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.