Dr Ahmed I. Fetian

Predictibilty with each case with solid digital driven protocol with super emergence profile creation

Full arch cases day in day out . whats certain in these cases is that we manage vertical dimenision precisly in each single case

foundation supporting it. Whether you're placing a crown, an overlay, or an endocrown, long-term success relies heavily on how we manage the peri-restorative gingival architecture.
​Here are a few quick reminders to keep in mind during your daily preparation and impression workflows:

​📌 1. Preserve the Biological Width (Supracrestal Tissue Attachment)
Encroaching on the junctional epithelium and connective tissue attachment is a fast track to chronic inflammation, unpredictable recession, or tissue hypertrophy. Always aim for margins that respect at least 2–3 mm of distance from the alveolar crest.

​📌 2. Smart Finish Line Depth
Keep margins supragingival or equigingival whenever possible. If subgingival placement is required for esthetics or structural retention, limit depth to 0.5–1.0 mm into the sulcus to maintain tissue health and simplify impression taking.

​📌 3. Master Your Sulcus Expansion
A clear margin is essential for digital scanning and analog impressions alike.
​Two-Cord Technique: Excellent for deep subgingival margins or high tissue tone. Use a fine #000 cord for apical displacement and a #0 or #1 cord for lateral retraction.
​Tissue Safety: Avoid aggressive packing—excessive mechanical pressure can cause irreversible gingival recession, especially in thin biotypes!

​📌 4. Emergence Profile & Contours
Under-contouring is always safer than over-contouring. Over-contoured restoration profiles trap plaque, hinder oral hygiene, and trigger localized gingivitis around abutment teeth.

​📌 5. Temporary Restorations Matter
Provisional crowns aren't just place-holders—they are soft tissue sculptors. Ensure smooth polish, ideal emergence profiles, and clean margin fit to allow tissues to heal before final cementation.
​What is your go-to tissue retraction technique for tough aesthetic cases? Single cord, dual cord, or retraction paste? Let’s discuss in the comments below! 👇

​

Dr ahmed fetian
Prosthdontist . full mouth rehab specialist

Final intraoral

Tooth wear rehabilitation rarely tests your restorative skills alone — it tests your ability to sequence a plan that respects vertical dimension, mandibular position, and long-term occlusal stability, all while coordinating across disciplines.

This case is a 70-year-old male undergoing a staged full-mouth rehabilitation: restoring vertical dimension and the anterior segment with teeth-retained prosthodontics, in parallel with Dr. Ahmed Saeed restoring the posterior segment with implant-retained prosthodontics Wonders dentistry د/ أحمد سعيد لطب الفم و الأسنان

Dealing with tooth wear cases is frequently more challenging than not — especially when solving simultaneously for vertical dimension, maxillomandibular relationship, and prosthetic convenience position. Time and again, it comes down to figuring out a time-efficient workflow paired with robust, long-term outcomes.

A few principles that tend to separate efficient, durable workflows from the ones that drag on or fail:

**Sequencing the VDO decision early and locking it**
Most inefficiency comes from revisiting the OVD decision mid-treatment. A diagnostic wax-up — tested at a semi-adjustable articulator, then trialed clinically with a Dahl-type appliance or full-arch provisional — removes a lot of back-and-forth later. Deciding upfront between anterior-only reorganization (Dahl principle) and full-arch simultaneous increase matters, since they carry different workflows and different failure modes.

**CR vs. prosthetic convenience position**
For most tooth wear cases without significant occlusal instability, recording in a reproducible retruded position and building the prosthetic scheme around that gives more predictable seating and fewer remakes than chasing a habitual bite that drifts. The exception: when the wear pattern is anterior-guidance-driven and the habitual position is stable and reproducible, CR conversion adds a step without adding value.

**Material selection for longevity vs. efficiency**
Monolithic lithium disilicate or zirconia posteriorly buys wear resistance and speed. But the real longevity lever is protecting the increased OVD with adequate anterior guidance and even, simultaneous posterior contacts — occlusal scheme design matters more than material choice.

Below is the case, stage by stage.
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A flawless smile transformation is only as good as the foundation it's built on. Long-term esthetics and function always start with periodontal health.

​Before jumping into the aesthetics, the focus is entirely on creating a healthy, inflammation-free environment. Through precise procedures like crown lengthening, tissue recontouring, and occlusal adjustments, a balanced framework is established.

​Once the gums and surrounding tissues are perfectly stable, the restorative phase begins. By focusing on meticulous tooth preparation, controlled bite alignment, and selecting materials that respect your natural biology, we achieve true functional harmony.

​The ultimate takeaway: The periodontal and restorative phases must work hand-in-hand. Healthy gums ensure restorative success, and a well-engineered restoration keeps your gums healthy for years to come.

Do you think prosthodontists are periodontist at core?

14-Day Transformation: Full-Mouth Rehabilitation

​A complex case presenting with advanced tooth wear, aesthetic compromise, functional impairment, and underlying endodontic issues.

​A comprehensive approach to treatment was applied, beginning with detailed history taking, meticulous data analysis, and the establishment of a precise diagnosis. Management of severe wear cases demands rigorous attention to multiple workflow segments, sequencing, and staging.

​1. Periodontal Assessment & White Aesthetics

​Chief among these considerations is a thorough periodontal assessment, evaluating both active disease status and overall tissue architecture. This phase of treatment planning is absolutely crucial for establishing the proper frame and proportions of the white aesthetic space.

​2. Mandibular Position & Occlusal Harmony

​Establishing a sound, restoratively driven mandibular position from the outset is fundamentally important. This dictates the optimal clinical method required to capture a maxillomandibular relationship that is reliably repeatable in the clinic and accurately reproducible in the laboratory.

​3. Biological Adaptation & Interim Verification

​Biological adaptation and soft tissue training are paramount for the ultimate periodontal integration of the final prosthetics. This is achieved through strict oral hygiene measures and highly polished PMMA provisional restorations. Beyond tissue conditioning, these provisionals provide a invaluable functional and aesthetic "test drive" of the proposed prosthetic solution.

​Ultimately, full-mouth rehabilitation cases are never the product of luck. They are the result of detailed, systematic planning combined with an optimized integration of both analogue and digital workflows.

​Together with this case, I have included the book covers of literature that heavily shaped my philosophy regarding full-mouth reconstruction.

​Invaluable insights and methodologies from leading minds in occlusion and comprehensive dentistry:

​Kois

​Spear

​Pankey

​Dawson

The long-term success of dental restorations depends on more than just the material selected; it requires a harmonious balance between preserving biology and adhering to sound restorative principles. Employing a minimally invasive approach to tooth preparation ensures optimal retention and resistance forms while safeguarding healthy tooth structure. Integrating these techniques with evidence-based practices—including precise adhesion protocols, correct margin design, and occlusal balance—creates a comprehensive strategy. This approach not only extends the lifespan and stability of the restoration but also protects the natural dentition, ensuring lasting functional and aesthetic success.

What material do you favor for your oral rehabs

Following the temporization phase of a full-mouth rehabilitation, rigorous dental and periodontal monitoring is crucial to guarantee tissue health and long-term treatment stability. This phase focuses on evaluating the soft tissue response adjacent to provisional restorations, verifying marginal adaptation, and managing plaque accumulation and inflammation. Implementing tailored oral hygiene protocols, tissue conditioning, and precise provisional contouring promotes stable, healthy gingiva and an optimal emergence profile, establishing a biologically sound foundation for final prosthetics.

Do you ever consider how to tissue train your cases?

اساسيات ال full mouth rehabilitation cases

انك تعرف تستعمل ال leaf gauge امته
و تستعمل ال lucia jig امته

و السؤال اللي بيطرح نفسو ، لو lucia jig متوفر كمنتج تفتكر تشتريه بكام ؟
و هتبقا عايز كام قطعه عشان تعرف تشتغل من غير ما تعطل ؟