Full-mouth multidisciplinary rehabilitation for a senior colleague: five-year follow-up
Dr. Mohamed El-Awady, a senior colleague and a friend of my father, came to us with worn teeth, old restorations and missing teeth. Treatment took about a year and combined implants, sinus lift, bone grafting, crown lengthening, root canal treatment and crowns, with an increase in the vertical dimension of the bite. Five years later, the result is still stable.
The start
Dr. Mohamed El-Awady is a respected senior colleague and a friend of my father. He came to me years ago with worn teeth, old restorations, some missing teeth and a collapsed bite.
What I love about this case is that he came on someone's recommendation. More than 99% of my patients come by word of mouth, and your work decides whether that word is good or bad.
The treatment
It was a big case that took about a year of work. The answer was not one specialty but one plan combining many:
- Dental implants with a sinus lift, some placed immediately after extraction.
- Bone grafting around the implants in the lower jaw.
- Crown lengthening to expose enough sound tooth structure.
- Root canal treatment where needed.
- Increasing the vertical dimension of the bite to compensate for wear.
- Crowns on natural teeth and implants, with vertical preparation to respect the gums.
As always, my friend Dr. Yaarob Kassem was with me, sometimes in the clinic sharing part of the work, sometimes on the phone.
Follow-up
We followed the case at one year, two years and five years. Thank God, the result is still stable.
The message
Big cases are never solved by one specialty. A dentist who understands implants, periodontics, endodontics and restorative dentistry can build one integrated plan. The best part of being a doctor is seeing people comfortable after treatment, and the best part of being a dentist is seeing their smile grow.
Clinical details for dentists
1 Before: worn teeth and old crowns 
2 During treatment: failing teeth removed, missing teeth and a collapsed bite 
3 Before: occlusal view of the upper arch 
4 Before: old restorations and decay in the back teeth 
5 Vertical preparation of the front teeth under isolation 
6 Crown lengthening and preparations in both arches 
7 Upper back implants 
8 Lower implants with bone grafting 
9 Bone graft secured around the lower implants 
10 Healed soft tissue around the implants 
11 Digital scan of the new bite 
12 Final crowns: occlusal views 
13 Final result 
14 X-ray: crowns on implants 
15 X-ray: root canal treated tooth and implant crowns 
16 2-year follow-up 
17 5-year follow-up
Case summary
Full-mouth rehabilitation: generalized wear, failing old restorations, missing posterior teeth and reduced vertical dimension of occlusion (VDO).
Treatment components
- Implants with sinus lift; immediate placement in selected sites.
- GBR around lower implants (sausage technique).
- Surgical crown lengthening.
- Endodontic treatment where indicated.
- Increase in VDO.
- Vertical preparation and full-coverage crowns on teeth and implants; digital workflow.
Follow-up
1, 2 and 5 years: stable restorations, healthy soft tissue and stable occlusion.
Take-home message
Complex cases need a multidisciplinary plan, not a sequence of separate treatments.
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