Hello! I have a 28 year old female who has her bridal shower on June 25th and is getting married on August 20th of this year. Her main concern is to improve her smile. She doesn't like the dark crown on #9 and the margin of the old veneer on #10 (peg lateral) shows. Upon evaluation, I noted asymmetric wear of her anteriors with flattened canine cusp tips and increased edge wear of #7-8 and #25-26 compared to the left side. I asked the patient to make a right lateral excursive movement and I was able to get the wear facets on #6 and 8 to line up with #24-27. I used a deprogrammer and the patient reported no notable changes with her joints and muscles, but did notice her bite was different when she initially took the deprogrammer off. I took CR bite records and mounted the models. I also performed a chairside "smile trial" to get an idea of what the desired esthetic end result will be and the patient was happy with the planned esthetics.

After evaluating the mounted models, Her first point of contact was #2 and #31. The anterior was open about 3 mm. I equilibrated the models at #2 and #31 and was able to close down the occlusion so that the anteriors were closer in contact. However, the rest of the posterior teeth are not in occlusion. I transferred the mockup onto the model and used composite to buildup the incisal edges of the canines and leveled the uneven edges at #23,24 so that I was able to achieve anterior guidance. Refer to attached photos of model work.

The preliminary plan is to do veneers on #7, 8, 10, replace the crown on #9, equilibrate #2,31,23,24, and add composite onto #6,11,27. I am pretty close to where I want to be in the anteriors, but the models still only contact at #2 and #31. The premolars have about 2-3 mm of interocclusal space and the left side molars are open about 1 mm. If I continue adjusting #2 and #31, my concern is that I will "overclose" the patient's bite and constrict her envelope of function. I suspect the patient would need ortho at this point to extrude her posteriors to get them into contact at this new VDO. However, the patient is on a short time line and I would like to give her at least a short term option to get her through her bridal shower and her wedding. Would you recommend adding composite onto the lingual cusp tips of her upper posteriors to get the rest of them into contact? I figured she could test out this occlusal scheme While she is in her anterior temporaries on #7-10. If she isn't breaking the temporaries and feels comfortable with the rest of her occlusion, we'll know that's where she needs to be and likely recommend ortho to get the rest of her teeth there.

What do you think of this game plan? Any concerns or other short term options I should consider? Thanks in advance!

Pre-Op photos

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Mock-up photos

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Mounted models before equilibration

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Mounted models after equilibration

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