Prosthodontic management of severely worn dentition: Including review of literature related to physiology and pathology of increased vertical dimension of occlusion

The factors causing severe wear of natural teeth must be identified and eliminated, or reduced before attempting restorative treatment. This will not only prevent further wear of teeth but also improve the long-term prognosis of restorative treatment. The different clinical situations can be classified in to three types, as described by Turner and Missirlian. While most of the cases can be managed without increasing the vertical dimension of occlusion (VDO), in some cases, the vertical dimension has to be increased. The evaluation and establishment of the occlusal vertical dimension (OVD) is considered particularly important. Before placement of fixed restorations to increase the VDO, a removable splint, and then provisional restorations must be tried to check the suitability of the increase in OVD. A kinematic transverse horizontal axis facebow transfer helps in the accurate transfer of horizontal relation to the articulator. Research with humans and animals has shown that if increases in OVD are not extreme and the occlusion is stable, then there is a good possibility of adaptation. Management of a case of severe teeth wear caused by bruxism is described.