Objective To analyse and summarize the clinical experience of occlusion reconstruction for the middle and old aged patients with severe worn dentition. Methods The diagnosis and treatment process of 23 patients with dentition defect and severe tooth wear was retrospectively analysed. Among the 23 patients, 15 were males, 8 were females, and the mean age was (57.6±12.6) years (41 to 80 years). The types of dentition defect included Kennedy Ⅰ (n=8), Kennedy Ⅱ (n=6), Kennedy Ⅲ (n=5) and Kennedy Ⅳ (n=4). All patients required occlusion reconstruction. Results After temporary treatment by splints of removable denture for 3 to 6 months, the dentitions were reconstructed with removable partial denture or fixed denture. Seven patients underwent occlusion reconstruction with fixed denture, 10 with splints of removable denture, and the other 6 with splints of removable denture and fixed denture. Patients were followed up for 3 to 5 years, occlusion adjustment was performed, and all patients were satisfied with the outcomes. Conclusion The treatment process of occlusion reconstruction for worn dentition in middle and old aged patients is long, while the short and mid-term effects are definite. Occlusion reconstruction and occlusion adjustment during regular follow up are the key factors to the successful treatment.