A Conservative Prosthodontic Approach to Full-Mouth Rehabilitation in a Patient with Severe Tooth Wear and Tetracycline Staining

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A Conservative Prosthodontic Approach to Full-Mouth Rehabilitation in a Patient with Severe Tooth Wear and Tetracycline Staining

Jimmy Londono, DDS, FACP; and Sung Bin Im, CDT

Severe tooth wear combined with intrinsic tetracycline discoloration presents a dual treatment challenge: restoration of occlusal function while reliably masking a darkened substrate to deliver an optimal esthetic outcome. Tetracycline staining can be deeply incorporated into dentin during tooth development, often limiting the predictability of bleaching and raising the restorative bar for shade control. This clinical case report describes a conservative prosthodontic approach for full-mouth rehabilitation in a 40-year-old female patient with severe wear and tetracycline staining. A 2-mm loss of vertical dimension of occlusion (VDO) was estimated and addressed through a comprehensive diagnostic workup, digital smile design, and a provisional evaluation phase to confirm patient adaptation before definitive treatment. Monolithic zirconia was selected for the fabrication of the definitive crowns to support minimally invasive preparation, provide favorable mechanical performance, and leverage multilayer optical properties for masking while maintaining a lifelike incisal appearance. The article outlines key clinical and laboratory steps—including evaluation of VDO, creation of a digital wax-up and eggshell provisionals, conservative preparation design, try-in verification, and an evidence-informed zirconia bonding/cementation workflow emphasizing air abrasion, phosphate monomer chemistry, and post-try-in decontamination. At 13 months, the restorations demonstrated stable occlusion and no complications, and the patient reported high satisfaction with function and esthetics.