4D Digital Kinematic Workflow for the Full-mouth Rehabilitation of Severe Tooth Wear: A 5-Year Case Report

Turner and Missirlian category 1 severe tooth wear involves loss of Occlusal Vertical Dimension (OVD) and may be accompanied by altered occlusal and neuromuscular function. Parafunctional habits may further increase biomechanical demands on restorations. This case report describes a Four-Dimensional (4D) digital kinematic workflow. The workflow integrates a Jaw Motion Analyzer (JMA), Virtual Articulator (VA), Electromyography (EMG) monitoring, and conventional analog verification.

A 61-year-old male presented with multiple missing teeth and generalized severe tooth wear. He also had reduced clinical crown height and loss of OVD. The patient reported long-term Selective Serotonin Reuptake Inhibitor (SSRI) therapy, xerostomia, severe nocturnal bruxism, and predominantly left-sided chewing. Treatment comprised periodontal and endodontic therapy, an occlusal stabilization splint, implant placement, staged CAD/CAM provisional restorations, and definitive full-contour zirconia restorations. At the 5-year follow-up, bilateral centric contacts and prosthesis integrity were clinically maintained. Three minor occlusal adjustments had been performed, and no major biological or mechanical complications were observed. A study-specific, self-administered 10-point visual analog scale indicated high satisfaction with comfort, function, and esthetics.

In this patient, combining a 4D digital kinematic workflow with conventional analog verification was feasible, and the clinical findings remained stable over 5 years. These observations do not establish superiority over conventional methods, a causal effect, or broad clinical applicability. Larger prospective studies using standardized technical parameters and validated patient-reported outcome measures are needed.