牙齿重度磨耗是一种以牙体硬组织进行性丧失为特征的慢性疾病，常导致咬合垂直距离降低、颌位关系紊乱和咀嚼功能下降，严重影响患者的口颌系统功能和生活质量。该疾病的咬合重建治疗面临颌位确定困难、修复空间受限和多学科协作等挑战。本文报道1例咬合紊乱伴重度磨耗且前牙开患者的序列治疗，总结讨论此类复杂病例的治疗经验。患者，男，56岁，因双侧后牙重度磨耗伴前牙开就诊，有20年夜磨牙病史，拒绝佩戴咬合板。根据磨耗程度和功能需求制定选择性修复策略，采用序列治疗方法进行咬合重建，治疗分为4个阶段：（1）急性症状控制与基础预防期，采用数字化引导的选择性调稳定咬合关系；（2）疾病控制期，完成牙周基础治疗和根管治疗；（3）功能美学重建期，完成种植修复及磨耗牙全瓷冠与贴面修复；（4）维护期，制作夜磨牙垫并定期随访。治疗后患者前牙开得到完全纠正，美观和功能均显著改善。12个月随访显示，患者咬合、关节和发音等口颌系统功能协调，修复体完好，口腔健康影响程度量表（OHIP-14）评分从41分降至12分，咀嚼效率（双色软糖混合能力测试）从1.89提升至2.68，患者对治疗效果满意。本病例为拒绝咬合板治疗的重度磨耗患者提供了一种可行的治疗思路。

Severe dental wear is a chronic disease characterized by progressive loss of hard dental tissues, often leading to reduced occlusal vertical dimension, disordered jaw relationships, and decreased masticatory function, seriously affecting patients' stomatognathic system function and quality of life. Occlusal reconstruction for this condition faces challenges including difficulty in determining jaw position, limited restorative space, and multidisciplinary coordination requirements. This article reports the sequential treatment of a patient with occlusal disorder accompanied by severe dental wear and anterior open bite, summarizing the treatment experience for such complex cases. A 56-year-old male patient presented with severe bilateral posterior tooth wear and anterior open bite, with a 20-year history of bruxism, and refused to wear an occlusal splint. A selective restoration strategy was formulated based on the degree of wear and functional requirements, using sequential treatment methods for occlusal reconstruction. The treatment was divided into 4 phases: (1) Acute symptom control and basic prevention phase, using digitally-guided selective occlusal adjustment to stabilize occlusal relationships; (2) Disease control phase, completing periodontal basic treatment and root canal treatment; (3) Functional and aesthetic reconstruction phase, completing implant restoration and all-ceramic crown and veneer restoration for worn teeth; (4) Maintenance phase, fabricating night guards and conducting regular follow-ups. After treatment, the patient's anterior open bite was completely corrected, with significant improvement in both aesthetics and function. At 12-month follow-up, the patient's stomatognathic system functions including occlusion, joints, and phonetics were well-coordinated. Prosthetic restorations remained intact. Oral Health Impact Profile-14 (OHIP-14) scores were improved from 41 to 12 points. Masticatory efficiency increased from 1.89 to 2.68. The patient was satisfied with the treatment outcomes. This case provides a feasible treatment approach for patients with severe wear who refuse splint therapy.