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131]

Review

Philosophies of full mouth rehabilitation: A systematic

review of clinical studies
Meenakshi Thimmappa, Vanshree Katarya, Ishita Parekh
Department of Prosthodontics, Pacific Dental College and Hospital, Debari, Rajasthan, India

Abstract Aim: To systematically review the available literature on full mouth rehabilitation of the worn out dentition
to help the clinician to choose a suitable philosophy to treat an individual Turner and Missirlian classification.
Settings and Design: Systematic review following PRISMA guidelines.
Materials and Methods: The electronic search engine explored for relevant published studies from the
earliest available date, from January 1960 till October 2018. Search terms included were “full mouth
rehabilitation OR occlusion OR philosophies of full mouth rehabilitation OR oral rehabilitation OR Pankey
Mann Schuyler philosophy OR Hobo Twin stage OR Hobo Twin Table OR worn out dentition OR Turner
and Missirlian classification”. All collected studies were analyzed and a total of 54 articles and 2 hand
searches were extracted, among which 32 articles were selected for the systematic review. Of these 32
articles, 8 were original research studies, 23 case reports and 1 study which comprised 3 case reports
were incorporated. Hence, a total of 26 case reports were considered for this systematic review based
on CAse REport guidelines.
Statistical Analysis Used: Qualitative analyisis.
Results: Among 26 case reports, 15 cases (57.69%) were treated by Pankey Mann Schuyler philosophy, 2 cases
(7.69%) by Hobo twin table and 9 cases (34.61%) by Hobo twin stage philosophy. 21 out of 26 cases were
introduced for category no. 1 (80.76%) and 4 cases for category no. 2 (15.38%) and only 1case presented
for category no.3 (3.84%) of Turner and Missirlian classification.
Conclusion: No philosophies are universally applicable. Although the most commonly used philosophy is
Pankey Mann Schuyler. Hobo Twin stage philosophy is the second most commonly used followed by Hobo
Twin table. Maximum patients with worn out dentition are grouped under category no.1 of Turner and
Missirlian classification system. Maximum cases of this category are treated by Pankey Mann Schuyler's
philosophy.

Keywords: Full mouth rehabilitation, hobo twin stage, hobo twin table, pankey mann schuyler philosophy,
turner and missirlian classification, worn out dentition

Address for correspondence: Dr. Meenakshi Thimmappa, Department of Prosthodontics, Pacific Dental College and Hospital, Debari ‑ 313 024, Rajasthan, India.
E‑mail: [email protected]
Submitted: 15‑Oct‑2019, Revised: 26-Jul-2020, Accepted: 15-Sep-2020, Published: 29-Jan-2021

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DOI: How to cite this article: Thimmappa M, Katarya V, Parekh I. Philosophies

10.4103/jips.jips_397_19 of full mouth rehabilitation: A systematic review of clinical studies. J Indian
Prosthodont Soc 2021;21:19-27.

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Thimmappa, et al.: An appraisal on concepts of full mouth rehabilitation: A systematic review

INTRODUCTION an individual case. The secondary objective is to survey the

occurrence rate of the category of T&M classification.
The minimal and gradual wear of occlusal surfaces of teeth
is a normal process during the lifetime of an individual. It METHODS
can be due to congenital and developmental anomalies such
as amelogenesis imperfecta and dentinogenesis imperfecta Protocol and registration
or can be acquired such as attrition, abrasion, and erosion.[1] A Preferred Reporting Items for Systematic Reviews and
However, excessive loss of tooth material may result in Meta‑Analyses 2009[9] protocol for a systematic review
pulpal pathology, occlusal disharmony, impaired function, was followed. This systematic review registered under
and esthetic disfigurement and eventually mental distress. the International Prospective Register of Systematic
The management of tooth wear is becoming a subject of Reviews (PROSPERO) bearing registration number‑164375.
expanding enthusiasm in the prosthodontic field. This
Eligibility criteria
requires the full mouth rehabilitation which converts all
CAse REport  (CARE) 2013[10] guidelines were followed
the unfavorable forces on the teeth which inevitably induce
for quality assessment. The following study characteristics,
pathologic conditions, into favorable forces that permit
i.e., Population, Intervention, Comparison, Outcome, and
normal function and therefore induce healthy conditions
Study design model were adopted:
and restoring quality life.
Population
Turner and Missirlian (T&M) in 1984 classified occlusal wear
Male and female individuals irrespective of age having worn
into three categories.[2] The rehabilitation of each category
out dentition due to acquired or developmental diseases.
should be possible by any of the proposed philosophies of
full mouth rehabilitation. These philosophies are Pankey Intervention
Mann Schuyler (PMS), Hobo twin table and Hobo twin The application of three philosophies; PMS, Hobo Twin
stage. However, all types of occlusal wear cannot be Table, and Hobo Twin Stage.
redressed by using any philosophy.
Comparison
PMS philosophy (1960) is based on the principles of the Three philosophies were compared.
spherical theory of Monson and functionally generated
path technique (FGPT) described by Meyer.[3,4] It restores Outcome
the anterior guidance first and then mandibular occlusion The philosophy which is clinically efficient, practically
plane followed by maxillary occlusal plane. Hobo Twin feasible, simple, and easy to apply within stipulated
table philosophy (1991) utilizes the two customized incisal time resulting in patient’s comfort and satisfaction to
guide tables, one with disocclusion and another without ensure a quality life. The selection criteria include basic
disocclusion.[5,6] In this philosophy, posterior occlusion is research studies of 3 philosophies, case reports and case
rehabilitated first followed by the development of anterior series, randomized clinical trials and implant therapy and
guidance. Moreover, Hobo Twin Stage philosophy (1997) published studies till 2018. Studies with missing data were
is based on the standard cusp angle which is used to build excluded from the study.
up the standard measure of disocclusion.[7,8]
Study design
A critical assessment of available literature on occlusal Nonrandomized studies such as observational studies,
philosophies of full mouth rehabilitation requires an case reports, and case series and randomized clinical trials
understanding of their historical development and proper were considered.
application. Occlusion plays a key role in establishing
the synchronous harmony between components of the Information sources
stomatognathic system. Henceforth, the selection of A search of electronic databases, including PubMed,
legitimate philosophy is the most important step in the MEDLINE, EMBASE, CINHAL, Web of Science,
prosthetic rehabilitation of a patient with mutilated dentition. Research Gate, Ebscohost, Google scholar, and Cochrane
library exploration for applicable studies distributed
The primary objective of this systematic review is to critically from January 1960 to October 2018 was performed. In
analyze the existing literature, including original articles and addition, 2 hand searches were carried out in textbook on
case reports of philosophies of full mouth rehabilitation, “Osseointegration and occlusal rehabilitation” by Sumiya
which will help in selecting an appropriate philosophy for Hobo et al., and textbook titled as “Functional Occlusion
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Thimmappa, et al.: An appraisal on concepts of full mouth rehabilitation: A systematic review

from TMJ to Smile Design” by Peter E. Dawson. Journals Bias assessment

included were, Journal of Indian Prosthodontic Society, Careful assessment of the compiled studies applying the CAse
Journal of Prosthetic Dentistry, Journal of Advanced REport guidelines performed by two senior Prosthodontists
Prosthodontics, Indian Journal of Dental Advancement, to investigate the possible bias within and across the studies.
International Journal of Dental Case Reports, International
Journal of Prosthodontics and Restorative Dentistry and RESULTS
International Journal of Current Research.
Study selection
Search A total of 54 published studies and 2 hand searches were
Search terms used were, full mouth rehabilitation; screened and assessed for eligibility. Of these, 22 studies did
occlusion; philosophies of FMR; PMS; PM instrument; not meet the eligibility criteria since they were not having
Hobo philosophy; Hobo twin table technique; Hobo twin any specific application of the philosophy of full mouth
stage technique; oral rehabilitation; occlusal rehabilitation; rehabilitation and 2 hand searches were found duplication.
implant occlusion; worn out dentition; T&M classification. Hence, 24 studies were rejected. The full text of the
Detailed search strategy from the PubMed database is remaining 32 studies was further reviewed and finally, 32
shown in Table 1. articles fulfilling the inclusion criteria were chosen. Figure 1
depicts study selection.
Study selection
This systematic review was performed independently by 2 Study characteristics
clinicians and 1 methodologist, in a blinded standardized Methods
manner to avoid any bias. No disagreements were found Among 32 articles, 8 were unique articles of the philosophies
among the reviewers. Original research articles, case reports proposed and 24 were case reports. CARE guidelines
and case series were included for the systematic review. checklist was followed in choosing the case reports.

Participants
Data collection process
The first search hits were explored by two investigators The included studies involved 26 participants. The main
to bar any duplications or studies not relevant to the inclusion criteria entailed worn out permanent dentition
research question. In selecting the publications, the titles irrespective of age and gender.
and abstracts were reviewed to identify the relevant studies, Intervention
which were then retrieved in full format and assessed by Application of any philosophy of full mouth
the third investigator for inclusion and exclusion criteria. rehabilitation.
The reasons for exclusion of studies were likewise noted.
Finally, the selected studies were the ones that answered Outcome
the review questions. Primary
The assessment of all case reports showed that among
Data items 26  cases, 15  cases  (57.69%) were rehabilitated by PMS
The variables considered for the study are (1) age, (2) gender philosophy, 2  cases  (7.69%) by Hobo twin table and
of the patient, (3) the cause of the occlusal wear, (4) to 9 cases (34.61%) by Hobo twin stage philosophy.
which T&M classification the clinical condition belongs,
(5) the applied philosophy, (6) practical applicability of the Secondary
philosophy, (7) follow‑up period, (8) outcome of treatment, Twenty‑one out of 26  cases were showed for category
and (9) the patient’s comfort. number 1  (80.76%) And 4  cases for category number
2 (15.38%) And 1 case for category number 3 (3.84%) Of
Table 1: Search strategy: PubMed; without limits t&m classification.
worn[All Fields] AND out[All Fields] AND (“dentition”[MeSH Terms] OR
“dentition”[All Fields]) full[All Fields] AND (“mouth rehabilitation”[MeSH
Terms] OR (“mouth”[All Fields] AND “rehabilitation”[All Fields]) OR
Table 2 summarizes the included studies with applied
“mouth rehabilitation”[All Fields]) Pankey[All Fields] AND mann[All philosophy of full mouth rehabilitation.
Fields] AND schuyler[All Fields] AND (“philosophy”[MeSH Terms] OR
“philosophy”[All Fields]) hobo[All Fields] AND (“twins”[MeSH Terms] DISCUSSION
OR “twins”[All Fields] OR “twin”[All Fields]) AND table[All Fields] AND
(“philosophy”[MeSH Terms] OR “philosophy”[All Fields]) hobo[All
Fields] AND (“twins”[MeSH Terms] OR “twins”[All Fields] OR “twin”[All Summary of evidence
Fields]) AND stage[All Fields] AND (“philosophy”[MeSH Terms] OR The concept of complete mouth rehabilitation is dependent
“philosophy”[All Fields])
on three principles, the existence of a physiologic rest
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Thimmappa, et al.: An appraisal on concepts of full mouth rehabilitation: A systematic review

occlusal vertical dimension. The condition presenting

excessive wear without loss of occlusal vertical dimension
but with restorative space available is categorized as number
2. Moreover, those presenting excessive wear without loss
of occlusal vertical dimension but with limited restorative
space available is classified under category number 3.

Occlusion plays a key role in establishing the synchronous

harmony between components of the stomatognathic
system. Hence, the selection of legitimate philosophy is
the most important step in the prosthetic rehabilitation
of a patient with mutilated dentition. A critical assessment
of available literature on occlusal philosophies of full
mouth rehabilitation requires an understanding of their
historical evolution and appropriate application. Hence,
this systematic review was performed to help the clinician
to choose a suitable philosophy to treat an individual T&M
classification.

For this systematic review, 54 published studies and 2 hand

searches[40,41] were collected. Of which only 32 studies
were selected at first hit. The other 22 articles[38,42‑61] were
omitted as these articles had not applied explicit use of any
philosophy rather a general consideration about occlusal
restoration was applied. Finally, among 32 included studies,
Figure 1: Flow diagram of study selection
26 were case reports  (1  case series with 3  case reports)
and 8 were original articles from respective authors of
position of the mandible which is constant, the recognition
philosophies of full mouth rehabilitation. However, no
of a variable vertical dimension of occlusion and the
higher levels of evidence such as randomized clinical trials
acceptance of dynamic, functional centric occlusion.[37]
are available related to this topic.
Once the etiology has been determined for occlusal Statistical assessment of case reports revealed that 21
wear, the evaluation of diagnostic data that includes the out of 26  cases were presented for category number
occlusal vertical dimension and consultation with the 1  (80.76%) and 4  cases reported for category number
patient to recognize the need for the restoration, and a 2 (15.38%) and 1 case for category number 3 (3.84%) of
comprehensive treatment plan should be formulated. T&M classification.
This purpose requires a classification to determine the
status of the existing condition and to plan a definitive The rehabilitation for each category of T&M classification
treatment. The classification of worn out dentition is useful done by any of the proposed philosophies of full mouth
to communicate with the professional about a case and to rehabilitation. These philosophies are PMS,[3,4] Hobo
apply a particular philosophy for rehabilitation. twin table,[5,6] Hobo twin stage,[7,8] Nyman and Lindhe
philosophy,[35] and Youdelis philosophy.[36] The literature
The most widely applied classification system is T&M showed that a particular category of T&M classification
classification[2] given by T&M in 1984. Other classifications can be treated by a particular theory. For this systematic
are additionally proposed for occlusal wear which includes review, specifically three philosophies, i.e., PMS, Hobo twin
Jones[38] classification in 1963 and Dawson’s classification[39] table and Hobo twin stage were chosen; as the maximum
in 1996 but are not that practically popular. of studies are available for these philosophies. Hence,
these three philosophies of full mouth rehabilitation were
The patient can be set into one of the three categories systematically reviewed to explore the effectiveness of
of T&M classification[2] relative to the occlusal vertical treatment in mutilated dentition, ease and duration of
dimension associated with an appropriate treatment plan. treatment and patient’s comfort and satisfaction leading to
Category number 1 includes excessive wear with loss of improved quality of life. No evidence‑based case reports
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Thimmappa, et al.: An appraisal on concepts of full mouth rehabilitation: A systematic review

Table 2: Summary of included studies with applied philosophies

Source Number of Age/ Inclusion criteria Turner and Philosophy applied Follow up
participants gender Misserlian category period
Mann and Pankey, 1960[3] ‑ ‑ ‑ ‑ PMS, Part‑I ‑
Pankey and Mann, 1960[4] ‑ ‑ ‑ ‑ PMS, Part‑II ‑
Hobo, 1991[5] ‑ ‑ ‑ ‑ HTT, Part‑I ‑
Hobo, 1991[6] ‑ ‑ ‑ ‑ HTT, Part‑II ‑
Hobo and Takayama, 1997[7] ‑ ‑ ‑ ‑ HTS, Part‑I ‑
Hobo and Takayama, 1997[8] ‑ ‑ ‑ ‑ HTS, Part‑II ‑
Tipton, 2010[11] 1 26/female Worn out dentition Category number 1 PMS ‑
Kar et al., 2010[12] 1 25/male Amelogenesis imperfecta Category number 1 HTS ‑
Baid et al., 2012[13] 1 75/male Worn out dentition Category number 1 PMS ‑
Shetty et al., 2012[14] 1 55/male Worn out dentition Category number 3 HTS 1 week
Banerjee et al., 2012[15] 1 54/male Worn out dentition Category number 1 HTS ‑
Mete et al., 2012[16] 1 27/female Amelogenesis imperfecta Category number 1 PMS 3 months
Kalahasti et al., 2012[17] 1 65/male Worn out dentition Category number 1 HTS ‑
Ahmed et al., 2012[18] 1 42/male Worn out dentition Category number 1 PMS 2 months
Chauhan et al., 2012[19] 1 48/male Worn out dentition Category number 1 PMS 1 week
Agrawal et al., 2012[20] 1 26/male Enamel hypoplasia Category number 2 HTT ‑
Shetty et al., 2013[21] 1 18/female Amelogenesis imperfecta Category number 1 PMS ‑
1 44/male Worn out dentition Category number 1 HTT ‑
1 38/‑ Worn out dentition Category number 1 HTS ‑
Basnet et al., 2014[22] 1 19/male Amelogenesis imperfecta Category number 2 PMS ‑
Avinash et al., 2014[23] 1 55/male Worn out dentition Category number 1 HTS ‑
Verma et al., 2015[24] 1 58/male Worn out dentition Category number 1 HTS ‑
Mishra et al., 2016[25] 1 65/female Worn out dentition Category number 1 PMS ‑
Qahhar et al., 2016[26] 1 50/male Worn out dentition Category number 1 PMS 1 year
Mohindra et al., 2016[27] 1 30/female Worn out dentition Category number 1 HTS ‑
Vyshnavi et al., 2016[28] 1 55/male Worn out dentition and Category number 1 PMS ‑
partially edentulous
Choukse et al., 2017[29] 1 52/male Worn out dentition Category number 1 HTS ‑
Zinzala et al., 2017[30] 1 48/male Worn out dentition Category number 1 PMS 6 weeks
Devassy et al., 2017[31] 1 59/male Worn out dentition Category number 1 PMS ‑
Darraj and Matto., 2017[32] 1 35/female Worn out dentition Category number 2 PMS 1 year
Kaushik et al., 2018[33] 1 48/female Worn out dentition Category number 1 PMS 6 months
Thimmaiah, 2018[34] 1 21/male Enamel hypoplasia Category number 2 PMS 2 years
Nyman and Lindhe, 1977[35] ‑ ‑ ‑ Nyman and Lindhe philosophy ‑
Schluger et al., 1990[36] ‑ ‑ ‑ Youdelis philosophy ‑
‑: Unavailability of relevant data, PMS: Pankey Mann Schuyler, HTT: Hobo Twin Table, HTS: Hobo Twin Stage

or case series are available for Youdelis philosophy and design as they are the beginning of functional movements
Nyman and Lindhe philosophy except the proposal of that establish anterior guidance and envelope of motion.
the same techniques.
The philosophy uses PM instrument to establish a
Based on the reviewed data, we can infer that PMS functional occlusal plane on the mandibular teeth. It
philosophy was used for category number 1, Hobo twin uses group function occlusion scheme. The sequence of
table was applied for category number 2 and Hobo twin treatment advocated by PMS comprises four phases. The
stage can be applied to both category number 1 and 3 of first phase includes; examination, diagnosis, treatment
T&M classification. planning, and predicting prognosis. Then, anterior guidance
is established in the second phase. Later during the third
The PMS philosophy is a very flexible concept as suggested phase, mandibular posteriors are rehabilitated followed by
by many authors. As indicated by Schuyler, the condylar maxillary posterior in the fourth phase using a FGPT.[4]
guidance does not dictate the anterior guidance. Hence,
this theory believes in harmonization of anterior guidance The PMS philosophy was found to be a more efficient,
for best possible esthetics, function, and comfort and organized, and coherent procedure. Complications
the determination of an occlusal plane based on anterior associated with this philosophy are exceptionally less
guidance. According to Dawson, anterior teeth play a as it divides the rehabilitation into separate series of
dominant role in establishing the functional path that appointments where anterior guidance is first established
mandible can travel. Hence, the position and the contours of and thus esthetics of patient is maintained throughout the
lower anterior teeth should be the starting point of occlusal treatment. This provides a major psychological comfort
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Thimmappa, et al.: An appraisal on concepts of full mouth rehabilitation: A systematic review

to the patient. Furthermore, there is never a need for Hobo Twin Table technique is a methodical approach
preparing more than eight teeth at a time. Its main drawback in which first occlusal morphology of posterior teeth
is that it uses FGPT which utilizes wax and it can get is reproduced where the cusp angle coincident with the
distorted easily. Furthermore, FGPT technique cannot be standard value of effective cusp angle produced according
used in periodontally compromised cases. Furthermore, the to the condylar guidance recorded. And second, anterior
original PMS technique requires PM instrument. morphology is reproduced and anterior guidance provided
which produced a standard amount of disocclusion.
The review of the literature showed a maximum of cases is
treated using PMS philosophy. Hence, we can say that it is a The drawback of this concept is that it makes the patient
widely used theory for rehabilitation. Its relative indication more uncomfortable because too steep cuspal angle makes
is when anterior guidance is disturbed and has to be restored the incisal table to be set at a too steep angle. Furthermore,
first as in the case of T&M category number 1. In literature, it is a technique sensitive as anterior guide table was
15 cases[11,13,16,18,19,21,22,25,26,28,30‑34] out of 26 cases are treated by fabricated by resin molding.[7]
PMS philosophy from the year of its introduction in 1963
till 2018 which makes 57.69% of the cases. Twelve cases The case reports for this philosophy are very limited in the
fall under category number 1 and 3 cases under category literature. Two case reports,[20,21] out of 26 total cases have
number 2 of T&M classification. In none of the cases, the been documented in the literature in the year 2012 and 2013
PM instrument was used. The maximum number of case which makes 7.69% of all cases, and each case falls under
reports is seen on male patients with a broad age group the category number 1 and 2 of T&M classification. No
ranging from 18 to 75 years. This age gap can be due to short‑term or long‑term follow‑up is seen in the studies.
altered morphology seen in the younger age group and Moreover, no implant case reports have been documented.
pathologic wear seen in the elder age group. Studies have
shown satisfactory results at a short‑term follow‑up of Later after 6  years, the concepts changed and it was
1  week–6 months.[16,18,19,30,33] Furthermore, on long‑term believed that the condylar path is unchangeable and
follow‑up of 1 year–2 years, the comfort, function, and anterior guidance can be changed suggesting that both are
esthetics were highly satisfied.[26,32,34] No case report has independent factors. It was proposed that the incisal path
been reported for implant therapy using PMS philosophy. is not a reliable reference point, so Hobo and Takayama
stated that the cusp angle is used as the main determinant of
Another philosophy was given by Hobo and Takayama in occlusion because of its reliability. Moreover, it is possible
1991 which is named as Hobo Twin Table philosophy.[5,6] It to accurately control the amount of disocclusion on the
is based on the principle that anterior guidance influences restoration without measuring the condylar path. This led
the working condylar path and concluded that they were to the introduction of a new philosophy in 1997 named
dependent factors. They believed in posterior disocclusion as Hobo Twin stage.[7]
in eccentric movements, unlike the PMS philosophy where
group function is achieved on the working side. Posterior It reproduces the occlusal morphology of posterior
disocclusion is dependent on the angle of hinge rotation teeth without anterior segment and produces cusp angle
and cusp shape factor. Hence, the concept developed coincident with the standard values of effective cusp angle,
anterior guidance to create a predetermined harmonious referred to as “Condition 1.” Second, it reproduces the
disocclusion with the condylar path. anterior morphology with the anterior segment and provides
anterior guidance which produces a standard amount of
The technique[6] utilizes two different customized incisal disocclusion which is referred to as “Condition 2.”[8]
guide tables. The first incisal table is termed as an incisal
table without disocclusion. It is fabricated by preparing Since the standard cusp angles were used as the main
die systems with the removable anterior and posterior determinant of occlusion, the measurement of the
segments. This table helps us achieve uniform contacts condylar path was not necessary, and the tooth contact
in posterior restorations during eccentric movements. condition during eccentric movements was controlled
The other incisal table is made when the articulator can precisely by every selected occlusal scheme. The Twin‑Hoby
simulate border movements by placing 3 mm plastic Articulator  (3M Dental) was designed for this purpose.
separators behind the condylar element. This is termed However, there are certain limitations of this theory
as incisal guidance with disocclusion. Disocclusion of also as it cannot be used for malaligned occlusion. It is
0.5 mm was achieved on the working side and 1 mm on again commonly used for T&M category number 1 and
the nonworking side. occasionally number 3.
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In literature, 9 cases[12,14,15,17,21,23,24,27,29] among 26 are reported on randomized clinical trials of all the philosophies need
from the year 2012–2017 applying Hobo Twin Stage to be carried out.
philosophy, which makes 34.61% of total cases. Out of
this, 8 cases belong to category number 1 and 1 case to Limitations
category number 3 of T&M classification. A short period Limited reports are available in the literature for
of follow‑up of 1 week has been documented.[14] One case philosophies of full mouth rehabilitation. The maximum
of implant therapy has been reported in the year 2012 number of studies are not having report on follow‑up
where Hobo Twin Stage philosophy was used.[17] and outcome of treatment, neither the subjective nor
the objective analysis. [11,12,13,15,17,20‑25,27‑29,31] Few studies
According to Nyman and Lindhe Scheme[35] for extremely have reported very constrained follow‑up and outcomes
advanced periodontitis cases even contact should be based on the clinical and radiographic findings.[14,16,18,19,30,33]
provided in the intercuspal position, although no great Only 2 reports have documented 1 year[26,32] of follow‑up
emphasis is placed upon the type of contacts. When and 1  case report showed 2  years[34] of follow‑up. No
distal support is present, anterior disocclusion should be randomized clinical trials are available in the literature.
provided. When there are long tooth‑borne cantilevered
restorations, the aim is to achieve simultaneous working CONCLUSION
and nonworking side contacts on the cantilever as in
Full mouth rehabilitation of a mutilated dentition requires
balanced occlusion. All restorations should be fabricated
an accurate diagnosis and treatment planning. This
on semi‑adjustable articulators with average settings and
requires meticulous identification of the oral condition.
supragingival margin placement.
Most commonly applied classification in literature is
Following the literature review, it was found that occlusal T&M classification and maximum numbers of cases
schemes were also formulated for oral rehabilitation in were recognized under category number 1. Furthermore,
periodontal diseases. Schluger et al.[36] in 1971 proposed restoring the occlusion in every case is a challenging
an occlusal scheme for advanced periodontitis diseases. situation as every case is unique in itself. All the proposed
The aim was to achieve simultaneous interocclusal contact philosophies are not universally applicable. Most commonly
of posterior teeth in centric relation position with forces applied philosophy is PMS as it is well structured. Hobo
directed axially. Anterior disocclusion is provided for Twin stage philosophy is the second‑most common
protrusive excursions and canine disocclusion for lateral followed by Hobo Twin table. Maximum cases of T&M
excursions. Cuspal anatomy is so arranged that if the canine category number 1 were treated by PMS Philosophy. On
disocclusion is lost through wear or tooth movement, the follow‑up periods, PMS philosophy has shown successful
posterior teeth will drop into group function occlusion. For treatment outcomes.
this concept, semi adjustable or fully adjustable articulators
Financial support and sponsorship
are recommended.
Nil.
On the appraisal of all case reports, it demonstrated
Conflicts of interest
that out of 26 cases, 15 cases (57.69%) were treated by
There are no conflicts of interest.
PMS philosophy, 2  cases  (7.69%) by Hobo twin table
and 9  cases  (34.61%) by Hobo twin stage philosophy. REFERENCES
Twenty cases of occlusal wear were seen as because
of worn‑out dentition  (76.92%), 4  cases owing to 1. Rajendran R, Sivapathasundharam B. Shafer’s Textbook of Oral
Pathology. 7th ed. New Delhi, India: Elsevier; 2012.
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