In one of our most recent Dawson Academy webinars, we looked at a case that strikes at the heart of what keeps many dentists awake at night: inheriting a failed comprehensive rehabilitation.

You’ve likely been there – a new patient walks in with recently completed dentistry that’s already failing. Do you take on the case and risk becoming the next dentist to disappoint this frustrated patient?

Or do you refer them out and miss an opportunity to truly help someone in need?

The challenge isn’t just technical – it’s also emotional and legal. You’re dealing with a patient who’s lost trust in dentistry, spent significant money, and may be considering litigation against their previous provider.

But looking beyond the tragic reality, there may actually be an opportunity to demonstrate the power of systematic, comprehensive dentistry – and how the fundamentals of Complete Dentistry can help even the most difficult rehabilitation cases.

When “Broken” Isn’t Just About the Teeth

What started as a casual conversation at a local restaurant evolved into a complex case that offers some insight into the world of Complete Dentistry.

The patient – a successful executive – had received comprehensive treatment just six months prior: eight upper and eight lower ceramic restorations. One veneer had already debonded three times, and multiple teeth showed signs of chipping.

Like many patients in this situation, his first request was predictable: “Can you just use better cement?”

In some cases, this would then lead to a consultation for a quick fix. But a thorough examination built around Complete Dentistry revealed a systemic failure in the previous treatment:

• Posterior teeth lacked proper contact
• Only two teeth touched on the left side in centric relation
• Multiple teeth showed chipped porcelain and unstable occlusion
• Lower incisors had been reduced to near butter-knife edges

The core issue wasn’t technical failure – it was the previous attempt to “open the vertical” without proper diagnostic protocols or understanding of muscle function.

This case demonstrates a critical truth: when comprehensive cases fail, they rarely fail for just one reason. Success demands more than better materials – it requires a systematic approach to diagnosis and treatment.

Complete Dentistry: A Systematic Diagnostic Approach To Rehabilitation Cases

When faced with failing dentistry, the instinct is to focus on materials and techniques – better cement, stronger porcelain, and improved bonding protocols.

Yet this situation shows precisely why Complete Dentistry’s systematic approach uncovers and addresses the real causes of failure.

Instead of immediately attempting to fix obvious problems, success begins with understanding the whole system via comprehensive documentation:

• A systematic photo protocol
• Mounted diagnostic models
• Detailed occlusal analysis
• Complete existing conditions documentation

This thorough approach revealed two critical insights:

1. The failing restorations weren’t the problem – they were symptoms of fundamental occlusal instability
2. Vertical dimension is determined by muscle function, not the other way around

In this case, the previous treatment had attempted to solve aesthetic and functional issues by arbitrarily opening the vertical dimension.

After six months, nature was already working to reclaim the original vertical dimension – a process that would have continued regardless of the materials used. This highlighted core Complete Dentistry principles:

• Muscles establish and maintain vertical dimension
• When teeth and muscles conflict, muscles always win
• Increasing vertical dimension doesn’t unload the TMJ
• Stability comes from working with, not against, natural forces

Only by understanding these fundamental relationships could we develop a treatment plan that would achieve lasting success.

The Complete Dentistry Solution: Implementation

Understanding the fundamentals is one thing – implementing them predictably is another. This case demonstrated how Complete Dentistry principles translate into practical success through a systematic approach.

Step 1: Establish True Stability

The temptation to immediately replace failed restorations is strong, but Complete Dentistry demands we first create a foundation of fundamental stability. Through careful analysis and adjustment, the dental team systematically:

• Verified centric relation with load testing to ensure joint health
• Created equal intensity contacts on all teeth
• Established proper anterior guidance for separation of posterior teeth
• Developed harmonious envelope of function

This foundational work proves essential because no restoration, regardless of material or technique, can achieve long-term success without true occlusal stability. The health of the entire system depends on getting these basics right.

Step 2: Verify Through Provisionals

Moving beyond traditional temporary restorations, the provisional phase was a critical diagnostic tool that allowed both verification and refinement of our proposed changes. During this crucial period, the team:

• Allowed three months for complete muscle adaptation
• Confirmed stability of proposed changes
• Validated phonetics and aesthetics
• Provided opportunity for patient feedback and adjustment
• Built confidence in final treatment outcome

This methodical approach gave them the certainty we needed before moving to final restorations.

Step 3: Strategic Implementation

With stability verified through provisionals, the team then proceeded with the final restoration placement following a carefully planned sequence designed to maintain stability throughout:

• Maintained posterior stops throughout treatment
• Completed anterior restorations first to establish guidance
• Restored posteriors quadrant by quadrant
• Verified occlusal scheme at each step

This systematic approach ensured that each step built upon the previous one, maintaining stability while working toward the final result. Five years later, the case demonstrated why Complete Dentistry works:

• No debonding or chipping
• Stable muscle comfort
• Maintained vertical dimension
• Satisfied patient
• Protected practice

The lesson? When comprehensive cases fail, they rarely fail for just one reason.

Success comes from addressing the fundamental requirements for stability, not just replacing the visible failures. Complete Dentistry provides the systematic approach needed to achieve predictable, lasting results.