Chief complaint:Worn down teeth

Medical history :Asthma and long term oral steroid intake

Clinical history : No history of sleep disturbances or migraines .

No history or recall of acidic reflux

ON CLINICAL EXAMINATION :

Extensive wear patterns suggestive of erosive wear coupled with occlusal issues .

Repose position shows no display of teeth

Smile shows adequate display of upper teeth .

Anterior and Posterior cross bite (bilateral )

Open bite in the anterior teeth .

Patient advised full mouth rehabilitation to correct the extensive wear on facial surfaces of the teeth.

TREATMENT DONE SO FAR :

Centric relation bite record revealed that the posterior mandibular FPD were in a minor interference... the same changed to a temporary one.

Implants placed in the lower jaw.#36 and #46

MY QUERY :

1]If I start with repose position....it suggests that maxillary teeth be increased in length...however the patient is a short heighted female and hence considering there is already an adequate display of maxillary teeth in smile , should I consider further increasing length of maxillary anteriors and if yes ; should it be to provide at least 1mm display of maxillary centrals in repose position ?

2]Based on the existing lower anterior display I have preliminarily thought of maintaining current length of mandibular anteriors and only increasing by half a millimeter alongside restoring chipped in is also edges ,if at all.

3]I was considering increasing the length of maxillary anteriors to increase visibility at rest and to increase the length of the maxillary posterior teeth to open up the vertical and to jump the bite.

However since the tongue appears to be positioning forward at rest position as evident on the photograph ,I feel it would be prudent to leave the open bite as it is to prevent locking in the mandible by creating an overbite ( in case I decide to increase the upper anterior length )

4]The mandibular jaw is slightly larger than maxilla with a class 3 tendency ... hence creating an overjet overbite will necessitate an increase in vertical dimension to jump the bite n rotate the lower jaw backwards.... Should I consider opening the vertical ?Also that will lead to long anterior teeth ....So to avoid all this should I leave her with an anterior open bite ?

5]The residual structure on the mandibular second molars is very less .Also occlusal surfaces have a flat morphology.That would necessitate either a CLP or a Vertical dimension increase to get more retention for the final restorations.Which modality should I opt for considering the preceding information

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