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Wear

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Some of the most challenging and mismanaged treatment plans involve the aesthetic reconstruction of complex wear cases. Simply put, trying to add restorative material such as porcelain, or composite resin, as is used in ‘bonding’ procedures, onto severely worn teeth, will usually result in catastrophic failure.

Why? Restoring worn teeth within the same conditions that led to the initial wear/breakdown will result in the same, continued wear patterns after treatment. The reason for this lies in the mechanical components that control the forces on a tooth or restoration. These mechanical components must be respected if a restoration is to survive the rigours of chewing and parafunction (clenching and grinding).

This can only be achieved when the dental team has a working knowledge of proper jaw mechanics. This team approach may necessitate orthodontics, periodontics or other dental specialties.

Case 1: This case was managed with minor equilibration and 6 veneers only.

Case 2: In this complex wear case there was minimal to no visual display of anterior teeth prior to treatment. This case was treated with a combination of gingival sculpting and dental equilibration followed by age-appropriate restorations, and an night -time occlusal splint.

The patient was initially resistant to longer teeth out of concern of an overly ‘toothy’ smile. These fears were alleviated after the provisional period.

Before

Before

Provisional/temporary phase

Final

Case 3: This patient presented with significant wear on his anterior teeth alone due to tooth grinding and potential airway restriction. In order to regain space, this patient underwent orthodontic treatment prior to anterior veneers. These cases need to be protected with appliance to reduce the risk of continued breakdown.

 

Case 4: This complex wear case, was treated with orthodontics to level the gum-line, and improve the bite mechanics followed by porcelain crowns and veneer restorations. Only the upper teeth were restored, as per patient request).

Case 5: Management of complex wear case and poor arch form with a combination of orthodontics and full mouth rehabilitation.

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