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Prosthetic-restorative approach for the restoration of tooth wear. Case report
This article presents a case report of combined prosthetic-adhesive rehabilitation in a patient with a generalized tooth wear.
A combined treatment adhesive - prosthetic was proposed to a male patient of 65 years old having a clinically significant tooth wear, with denti...
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... Since these situations get more challenging, issues connected to the patient's OVD re-establishment must be studied because its recovery is critical for creating prosthetic works 11 , despite the fact that it is not taken into account in the majority of instances. Physiologically, all teeth wear as a result of functional activity; however, this process can be accelerated and intensified when posterior elements are lost, causing overloading of the remaining anterior teeth and increasing the potential for wear 10 , occlusal disorders, and parafunctional habits such as bruxism [17][18][19] . Bruxism is defined as the parafunctional grinding of teeth, or an oral habit characterized by involuntary rhythmic or spasmodic nonfunctional gnashing, grinding, or clenching of teeth, other than chewing motions of the mandible, which may result in occlusal injuries. ...
... Furthermore, bruxism occurs in eccentric postures, which results in the application of high 43 | P a g e Website: https://www.banglajol.info/index.php/UpDCJ stresses to a few teeth rather than many, as occurs in functional activity when the jaw is at or near the centric occlusion position 19 . Tooth sensitivity, excessive reduction of clinical crown height, and probable alterations in OVD owing to the degree of dental wear are all connected with tooth tissue loss caused by this parafunction [21][22][23] . ...
Tooth wear is caused by a variety of reasons, many of which are unknown. Tooth wear management is difficult and complex. For effective treatment, accurate measurement of occlusal vertical dimension (OVD), interocclusal rest space, and centric relation records are required. The analysis of facial soft tissue contours is very crucial. A clinician must remember two things before treating a case with full mouth rehabilitation; severe wear does not always cause loss of OVD and it also does not eliminate all defective occlusal interferences.
A systematic method may be beneficial in achieving a predictable and desirable result. This paper describes the step-by-step treatment of a 63-year-old patient who had lost occlusal vertical dimension due to parafunctional habits. Making occlusal overlay bilateral splints in acrylic resin and provisional restorations in mandibular teeth for the healing of the intermaxillary distance was the first strategy for oral rehabilitation. The ultimate rehabilitative therapy evolved into direct composite resin restorations associated with all-ceramic crowns fortified by lithium disilicate after the patient's adaption and muscle stability to the new occlusal situation. We established that all teeth had solid connections with similar intensity in centric relation, as well as anterior guiding in line with functional jaw movement.
... Erosion can be defined as the loss of tooth structure due to a chemical process of multifactorial origin that does not involve bacterial action. 1,2,3,4,5 Awake and sleep bruxism, unbalanced dietary habits (with high intake of acidic foods and beverages, such as carbonated beverages, fruit, fruit juices, vinegar), and abnormal production of intrinsic acid in disorders, such as bulimia nervosa, acid regurgitation, and hiatal hernia are all causal factors of dental wear. Insufficient salivary flow rate, the buffering capacity and composition of saliva, use of medications, and aging are other etiological cofactors. ...
... 5,11 Proper treatment improves oral hygiene, reduces thermal sensitivity and susceptibility to carious lesions, prevents pulp involvement, prevents additional wear, and restores esthetics and function, thus improving quality of life. 2 The treatment plan consists of a clinical, functional, and esthetic evaluation to establish an etiology-based treatment strategy. This is followed by the preventive and restorative phases, ending with an adequate maintenance program. 2 The three-step technique for fullmouth rehabilitation, using ceramic restorations and adhesive cementation, was developed to simplify the dentist's task, as the diagnostic wax-up is performed progressively through interactions between the patient, dentist, and technician. ...
... This is followed by the preventive and restorative phases, ending with an adequate maintenance program. 2 The three-step technique for fullmouth rehabilitation, using ceramic restorations and adhesive cementation, was developed to simplify the dentist's task, as the diagnostic wax-up is performed progressively through interactions between the patient, dentist, and technician. This minimally invasive technique takes into account three essential parameters: VDO, position of the incisal edge, and position of the occlusal plane. ...
In the severely eroded dentition, full-mouth adhesive rehabilitation is particularly challenging because of the large number of affected teeth, loss of VDO, esthetics, and anatomy. This article presents a case report of prosthetic rehabilitation in a patient with generalized dental wear. A 32-year-old male patient presented with clinically significant dental wear affecting all teeth, with dentin exposure and short clinical crowns. A treatment approach with all-ceramic crowns and veneers was proposed. All-ceramic indirect restorations proved durable, aesthetic, and protected the tooth structure, restoring the vertical dimension of occlusion to a very satisfactory degree. Indirect restorations based on the new vertical dimension of occlusion (VDO) can restore anatomy and function.
... Esse material apresenta diversas vantagens como estética favorável, facilidade da técnica, preparo conservador e baixo custo 27 . As combinações de restaurações diretas com as próteses provisórias, baseadas na nova DVO, ajudam a restabelecer a anatomia e a função 28 . ...
A perda acentuada da estrutura dental pode causar diminuição da dimensão vertical de oclusão (DVO). Diversos procedimentos são indicados para o restabelecimento da DVO, e durante a conduta inicial, a prótese parcial provisória tipo overlay pode ser utilizada. Objetivo: relatar o restabelecimento da DVO diminuída por meio da prótese tipo overlay no arco superior, prótese parcial removível provisória e restaurações em resina composta no arco inferior. Caso clínico: paciente, gênero masculino, 54 anos, apresentou-se na Clínica de Reabilitação Oral da Faculdade de Odontologia Morgana Potrich (Mineiros – GO, Brasil), queixando-se da deficiência estética e funcional que acometia os elementos dentais. No exame extra-oral observou-se sulcos nasolabiais profundos, depressão da comissura labial e a mandíbula projetada anteriormente. Durante o exame intra-oral notou-se mordida topo a topo e desgaste acentuado nos elementos dentários superiores e inferiores além de regiões com ausências dentárias. Desta forma, foi proposto a reabilitação inicial por meio da overlay no arco superior, prótese parcial removível provisória e restaurações diretas no arco inferior. A moldagem funcional e obtenção dos modelos foram realizados. Para mensurar a DVO e montar os modelos em articulador semi-ajustável, as técnicas métrica e fonética foram associadas. Após acrilização, as próteses foram instaladas e posteriormente os dentes anteriores inferiores restaurados. Conclusões: o uso da prótese tipo overlay, auxilia no restabelecimento inicial da DVO. Além disso, a associação desse procedimento juntamente com restaurações diretas e prótese parcial removível provisória restabeleceu estética, função e conforto.
... Vakalar daha karmaşık hale geldikçe, çoğu durumda göz önünde bulundurulmamasına rağmen, daimi protez çalışma ve planlamaları yapmadan önce hastanın ODB'nin yeniden oluşturulmasına ilişkin tedaviler dikkate alınmalıdır. Vakaların çoğunda fizyolojik olarak tüm dişler fonksiyonel aktivite nedeniyle aşınmaya maruz kalır, ancak, oklüzal bozukluklar ve bruksizm gibi parafonksiyonel alışkanlıkları arttıran posterior dişlerin erken kaybı olduğunda kalan ön dişlerin aşırı yüklenmesi bu dişerin aşınma potansiyelini 8 , hızlandırılabilir ve yoğunlaştırılabilir. [9][10][11] Bu parafonksiyonel alışkanlar diş dokusu kaybı ve dişin oklüzal yüzeyinin aşırı aşınmasına neden olabilir, sonuç olarak diş hassasiyeti ve ODB 'deki olası değişiklikler görülmektedir. 12 Aşınma, hastanın yaşı için aşırı olduğu zaman, fonksiyonel ve / veya estetik nedenlerle tedavi gerektiren patolojik bir durum olarak kabul edilir. ...
Özet: Diş aşınmaları yaşlı hastalarda en sık karşılaşılan durumlardan biridir. Dikey boyut kaybı nedeniyle hem fonksiyonel hem de estetik problemleri neden olmaktadır. Normal dikey boyutu yeniden kazanabilmek için birkaç tedavi seçenekleri vardır. Sunulan vakada 51 yaşındaki erkek hastada yaygın diş aşınmaları ve çiğneme fonksiyonunda sorunlar mevcuttu. Dikey boyutun geri kazanılması amacıyla premolar dişlerin restorasyonu ile dikey boyut düzenlenmiş ve posterior dişler için implant destekli sabit protez yapılması planlanmıştır. Hastanın estetiğini düzeltmek, fonksiyona katkı sağlamak ve dikey boyutunun alışmasını kolaylaştırmak için üst alt anterior dişlere kompozit veneer restorasyonlar yapılmıştır. Bu restorasyonlar rehabilitasyonun ilk aşamasını oluşturacak ve hastanın planlanan tedavi sürecine alışmasını ve konforunu artıracaktır.Anahtar kelimeler: Diş Aşınmaları, Dikey Boyut Kaybı, Dental Kompozit. Abstract: Teeth wear is one of the most common conditions seen in elderly patients. Loss of normal occlusal vertical dimension can severely affect both function and esthetic. There are many approaches to regain the normal occlusal vertical dimension. In the presented case a 51 years old male patient had severe tooth wear in the maxillary and mandibular anterior teeth with loss of interocclusal space due to early loss of his posterior teeth. In order to regain the vertical dimension, premolar teeth were restored with composite restoration and the vertical dimension corrected for some extent, implant-supported fixed prosthesis was planned for the posterior area. For the anterior teeth, composite veneer restorations were made to upper and lower teeth in order to provide esthetic, function and to facilitate the patient’s adaptation of the increased vertical dimension. These restorations will create the first stage of rehabilitation and will increase the adaptation and comfort of the patient in the planned treatment process. Keywords: Tooth wear, Vertical Dimension Lose, Dental Composite.
... Physiologically all teeth suffer wear due to functional activity, however, this process can be accelerated and intensified when there is loss of posterior elements causing overloading of the remaining anterior teeth and increasing the potential to wear, 7 occlusal disorders and parafunctional habits such as bruxism. [16][17][18] According to glossary of prosthodontic terms, bruxism is the parafunctional grinding of teeth, or an oral habit consisting of involuntary rhythmic or spasmodic nonfunctional gnashing, grinding, or clenching of teeth, in other than chewing movements of the mandible, which may lead to occlusal trauma. There is no single cause that is responsible for bruxism, but some etiologic factors include: morphological factors such as dental occlusion, psychosocial factors such as stress and certain personality characteristics, patho-physiological factors (i.e., diseases, trauma, genetics, smoking, alcohol, caffeine intake, illicit drugs and medications) and sleep disorders (sleep apnea and snoring). ...
One of the most important strategies of the restorative treatment is the valuation and re-establishment of occlusal vertical dimension (OVD). This phase must not be neglected, because the decrease or increase of OVD causes damage to teeth, muscles, joint and difficult the patient’s swallowing and phonation. This paper presents the treatment of a patient with loss of occlusal vertical dimension with dental wear caused by parafunctional habits. The planning for oral rehabilitation was initially making occlusal overlay bilateral splints in acrylic resin for the recovery of the intermaxillary distance and after the patient’s adaptation and muscular stability to the new occlusal condition, the definitive rehabilitative treatment evolved into direct restorations in composite resin associated with all- ceramic crowns reinforced by lithium disilicate.
... As these cases become more complex, aspects related to patient's OVD re-establishing must be observed because its recovery is of great importance for making prosthetic works [8], although it's not taken into consideration in most of the cases. Physiologically all teeth suffer wear due to functional activity, however, this process can be accelerated and intensified when there is loss of posterior elements causing overloading of the remaining anterior teeth and increasing the potential to wear [7], occlusal disorders and parafunctional habits such as bruxism [16][17][18]. According to glossary of prosthodontic terms, bruxism is the parafunctional grinding of teeth, or an oral habit consisting of involuntary rhythmic or spasmodic nonfunctional gnashing, grinding, or clenching of teeth, in other than chewing movements of the mandible, which may lead to occlusal trauma. ...
One of the most important strategies of the restorative treatment is the valuation and re-establishment of occlusal vertical dimension (OVD). This phase must not be neglected, because the decrease or increase of OVD causes damage to teeth, muscles, joint and difficult the patient’s swallowing and phonation. This paper presents the treatment of a patient with loss of occlusal vertical dimension with dental wear caused by parafunctional habits. The planning for oral rehabilitation was initially making occlusal overlay bilateral splints in acrylic resin for the recovery of the intermaxillary distance and after the patient’s adaptation and muscular stability to the new occlusal condition, the definitive rehabilitative treatment evolved into direct restorations in composite resin associated with all- ceramic crowns reinforced by lithium disilicate.
... At the same time, anterior teeth were intruded in order to create space for the restorative material. Once the vertical dimension has been increased, a favourable incisal guide which complies with the aesthetic and phonetic demands must be restored (9). In recent years, there has been an increasing trend towards the restoration of severely worn dentitions using more conservative approaches with adhesive restorative materials (2-6). ...
Tooth wear is defined as the progressive loss of a tooth’s surface due to actions other than those which cause tooth decay or dental trauma. It is a pathological condition with an increasing prevalence among young people. The aim of this article is to describe an alternative treatment modality to rehabilitate the anterior guidance by a minimally invasive interdisciplinary ortho-restorative treatment. Two patients came to the dental clinic for restorative treatment in order to rehabilitate the worn anterior dentition. Clinical analysis showed tooth surface loss located at the incisal edges by attrition due to an inadequate anterior guidance. In both cases the occlusal vertical dimension was reduced. First, following Dahl’s principle, resin attachments were placed in the upper canines. These attachments allowed the extrusion of posterior teeth in order to increase the occlusal vertical dimension. Furthermore, anterior teeth were intruded in order to create space for the restorative material. In the second phase, the restorative treatment was completed. Due to the characteristics of the case, feldspathic ceramic veneers were indicated. A diagnostic wax-up was performed to assist the treatment planning and a mock-up was prepared. Then, maxillary incisors were prepared through the mock-up to ensure a minimally invasive technique. Afterwards, silicone impressions were taken. Finally, veneers were cemented with a light-cured cement. In the present case, the functional and aesthetic parameters required by the patients were achieved, thus satisfying their needs.
Key words:Tooth wear, anterior guidance, feldspathic veneers, Dahl’s principle, minimally invasive.
... The idea of increasing vertical bite for tooth wear restoration was described and popularized by Dhal (4,6). There is still considerable debate in the literature about treatment modalities used to increase VDO (10,11). An increase in VDO should be determined on the basis of a need to accomplish satisfactory and aesthetically pleasing restorations. ...
The aim of this study is to report a case of restorative treatment of severely worn dentition. In this case report, the erosive/abrasive worn dentition have been reconstructed with metal ceramic crown on the posterior teeth and with ceramic veneers on the anterior teeth 1.3 - 2.3 and 3.4 - 4.3.
A prosthetic treatment was proposed to a male patient of 58 years old having a clinically significant tooth wear. After clinical exam, impressions of maxillary and mandible arches were taken with alginate to obtain preliminary casts for diagnostic waxing to all maxillary and mandibular teeth and fabrication of all provisional crowns in acrylic resin for posterior teeth, and from the diagnostic wax-up were fabricated a silicone guide masks for anterior teeth. An increase in VDO should be determined on the basis of a need to accomplish satisfactory and aesthetically pleasing restorations; it was proposed to increase the incisal lenght of the maxillary anterior incisors, together with alteration of the VDO 3 mm anteriorly. The posterior teeth 1.6 - 1.5 - 1.4 - 2.4 - 2.6 - 3.5 - 3.6 - 3.7 - 4.4 - 4.7, where the amount of tissue lost was greater, were recontructed with metal ceramic crowns. Two implants (Nobel replace 4.3x10) was placed. The implant were located in the area 4.5 - 4.6. The anterior teeth were restored with veneers.
The prosthetic challenge with restoring severely worn dentitions is to preserve as much of the already diminished tooth structure as possible for retention while also providing enough interocclusal space for the restorative material.
Prosthetic rehabilitation of severely worn teeth with loss of vertical dimension is difficult due to limited space and the need for
complex treatments. To improve aesthetics, maintain anterior tooth relationships, and provide space for the prosthesis, effective
treatment alternatives are needed to increase the Occlusal Vertical Dimension (OVD). This will reduce the need for invasive
procedures and endodontic treatments. For optimum treatment, accurate measurements of the OVD, interocclusal resting area,
and central relationship recordings are needed. The contours of the facial soft tissues should be examined. Before beginning the
full mouth rehabilitation, it should be kept in mind that severe abrasion does not always result in the loss of vertical dimension, and
it does not necessarily eliminate all defective occlusal interactions. In preventive and restorative dentistry, managing tooth wear
and attrition is a fascinating subject. One of the treatment alternatives after a confirmed diagnosis is full mouth reconstruction
along with identifying the sources. It is complex and difficult to manage dental attrition. A clinical evaluation of the patient following
the cementation of temporary fixed restorations or the use of a diagnostic splint or temporary removable prosthesis can assist in
determining the OVD. It is recommended to utilise fixed restorations rather than a removable appliance to increase OVD since
patient adaptation is predictable. In the present case, the vertical dimension was restored with an improvement in both function
and aesthetics, providing a satisfactory clinical outcome
La pérdida de una pieza dentaria en el sector anterior supone para la mayoría de nuestros pacientes no sólo un problema funcional sino un problema psicosocial, lo que es debido a la importancia estética y fonética que caracteriza estas pie-zas. En este artículo se describe la reposición de una pieza anterior con quiste y gran defecto óseo por un implante, des-tacando la importancia de combinar diferentes técnicas para conseguir resultados más satisfactorios a corto y largo plazo. Palabras clave: Multidisciplinar, interdisciplinar, estética dental , injerto tejido conectivo. Abstract The loss of a tooth in the aesthetic area results, for most of our patients, in not only a functional but also a psychoso-cial problem which is due to the importance of these teeth in aesthetics and phonetics. In this article the reposition of an incisor with a cyst and great osseous deffect by an implant is described, highlighting the importance of combining different techniques to reach better results in the long and short term.
