When a patient consults for worn or shortened anterior teeth, they often think the solution is simple: redo the front teeth. The clinical reality is different. These teeth are worn because the occlusion has evolved, generally due to prolonged bruxism which has caused the posterior teeth to lose height. Restoring the anterior teeth without correcting the cause leads to predictable failures.
Here’s why occlusal rehabilitation often starts with the posterior, and how it is carried out at Dental Swiss Clinics in Montreux.
The Clinical Trigger
It’s not tooth wear that triggers occlusal rehabilitation. It’s the patient’s aesthetic request which, upon clinical analysis, reveals that a simple anterior treatment will not last.
Patients often arrive saying: “My front teeth are damaged, I want them redone.” The question then is not just aesthetic. It is functional. Why are these teeth worn? What happened to the posterior teeth over the years that led to this situation? Has the vertical dimension decreased?
These questions determine the nature of the treatment. Without them, anterior restoration is doomed to short-term failure.
As long as the patient has not expressed a clear aesthetic desire for the front teeth, information and monitoring remain the course of action. Worn teeth are not treated “on principle.” Treatment occurs because there is a demand and a plan.
What the Patient Needs to Understand
To regain a harmonious and lasting anterior smile, the vertical dimension must first be re-established in the posterior teeth.
This concept is foreign to most patients. They come for the front, and they are told that treatment will start with the back. It takes time for this to make sense.
Specifically, when posterior teeth have lost height due to bruxism, they no longer adequately support the occlusion. The anterior teeth compensate, come into contact beyond their physiological function, and wear down in turn.
If the anterior teeth are redone without having re-established posterior height, they immediately resume their compensatory role, and the wear process restarts. Even the most precise ceramic restorations cannot withstand this situation. Fractures, debonding, wear of palatal surfaces—the list of predictable complications is long.
Treating the posterior teeth first allows for the re-establishment of a stable functional framework within which the anterior teeth can be durably restored.
Ceramic Table Crowns in the Practice
This is where ceramic table crowns come in. These are restorations that cover the occlusal surface of the posterior teeth, without completely preparing them. Their role: to restore lost height and give each tooth its functional thickness back.
At Dental Swiss Clinics, these ceramic restorations are designed and manufactured in-house using a fully digital workflow. They precisely adapt to the new vertical dimension planned upstream through clinical analysis and digital simulation.
Once the ceramic table crowns are placed and the occlusion is stabilized, the groundwork is ready for the aesthetic restoration of the anterior teeth. The patient regains a harmonious smile that, this time, will last.
What Makes a Patient Commit
An occlusal rehabilitation project is never trivial. It involves several sessions, a significant financial investment, and a shared understanding between the patient and the practitioner.
In my practice, the rule is simple: this type of treatment must be the patient’s project, not the practitioner’s. Otherwise, it cannot work.
This requirement dictates how I approach preparation. Before proposing anything, the clinical study must be complete. Intraoral scan, occlusion analysis, vertical dimension evaluation, radiological assessment, digital mock-up when the situation allows. Then the treatment plan is presented step-by-step, with the stakes, alternatives, expected results, and the full quote.
This presentation moment is decisive. The patient must clearly see what will be done, why, in what order, and at what cost. They must be able to ask all their questions, express their hesitations, and gauge the commitment.
When this preparation is carried out rigorously, something happens. The patient takes ownership of the project. They become an actor, not a passenger. This is the only condition for undertaking a treatment of this magnitude.
If the patient does not take ownership of the project at this stage, it is not the right time. We can inform, monitor, and revisit later. But we do not proceed.
Situations that Contraindicate
Certain situations dictate not proceeding with occlusal rehabilitation, even if there is an aesthetic request.
Unrealistic expectations that cannot be modified after discussion. A patient who, despite explanations, maintains an expectation that the treatment cannot satisfy. Undertaking treatment under these conditions is not in their best interest.
Unstabilized active bruxism. If the patient continues to generate major parafunctional forces without a management strategy (splint, awareness, reduction of triggering factors), even the strongest restorations will eventually fail.
Uncontrolled periodontal situation. One does not rehabilitate on fragile foundations. Active periodontal disease must be treated before any reconstruction project.
Refusal to commit to the complete process. A patient who absolutely wants to treat only the anterior teeth without touching the posterior cannot be accommodated in this project. The result will not last, and it is not a service to engage them in a treatment doomed to failure.
What This Approach Guarantees and What It Does Not Guarantee
It guarantees a rigorous evaluation, a coherent treatment plan, and end-to-end clinical execution by the same practitioner.
It does not guarantee a result identical to a digital simulation. Nor does it guarantee absolute satisfaction if the patient has not fully adhered to the initial project. The rigor of the preparation is what makes the difference.
Frequently Asked Questions
How long does a complete occlusal rehabilitation take?
This depends on the number of teeth involved and the complexity of the case. The study phase can take several weeks. The treatment itself generally spans several sessions, with progressive stages and a period of adaptation to the new occlusion.
Can only the front teeth be done?
No, when vertical dimension loss has been identified. Treating only the anterior without stabilizing the posterior leads to predictable failures. This is a clinical position I explain during consultation before any commitment.
Are ceramic table crowns permanent?
Yes. Manufactured from ceramic in-house using a digital workflow, they are designed to last and serve as the foundation for the subsequent restoration of the anterior teeth.
What is the cost of occlusal rehabilitation?
It depends on the number of teeth to be treated and the complexity. The quote is established after a complete clinical study. See the prices page for general ranges.
Should bruxism be treated before starting rehabilitation?
Bruxism must be identified and understood. A bruxism splint may be indicated to protect the new work. Patient awareness of their habits is also important.
For an evaluation of your situation, contact Dental Swiss Clinics in Montreux, Monday to Friday from 8 AM to 8 PM.