Esthetic rehabilitation of tooth wear caused by nocturnal bruxism and erosion

Abstract

Introduction: In the case of a young female patient with high esthetic demands, the complete oral rehabilitation of tooth wear caused by bruxism and acid erosion is a great chal lenge. If the tooth wear affects only the anterior teeth and the premolars, the small interocclusal space does not provide adequate space to restore the original height of the anterior teeth, so the vertical dimension of the occlusion also need to be restored. Aim: Full mouth esthetic rehabilitation with increasing occlusal vertical dimension (OVD) for a patient with worn front and premolar teeth caused by nocturnal bruxism and acidic erosion. Methods: 40 years old woman presented, whose main concern was having esthetically unpleasant cuboid shaped worn front teeth. First digital smile design was applied (3Shape TRIOS Smile Design), followed by gothic arch tracing and face bow registration. The OVD was increased with 3.0 mm and diagnostic wax-up (upper front- and premolar teeth; lower front-, premolar- and molar teeth) was made on casts mounted on articulator programmed to individual patient parameters. A motivational mock-up was made to show the patient the expected outcome and according to this silicone keys were made for minimal invasive preparation. During optical impression taking (TRIOS 3, 3Shape) the bite was registered with the help of chairside temporaries. PMMA temporaries were milled. Results: After 2 months of wearing, the functional PMMA temporaries were scanned and overlapped on virtual model of prepared teeth using gingival, dental reference points (3Shape Dental System). Monolithic final restorations (crowns, overlays, veneers) were milled (IPS e.max CAD, Ivoclar Vivadent) and cemented in absolute isolation using clear luting cement. Conclusions: To reach the satisfied esthetics in the front region a careful treatment planning was made, that includes the analysis of the face and teeth, also creating conventional wax up and mock-up. The vertical dimension was increased in temporary phase, then with copying functional temporaries a digital workflow was used for a predictable final result.

Keywords

• esthetic rehabilitation
• tooth wear
• smile design
• mock-up
• pmma temporary
• backward planning
• monolithic
• glass ceramic