- Several or all teeth must be planned as a system
- Function and aesthetics cannot be solved in isolation
- Bite elevation or space gain for non-prep/minimal-prep in the anterior
- Willingness for diagnostics before design
109FIFTY · 03
Full mouth: plan, approximate, implement reconstructably
Smile design. Reconstructability. Clear workflow.
Full-mouth rehabilitation plans form, function and bite as a system – defect-oriented per tooth. It often also involves bite elevation in abrasion or limited anterior space, to gain room for non-prep or minimal-prep. Smile design and 3D try-in make the goal visible in advance; scan, design (e.g. exocad®), milling and 3D printing create a documented digital reference.
Full-mouth planning connects tooth form, bite, materials and the desired overall effect into a system. First the person is read – not the product. Digital capture, design and manufacturing work with chairside dental technology: intraoral scan, design in professional software (e.g. exocad®), 5-axis milling and 3D printing yield a traceable digital reference – more precise and better documented than classic hand-off chains.
109FIFTY principle
Defect-oriented planning
Planning is defect-oriented. Each tooth receives only the extent its own findings require.
European consensus literature on severe tooth wear prioritises diagnosis and cause clarification before restoration; OVD consensus literature supports structured functional assessment – without time or outcome guarantees.
109FIFTY principle – supplemented by verified consensus sources (Loomans, Goldstein).
109FIFTY principle
Bite elevation and space for non-prep
Many full-mouth cases arise not only from an aesthetic wish, but from missing space: worn dentition, congenitally little space or crowded anterior teeth. A planned, discreet bite elevation – often with tabletops in the posterior – can create space so that non-prep or selective minimal-prep remains possible in the visible area.
In that sense full mouth becomes a prerequisite for tissue-preserving veneers – not an end in itself of maximum restoration.
109FIFTY principle
Smile design – brief outline
Smile design makes a visible, comparable and documentable goal visible in advance: standardised photography, scan, virtual set-up and 3D try-in. Tooth colour, form and lip relation are assessed together – not chosen “blind” from a shade guide.
The principle remains: show the goal first. Classic wax-up/mock-up was often labour-intensive and imprecise; digital 3D simulation implements the same principle more precisely and traceably. It does not replace examination.
109FIFTY principle
Human and machine
Scan, design (e.g. exocad®), milling and printing support precision, transfer and traceability. The digital chain makes planning and implementation stronger than purely analogue hand-offs: data stay comparable, steps documentable, and reopening for repair needs or extension clearer.
Artistic dental-technical understanding – layering, translucency, characterisation – makes the restoration individual. Digital tools replace neither diagnosis nor chairside coordination with the patient.
109FIFTY principle
Joint coordination in complex rehabilitations
In complex rehabilitations, functional requirements, aesthetic goal and dental-technical execution are coordinated early together. Dental technology receives the brief not only as a file, but from the joint clarification with the patient – wish, facial dynamics and limits are understood chairside.
Such an overall design cannot be conveyed through individual files or a classic lab prescription alone.
Indication
When it may fit.
And when it may not.
- Expectation of guaranteed longevity without findings and care
- Untreated inflammation or unexplained functional disorders
- Circumferential grinding “for the lab” instead of tissue preservation
Process
Workflow
- 01
Findings & planning
Bring together teeth, bite, function, facial dynamics/lip effect and colour goal – defect-oriented per tooth; plan bite elevation for space gain if needed.
- 02
Understand together
Patient, dentist and dental technician clarify goal definition and limits of change – dental technology receives the brief from this joint clarification, not only via file.
- 03
Smile design & 3D try-in
Visible, comparable and documentable goal before irreversible steps; check effect in facial dynamics and speech in the 3D simulation.
- 04
Implement and follow up
Clinical implementation after individual planning; function and risk-based care; use the digital reference for traceability.
Materials & technique
Materials and data
- Definitive restorations in the sense of the philosophy planned as ceramic – typically lithium disilicate (e.g. IPS e.max®), often zirconia with implants
- Digital chain: intraoral scan → design (e.g. exocad®) → 5-axis milling / 3D printing as documented reference
- Hybrid materials for 3D simulations; individual layering and surface work on the definitive ceramic
Limits and framing
What to keep in mind.
- Function and aesthetics must be planned together – isolated “anterior only” solutions often remain unstable.
- Without diagnostics and a clear goal definition, the risk of unwanted compromises rises.
Knowledge
Frequently asked questions.
What does defect-oriented planning mean?+
Each tooth receives only the extent its own findings require. That is a 109FIFTY principle, supplemented by consensus literature on wear and occlusal vertical dimension.
What does a digital reference provide?+
Scan, design and manufacturing data make planning and implementation traceable and comparable – from 3D try-in to definitive ceramic. That strengthens precision and documentation; it does not replace examination or chairside fine adjustment.
Why is a lab prescription alone not enough?+
In complex rehabilitations, function, aesthetic goal and execution are coordinated early together. Dental technology receives the brief from this clarification with the patient – wish and facial dynamics are understood chairside, not only through individual files or a classic lab prescription.
- Consensus
[loomans2017]Loomans B et al. Severe tooth wear: European consensus statement on management guidelines. J Adhes Dent. · DOI 10.3290/j.jad.a38102 · PMID 28439579 ↗ - Consensus
[goldstein2021]Goldstein G, Goodacre C, MacGregor K. Occlusal vertical dimension: best evidence consensus statement. J Prosthodont. · DOI 10.1111/jopr.13315 · PMID 33783090 ↗ - Systematic review
[siqueira2021]Siqueira R et al. Intraoral scanning reduces procedure time and improves patient comfort: systematic review. Clin Oral Investig. · DOI 10.1007/s00784-021-04157-3 · PMID 34568955 ↗
Note
Possible providers — not a recommendation
Whether and how to treat is decided solely by the treating provider after examination — not by 109FIFTY. Naming MEDIKUSS and MEDISMILE is a factual note on possible providers with concept experience, not advertising and not a recommendation.