Dental Case of the Month – Worn Dentition Restoration
Worn Dentition Restoration
The worn dentition presents many challenges for the restorative dentist. Some issues to address are the lack of space for the restorative materials and the loss of sound tooth structure.
Tooth wear typically occurs from teeth sliding against each other over time (attrition) and/or acid erosion. It is normal for teeth to wear, however, if the rate is excessive then intervention is necessary.
Patients who grind or clench their teeth are often unaware they are doing so. This is considered to be a neuro-muscular event. This may be stress or habit related and can cause sever damage to the teeth. Grinding can occur during the day or while sleeping.
Once a diagnosis of advanced tooth wear is made, typical therapy will include a bite guard.
In the above case, both attrition and erosion were present. My goal was to create adequate room for the restorative materials and to preserve as much natural tooth structure as possible. If I were to make crowns for these teeth, I would need to remove a lot of the remaining natural tooth structure potentially weakening the teeth or exposing the pulp (requiring root canal therapy).
Bonding Ceramic Restorations
My approach was to add to the deficient tooth structure by bonding ceramic restorations to most of the remaining teeth. This allowed me to “open the bite” creating the space to make all the worn teeth slightly “taller.” I was also able to use the good existing enamel as a substrate to bond the new ceramic restorations to. The strongest bond in dentistry is to enamel which is why I tried to preserve as much of it as possible.
The ceramic material chosen for the posterior teeth was lithium disilicate (Ivoclar e.max) and the material for the anterior teeth was feldspathic porcelain (Noritake). Both materials bond well to teeth. The lithium disilicate is about four times as strong as the feldspathic porcelain. However, the feldspathic porcelain has better esthetic properties. This allows me to achieve the greatest strength and esthetics for this patient.
Once the case was completed, occlusal guards were fabricated to protect the new restorations.
What’s nice about this treatment plan is that if something breaks or chips it will most likely be limited to a single restoration, which is easily repairable. My goal for this patient is for him to keep his natural teeth for as long as possible.