Management of worn dentition II—localized severe wear
Restoration of extremely worn dentition requires careful assessment of etiology. In selecting the appropriate treatment for this condition, assessment of vertical dimension of occlusion, space required for restorative materials, and characteristics of restorative materials should be considered.
CASE STORY
A 67-year-old Caucasian female presents with a chief complaint o). “I am here because my lower front teeth are wearing away.” The patient presents with extremely worn dentition and is unhappy with the appearance of her teeth and her smile and with the color of her remaining teeth.
Figure 1: Preoperative left.
Figure 2: Preoperative right.
Figure 3: Preoperative frontal.
Figure 4: Preoperative maxilla.
Figure 5: Preoperative mandible.
LEARNING GOALS AND OBJECTIVES
- Manage treatment of patient with worn dentition.
- Assess vertical dimension of occlusion.
- Criteria for establishment of an occlusal scheme
- Establish parameters to predict long-term success of restorations.
Medical History
- The patient reported to be in good health with no signs or symptoms of any systemic disease.
Dental History
- Under the care of a general dentist for the past 10 years
- Routine dental visits throughout much of her life
- Third molar extractions at 23 years of age
- Multiple restorations
- Metal ceramic crown on maxillary right central incisor (8), 8 years ago
- Endodontic therapy on mandibular left second and first molars (18 and 19)
- Root resection of mandibular left first molar (19), 10 years ago
Significant Soft Tissue Examination Findings
- Hyperplastic maxillary labial frenum
- The temporomandibular joints examination was within normal limits.
Clinical Findings/Problem List
- Maxillary palatal torus
- Mandibular bilateral lingual tori
- Labial and buccal exostoses bilaterally in the maxilla
- Generalized wear facets with severe attrition on mandibular incisors
- Maxillary right central incisor (8) supraerupted, aesthetically unpleasing with existing metal ceramic crown
- Maxillary left central incisor (9) presented with abrasion on the incisal edge due to the repeated usage of toothpicks
- Multiple defective existing amalgam restorations
- Maxillary right first premolar (5) presented with a gold onlay
- Caries
- Fractured lingual wall of mandibular right first and second molars (30 and 31)
- Class I malocclusion by Angle’s classification was observed with 100% vertical overlap and 0% horizontal overlap
- 4-5 mm of loss of vertical dimension of occlusion
- Periodontal evaluation revealed generalized erythematous and edematous gingival tissues; bulbous free gingival margin; generalized pocket depths ranging 2-5 mm; and localized deep pocket depths ranging 7-9 mm around mandibular left molars (18 and 19); mobility was generally class I to class II except mandibular left second molar (18) that exhibited class III mobility.
Radiographic Findings
- The trabecular bone pattern was generally normal except in the area of the mandibular left molars (18 and 19)—periapical radiolucency and distal vertical radiolucency were evident, respectively. These teeth also showed widened periodontal ligament space
- There was generalized mild horizontal bone loss and localized severe horizontal and vertical bone loss around mandibular left molars (18 and 19).
- Maxillary left lateral incisor (10) showed apical root resorption.
- The crown-to-root ratio ranged from 1: 1 to 1: 1.5.
Diagnosis
- Generalized mild to moderate gingivitis
- Generalized mild chronic periodontitis
- Localized severe/>
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