At International Plus in Istanbul we frequently treat patients whose dental problems have developed over years of unconscious habits. This case study follows Bohdan who had spent decades coping with the destructive effects of severe bruxism which is a condition involving chronic teeth grinding and clenching. His rehabilitation required a comprehensive and multidisciplinary approach combining dental implant surgery and gingivectomy and endodontic therapy and a carefully planned full mouth restoration to rebuild both his function and his smile.
Treating Severe Bruxism and Tooth Wear
The case of Bohdan represents a pattern we see frequently at International Plus. Years of unconscious bruxism had produced clear visible consequences such as significant wear on the biting surfaces of his teeth and fractures across multiple posterior teeth and a progressive loss of natural tooth structure that had compromised his entire bite. Severe bruxism treatment is rarely a simple matter of addressing one or two problem areas because the forces involved affect the entire dental arch.
For Bohdan the functional consequences had become impossible to ignore. Chewing had become inefficient as his worn teeth could no longer break down food properly. His bite had slowly collapsed as the teeth lost vertical height and creating subtle but meaningful changes in how his jaws related to one another. Worn teeth repair at this stage requires more than fillings or individual crowns since it requires a complete reconstruction that addresses every aspect of the damaged system.
Patients like Bohdan often arrive at International Plus after years of piecemeal repairs that failed to address the underlying problem. The comprehensive approach available at our clinic in Istanbul combined with the advanced healthcare infrastructure of Turkey makes full mouth dental rehabilitation a realistic option for international patients seeking definitive solutions rather than temporary fixes.
Strategic Extractions and Bone Grafting
The surgical phase for Bohdan was planned with the philosophy that guides every case at International Plus: preserve what can be preserved and replace what cannot. Clinical and radiographic evaluation identified teeth 15 and 16 and 27 as having poor long term prognosis. These teeth could no longer support restorations reliably and keeping them would have jeopardized the entire rehabilitation plan.
At the same session the decision was made to remove all four wisdom teeth. Wisdom teeth removal in a case like this is more than a routine extraction because these teeth had become potential sources of complication for the planned full mouth reconstruction. Our experienced surgical team performed all extractions using atraumatic techniques that preserved the surrounding bone for future restoration.
In the extraction sites where implants would be placed dental implant surgery was performed simultaneously with bone graft augmentation. This combined approach shortens the overall treatment timeline and ensures the bone has sufficient density to support the implants for decades. After implant placement and grafting Bohdan entered a carefully monitored osseointegration process before the prosthetic phase could begin.
Restoring Vertical Dimension of Occlusion
When Bohdan returned after his healing period the most sophisticated phase of his rehabilitation began. Years of bruxism had produced a condition called vertical dimension loss meaning that the natural height of his bite had been reduced as his teeth progressively wore down. Restoring vertical dimension is one of the most demanding procedures in restorative dentistry because it affects not only the teeth but also the jaw joints and facial muscles and overall facial proportions.
Our prosthetic team planned a 28 unit full mouth fixed restoration designed to re establish the correct vertical relationship between his upper and lower jaws. This was not a purely cosmetic decision because restoring the lost height was essential to achieving proper occlusal balance and relieving stress on the temporomandibular joints and preventing further breakdown from continued grinding forces.
This phase showcased the full power of the 100 percent digital dentistry workflow at International Plus. Using our 3D FaceScan system the facial proportions of Bohdan were analyzed in detail. This data was matched with intraoral digital scans to design a smile that restored the collapsed vertical dimension while harmonizing with his unique facial structure. Few clinics in Turkey integrate facial analysis with intraoral scanning at this level and this integration proved essential for this case.
Root Canal Treatments for Tooth Alignment
One of the most technically demanding aspects of the case involved the lower anterior region. The lower front teeth of Bohdan were positioned too far toward the outside of the jaw. This placement disrupted his bite and prevented the ideal alignment needed for the new restorations. Rather than resorting to lengthy orthodontic treatment our prosthetic team achieved the needed repositioning through a combination of strategic tooth preparation and endodontic therapy.
By removing the dental pulp through endodontic therapy and carefully preparing the teeth we repositioned them toward the inner side of the arch. This approach delivered anterior teeth alignment in a fraction of the time orthodontics would have required and integrating the correction seamlessly into the broader restoration plan.
Gingivectomy for Anterior Aesthetic Balance
Another challenge was the proportion between his upper and lower front teeth. The upper anterior teeth of Bohdan had shorter clinical crowns than his lower teeth creating a visual imbalance that no amount of restoration alone could fix. The solution was a gingivectomy procedure which is a minor surgical intervention that reshapes the gum tissue to reveal more tooth structure.
The gingivectomy performed at International Plus is a precisely planned procedure and not a cosmetic shortcut. Our team carefully calculated how much gum tissue needed to be contoured to achieve ideal tooth proportions while maintaining the health of the underlying periodontium. For Bohdan this step transformed the upper anterior esthetics from a lingering imbalance into a harmonious focal point of his new smile.
Achieving Natural Front Implant Aesthetics
Perhaps the most artistically demanding element of the rehabilitation involved position 21 where an anterior dental implant had been previously placed. Front tooth implants present a special challenge because the result must be visually indistinguishable from a natural tooth. Our Dental Art laboratory team meticulously planned the soft tissue form and the harmony between the implant crown and the surrounding gums.
The try in phases involved extensive collaboration between our clinical team and the patient himself. Tooth length and form and overall aesthetics were evaluated together with Bohdan at multiple points. This collaborative process is the cornerstone of natural smile design at International Plus ensuring that the final outcome reflects both clinical expertise and the patient’s personal aesthetic preferences. The final restorations were fabricated from Ivoclar zirconium which is the standard material of choice at International Plus for all permanent restorations.
Frequently Asked Questions
Can severe tooth wear from bruxism be repaired?
Yes. Severe wear caused by teeth grinding can be effectively repaired through full mouth rehabilitation using durable Ivoclar zirconium crowns to restore both function and aesthetics. A comprehensive plan addresses the entire bite system rather than individual teeth.
What does increasing the vertical dimension mean?
Increasing the vertical dimension restores the natural height of your bite that has been lost due to severe wear. This helps improve facial proportions and alleviate jaw stress and re establish the proper relationship between upper and lower jaws.
Why is bone grafting done at the same time as implant surgery?
Bone graft augmentation is performed simultaneously with implant placement to ensure the jawbone has enough density to support the implant securely for a lifetime. This combined approach also shortens the overall treatment timeline.
Our clinic which is shaped by the grand vision of our founder possesses deep clinical competence and superior expertise in dentistry. We do not just make teeth because we restore quality of life through the harmony of science and art.
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This content is written, reviewed, and approved by the International Plus Medical Review Board to ensure clinical accuracy and adherence to strict editorial standards. All medical information is regularly monitored, audited and updated in light of the latest scientific advancements.
However the information provided here is for general informational purposes only and cannot be used for self diagnosis or making individual health interpretations. Results of medical treatments depend on individual anatomy and the unique healing process of each patient. This information should not replace a personal consultation with a qualified healthcare professional. To understand the best options for your specific needs and to receive a personalized treatment plan, we invite you to book a free consultation with the expert medical team at International Plus.
International Plus was established from scratch in 2014 with the sole purpose of providing a world class center for plastic and cosmetic surgery by SAMİLSAN SAĞLIK HİZMETLERİ TURİZM DANIŞMANLIK TİCARET LİMİTED ŞİRKETİ International Plus has developed a worldwide reputation for its unique treatments and techniques. With over 10 years of experience, our talented medical experts are among the best in their respective fields. You are our priority. We are convinced that good communication between you and your surgeon is essential when planning your treatments. We offer realistic advice and the most suitable treatments for you.
