather than splinted as a single unit. They were divided into three sections in both the maxillary and mandibular arches: from molar to first premolar, from canine to canine, and from first premolar to molar.

All final restorations were cemented using Kerr Maxcem Elite™ Chroma, a self-adhesive resin cement that offers high bond strength, excellent marginal sealing, and chromatic control during cementation. In addition, Kerr OptiBond™ Universal was incorporated where indicated to enhance adhesion on prepared tooth surfaces, reinforcing the long-term stability of the restorations.

The patient was followed clinically for a period of three years, during which excellent biological, functional, and esthetic stability was observed. No postoperative sensitivity, inflammation, or prosthetic complications were reported. The soft tissues adapted harmoniously to the prosthetic emergence profiles, demonstrating the effectiveness of the BOPT approach.

Occlusal stability and masticatory efficiency remained consistent over time, and the color integration of the zirconia restorations continued to be highly satisfactory. 

The patient reported a significant improvement in comfort, confidence, and overall quality of life. This case confirms the clinical reliability of combining a fully digital workflow with biologically oriented prosthetic concepts and high-performance restorative materials. The integration of Kerr products throughout the provisional and definitive phases contributed to a predictable, efficient, and patient-centered rehabilitation with long-term success.

Hygiene therapy and maintenance protocol

Prior to the definitive prosthetic phase, the patient underwent comprehensive hygiene therapy, including professional supragingival and subgingival cleaning and individualized oral hygiene instructions. After completion of the full-mouth rehabilitation, the patient was enrolled in a strict maintenance and recall program, consisting of periodic professional hygiene sessions and clinical evaluations at regular intervals. This protocol was aimed at ensuring periodontal stability, preserving peri-prosthetic tissue health, and promoting the long-term success of the restorations.

This case demonstrates the clinical reliability of combining digital workflows with the BOPT approach for comprehensive oral rehabilitation. The integration of prosthetic and surgical planning allows predictable soft tissue management and esthetic enhancement. 

Utilizing BOPT crowns provides continuity in the emergence profile and ensures long-term biological and mechanical stability. The patient-centered, digitally guided process resulted in a highly functional and esthetically pleasing outcome with excellent tissue health and patient satisfaction.