Rehabilitation of patients with compromised dentition poses a significant challenge in contemporary restorative dentistry.¹ Malaligned teeth, spacing discrepancies, unfavorable tooth positions and altered occlusal planes, not only compromise aesthetic but also negatively affect the oral function, masticatory efficiency and long term prosthetic prognosis.² Fixed prosthetic rehabilitation remains a widely accepted treatment modality for restoring function and aesthetics however its success is highly dependent on proper tooth positioning, occlusal harmony and space distribution.¹

In many clinical scenarios attempting to compensate for malposition teeth solely through prosthetic means may lead to over contoured restorations, aggressive tooth preparation, compromised aesthetics and biomechanical failure. Sequential tooth movement before final prosthodontic reconstruction provides a conservative treatment option that allows optimum prosthetic design. 3 This stepwise protocol enables incremental correction of errors in truth alignment and space, gradually enhancing the relationship on which fixed prosthesis are built.⁴

Functionality-wise, the proper chewing function, the evenness of force distribution and solid occlusal contacts are all determined by a correct alignment; this cannot be achieved unless they are correctly aligned.¹ Improperly positioned teeth can cause occlusal interferences, temporomandibular pain and increased wear of restorations. Aesthetically, tooth alignment, axial inclination and symmetry are critical determinants of smile harmony and patient satisfaction.² The sequential tooth positioning enables clinicians to address these parameters systemically before final restoration.⁵ Despite its theoretical advantages, limited clinical literature has systemically evaluated the combined function and aesthetic outcomes of sequential tooth positioning followed by fixed prosthetic rehabilitation.⁶ Most available evidence focuses either on orthodontic alignment or prosthetic outcomes in isolation.⁷

Therefore, this study aimed to clinically evaluate the impact of sequential tooth positioning prior to fixed prosthetic rehabilitation on functional efficiency and aesthetic outcomes in patients requiring comprehensive oral rehabilitation.

This clinical evaluation was conducted at the prosthodontic department of the institution, after clearance from the institutional review board protocol (#1243/B-KMC dated 3rd Feb 2025). A total of 50 patients were included based on predefined inclusion and exclusion criteria. Patients presenting with maligned teeth, spacing issues, altered tooth position or occlusal discrepancies required fixed prosthetic treatment were included after obtaining the written consent. A complete clinical examination, diagnostic cast and radiographic assessment were carried out for all patients prior to the treatment planning. Sequential tooth positioning was carried out prior to definitive prosthetic rehabilitation following a phased and conservative approach. Tooth movement and positional correction were performed to achieve favorable alignment, axial inclination and appropriate distribution of prosthetic space. Using the established prosthodontics principles and treatment protocols, the definitive fixed prosthetic reputation was finalized after the stabilization period of the teeth’s position. The occlusal stability, masticatory efficiency, and patient comfort during mastication were all examined before and after treatment. The clinical occlusal stability in terms of contacts in the centric position, absence of premature contacts, and harmonious occlusion was examined. The patient’s input was clearly defined in the assessment of the mastication comfort and efficiency. The patient’s satisfaction with the tooth’s alignment, smile, and aesthetic results was used to assess the outcome of the treatment. All results were recorded and presented in terms of number and percentage. The significance threshold is set at p < 0.05. All analyses were done using SPSS version 28.

A total of 50 patients completed the treatment protocol and were included in the final analysis. Table 1 highlights the improvement in functional outcomes following sequential tooth positioning and fixed prosthetic rehabilitation. Improved occlusal stability was observed in 42 patients (84%), enhanced masticatory efficiency in 40 (80%) patients, while improved functional comfort during mastication in 43 (86%) patients.

Table 1: Functional Outcomes Following Treatment (n = 50)

The aesthetic outcomes observed after treatment improved in tooth alignment and smiled harmony was noted in 44 (88%) patients, while overall aesthetic satisfaction was reported by 45 (90%) patients (Table 2).

Table 2: Aesthetic Outcomes following Treatment (n = 50)

Five patients (10%) reported experiencing temporary pain throughout the therapy phase, as shown in Table 3, but no significant biological or mechanical problems were found.

Table 3: Complications Reported During Treatment (n = 50)

The present clinical evaluation demonstrates that sequential tooth positioning period to fix prosthetic rehabilitation significantly improves both functional and aesthetic outcomes. A high percentage of patients exhibited improved occlusal stability and masticatory efficiency, emphasizing the clinical importance of establishing favorable tooth position before definitive restoration.

Prior research in the prosthodontic literature has repeatedly emphasized the difficulties in correcting malpositioned teeth using only prosthetics.^8–11 When tooth position is not sufficiently adjusted before rehabilitation, overly contoured restorations, excessive tooth reduction, and poor aesthetics are frequent outcomes. Authors such as Aini et al, (2025)¹² and Testori et al, (2018)¹³ occasion have emphasized that stable or closer relationships are fundamental to long term restorative success. The findings of the present study align with this principle as improved occlusal stability were observed in 42 (84%) of patients following treatment.

Masticatory efficiency is closely related to occlusal harmony and proper distribution of occlusal forces. Studies by Cristache et al, (2024)¹⁴ and Piscopo et al, (2022)¹⁵ have demonstrated that Malaligned teeth and unstable occlusion can significantly impair achieving efficiency and patient comfort. Following sequential tooth insertion and fixed therapy, 40 (80%) of the patients in the current study reported improved masticatory efficiency, demonstrating a high correlation between improved functional performance and corrected tooth position.

One of the most important outcomes of this present investigation was an improvement in aesthetics. The smile is an important factor that is greatly influenced by tooth position, axial inclination, and symmetry. The importance of tooth position has been emphasized by previous studies by Funato et al (2007)¹⁶ that have shown that tooth position is a prerequisite to natural and harmonious aesthetic outcomes in fixed prosthodontics. The high aesthetic satisfaction of 45 (90%) patients is an evidence of the importance of a stage treatment approach.

In addition, sequential teeth placement makes possible a more conservative preparation of teeth. The need to severely overreduce teeth to allow for malposition is eliminated if teeth are properly aligned before restoration. This is in agreement with the philosophy of MID, which supports the preservation of natural anatomy, periodontal health, and restoration survival longevity. These benefits are in agreement with those of clinical studies ^1,3,17,18 on the interdisciplinary approach of orthodontics-prosthesis. The clinical practicability of sequential teeth placement is also supported by the small number of problems encountered in the present investigation. A small percentage of patients experienced transient pain, which was self-limiting and did not influence the outcome of treatment. Results of clinical investigations have also indicated similar findings, with patients adapting well to the stage therapy program.

LIMITATION

Despite the positive findings, the following restrictions should be highlighted: the study did not have a control group receiving only prosthetic rehabilitation, and the study used subjective measurements. In order to reinforce the positive aspects of this treatment approach, future studies should focus on randomized studies with a larger number of samples and objective measurements.

Prior to the rehabilitation of the fixed prosthesis, the placement of the teeth in a consecutive manner is extremely advantageous for the functional and aesthetic outcomes. It is highly recommended for the management of complicated restorative problems that the placement of the teeth in a consecutive manner be included in the treatment planning.

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