Assessing Treatment Options Based on Expected Long-Term Results: Case Report Demonstrates 6-Year Outcomes

A patient whose chief concern was the esthetics of her anterior teeth presented for a second opinion after it had been recommended that crowns be placed throughout her mouth. Examination revealed numerous defective and some fractured restorations with recurring caries. With treatment goals including creating and maintaining a healthy periodontal environment, leveling the occlusal plane, and decreasing biomechanical risk, the treatment plan incorporated an interdisciplinary approach that utilized orthodontics, a Kois deprogrammer, and implant therapy. Demonstrating 6-year outcomes, this report discusses use of a method to assess treatment options based on expected long-term results.

Achieving esthetic success while avoiding extensive tooth reduction

This case report demonstrates the importance of both careful diagnosis and thorough patient education when planning treatment for a worn and actively chipping dentition. At presentation, the patient had assumed that porcelain crowns would be needed to restore her teeth. Historically, her wear had been attributed to nocturnal bruxism. However, after a diagnostic work-up, her attrition was determined to be the result of an aberrant tooth position, which resulted in a constricted envelope of function. This diagnosis provided the opportunity to orthodontically reposition the teeth, and then achieve normal function and esthetic success with either indirect porcelain adhesively retained or additive direct resin restorations instead of more invasive, cohesively retained porcelain crowns. During orthodontic treatment, the teeth were restored with direct resin. No further restorative treatment was needed. This case has been successful for more than 6 years post-treatment, without the use of a protective appliance.