Overview: Sequential surgical & restorative procedures re-established functional occlusal stability and improved aesthetics. This case underscores the importance of an integrated and personalised treatment plan in managing advanced pathological tooth wear.
Patient Profile
- Age: 48
- Gender: Female
- Main Complaint: Teeth getting shorter, concern about the longevity of teeth.
- Clinical Presentation
Clinical presentation
The patient presented with significant wear and fore-shortening of teeth.
- Evidence of bruxism, leading to:
- Fracture of multiple posterior teeth.
- Tooth wear and erosion of anterior teeth.
- Disharmonised bite due to fractured posterior teeth and misalignment.
Diagnosis
Primary diagnosis: Pathological tooth wear secondary to bruxism and erosion.
Treatment outcome: Functional and Aesthetic improvement
Treatment Plan
- Initial Consultation and Diagnosis
The patient was informed of :
- Extent of tooth damage caused by parafunctional grinding
- Necessary steps to restore dental health. The treatment plan comprised several phases:
2. Surgical Intervention
Based on the smile design, minor crown lengthening surgery on the upper anterior teeth was performed. This was crucial in achieving a balanced and aesthetically pleasing smile.
3. Restorative Procedures
Placement of multiple fillings and crowns to reconstruct the dentition & alteration of vertical dimension of occlusion (VDO).
These restorations aimed to rebuild the fractured and worn teeth to restore their structural integrity. Occlusion was carefully adjusted to achieve favourable functional stability.
4. Protective Measures
A nightguard was fabricated to mitigate further tooth grinding and protect the newly restored teeth.
Outcome and Follow-Up
The comprehensive treatment plan resulted in:
- Significant improvement in both the patient’s smile and the chewing function.
- Increased patient satisfaction with the appearance and longevity of her restored teeth.
- Enhanced protection of dental restorations through the use of a nightguard.
- Regular follow-up appointments were scheduled to monitor the patient’s progress and ensure the continued success of the treatment.
Learning Outcome
Smile design, occlusal analysis as part of comprehensive restorative treatment planning are essential for managing patients with pathological tooth wear. This approach effectively addresses both aesthetic and functional concerns, leading to stable and improved patient outcomes.
This case underscores the importance of an integrated treatment strategy that combines restorative procedures with protective measures and surgical interventions to achieve optimal results in patients suffering from severe tooth wear.
