Restoring esthetics and anterior guidance in worn anterior teeth. A conservative multidisciplinary approach

Oral Rehabilitation of a Worn Out Dentition

Noncarious loss of the tooth surface continues throughout the life of a person. One of the most common causes of the noncarious tooth surface loss is tooth wear which is a common condition found in the elderly. A case is presented here which demonstrates the provision of full mouth rehabilitation to a patient with severe worn out dentition and highlights the complexity associated with the treatment of generalized worn out dentition.

How to cite this article

Farooq I, Siddiqui TM. Oral Rehabilitation of a Worn Out Dentition: A Case Report. World J Dent 2012;3(3):265-268.

Comparison between incisal embrasures of natural and prosthetically restored maxillary anterior teeth

STATEMENT OF PROBLEM

The loss of one or more of the incisal embrasures may pose a problem in restoring missing tooth structure. Despite its acknowledged importance in dental esthetics, few researchers have investigated the esthetic impact of incisal embrasures.

PURPOSE

The purpose of this study was to compare parameters of the incisal embrasures of natural maxillary anterior teeth (ND) with those of prosthetically restored maxillary anterior teeth (PRD) and to compare the resemblance of the prosthetic restoration to natural form.

MATERIAL AND METHODS

Twenty gypsum casts of the maxillary anterior teeth (MAT) of patients made at the completion of their orthodontic treatment comprised the control group. The experimental group consisted of 20 gypsum casts of prosthetically restored maxillary anterior segments. Five incisal embrasures of each cast were digitally photographed under uniform, standardized conditions: the incisal embrasures between the canine and lateral incisor on each side, between the lateral and central incisors on each side, and between the 2 central incisors. The photographs were measured by image analyzing software (Bioquant Nova Prime). The parameters compared were: (1) the areas of the incisal embrasures in the natural and prosthetic casts (measured in mm(2)); (2) the areas of homological incisal embrasures in each of the groups; and (3) the degree of lateral symmetry of the natural casts as compared to the prosthetic casts. The results were subjected to 2-way ANOVA and Student t tests (alpha =.05).

RESULTS

The total area of incisal embrasures of the PRD casts was smaller than the total area of those of the natural dentition casts (P=.005). The incisal embrasures of the PRD casts were smaller than the homological embrasures of the natural dentition casts (P<.01). Both groups demonstrated a lack of lateral symmetry (P<.001). The natural dentition casts demonstrated a greater asymmetry than the restored dentition casts (canine/lateral P<.045 and lateral/central P<.035). There was no significant difference in the sizes of the central incisal embrasures of the 2 groups. The corresponding incisal embrasure areas (ND versus PRD) were significantly different, except for the 2 central embrasures.

CONCLUSIONS

Prosthetically restored dentition casts differed from natural dentition casts in 2 parameters: the area of the incisal embrasures and the degree of lateral symmetry.

A conservative approach for treating young adult patients with porcelain laminate veneers

Controversy persists regarding the treatment planning criteria for young adult patients in need of esthetic restorations. The trend of conservative treatment modalities continues to become widely acknowledged. One of the conservative treatment modalities is porcelain laminate veneers (PLVs). PLVs not only provide suitable esthetics but also reliable functional strength. This article presents two anterior esthetic cases to demonstrate a conservative treatment planning approach and its application as a nontraditional solution for young adult patients. It is recommended that a conservative approach be used wherever possible as an alternative to treatment options that may aggressively sacrifice tooth structure as well as the health of the supporting tissues.

CLINICAL SIGNIFICANCE

By using a conservative approach to treatment with porcelain veneers, long-lasting, esthetic, and functional results may be achieved. Sacrificing as little tooth structure as possible and conserving the supporting tissues will facilitate prospective treatments for young adult patients.

Attrition, occlusion, (dys)function, and intervention: a systematic review

OBJECTIVES

Attrition and occlusal factors and masticatory function or dysfunction are thought to be related. This study aims to systematically review the literature on this topic with the emphasis to find evidence for occlusion-based treatment protocols for attrition.

MATERIALS AND METHODS

Literature was searched using PubMed (1980 to 2/2006) and the Cochrane Library of Clinical Trials with the keywords 'tooth' and 'wear'. Five steps were followed. Exclusion was based on the following: (1) reviews, case-reports, studies on non-human tooth material, and studies not published in English and (2) historical or forensic studies. Included were (3) in vivo studies. Next, studies on (4) occlusal factors, function or dysfunction [temporomandibular disorders (TMD), bruxism], or intervention, and (5) attrition were included. Two investigators independently assessed the abstracts; measure of agreement was calculated using Cohen's kappa; disagreement was resolved by discussion. Full-text articles were obtained and correlation between outcomes on occlusal factors, (dys)function, treatment, and attrition were retrieved. References in the papers included in the final analysis were cross-matched with the original list of references to add references that met the inclusion criteria.

RESULTS

The search procedure revealed 1289 references on tooth wear. The numbers of included studies after each step were (1) 345 (kappa=0.8), (2) 287 (kappa=0.87), (3) 174 (kappa=0.99), (4) 81 (kappa=0.71), and (5) 27 (kappa=0.68). Hand searches through the reference lists revealed six additional papers to be included. Analysis of the 33 included papers failed to find sound evidence for recommending a certain occlusion-based treatment protocol above another in the management of attrition.

CONCLUSION

Some studies reported correlations between attrition and anterior spatial relationships. No studies were found suggesting that absent posterior support necessarily leads to increased attrition, though one study found that fewer number of teeth resulted in higher tooth wear index (on the remaining teeth). Attrition seems to be co-existent with self-reported bruxism. Reports on attrition and TMD signs and symptoms provide little understanding of the relationship between the two.

Direct restoration of worn maxillary anterior teeth with a combination of composite resin materials: a case report

Tooth loss, alterations on tooth structure, and reduced vertical dimension are known to severely compromise the stomatognathic system. This case report describes the treatment of a patient who presented with an extremely worn maxillary anterior dentition with a loss of posterior support owing to the loss of almost all the posterior teeth, except the mandibular premolars. Provisional removable partial dentures were used to create an optimum maxillomandibular relationship and to provide restorative space prior to the restoration of the remaining teeth. This restoration was accomplished with a combination of layered hybrid and microfilled composite materials, which restored the maxillary anterior teeth to optimum esthetics and function.