Systematic Application of Hobo Twin-stage Approach to Rehabilitate Worn Dentition: A Case Report

Abstract

Aim: To demonstrate the systematic application of Hobo twin-stage procedure for rehabilitating severely worn dentition, ensuring optimal functional and esthetic outcomes while minimizing treatment complexity and patient visits. Background: Bruxism and habits such as tobacco chewing can result in severe occlusal wear that compromises the patient’s occlusion, esthetics, and function. Rehabilitating such cases poses challenges, including the need for precise planning and the selection of appropriate treatment protocols. The twin-stage procedure by Hobo and Takayama provides a systematic method of occlusal rehabilitation based on mathematical analysis of mandibular movement, offering a reliable and simplified approach for managing such cases. Case description: A 45-year-old male presented with severely worn and discolored teeth. He complained of difficulty in chewing and was seeking improvement in the appearance of his teeth and smile. Contributing factors identified included a long-standing bruxism habit and a 20-year history of chewing tobacco. To address the functional and esthetic concerns, a reorganized approach was planned, involving a 2 mm increase in vertical dimension and full-coverage zirconia crowns. The Hobo twin-stage procedure was employed, which involved simultaneous full-arch tooth preparation followed by the fabrication of restorations using standard articulator setting values. The patient adapted well to the altered vertical dimension, and zirconia restorations were fabricated using CAD-CAM technology. Follow-ups over 2 years confirmed the success of the treatment, with the patient reporting satisfaction with the esthetic and functional outcomes. Conclusion: The Hobo twin-stage procedure provides a systematic, predictable, and efficient approach for rehabilitating mutilated dentition. By leveraging mathematical principles and simplified articulator settings, this technique ensures functional stability, esthetic enhancement, and patient satisfaction. Clinical significance: The Hobo twin-stage approach ensures precise occlusal rehabilitation with a minimal number of appointments and simplified instrumentation, making it a valuable method for clinicians to manage mutilated dentition.