Restoration of mutilated dentition is always a challenging task. Each case is unique by itself and involves meticulous planning of an appropriate occlusal scheme to reconstruct the debilitated dentition. There are many philosophies indicated for an occlusal rehabilitation. Pankey Mann Schuyler philosophy is a simple, organized technique in managing full mouth rehabilitation cases. This article describes modified Pankey Mann Schuyler philosophy by customising the anterior the guide table in accordance to the provisional restoration in a cardiac patient.