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Nov 2019
22nd
 

Case of the Month- November 2019

Our case of the month for November involves a re construction of the bite over a number of years. The main reason for treatment was due to severe tooth wear due to bruxism. Bruxism is essentially grinding at night to such an extent that the enamel is worn over a number of years. This can cause a number of problems such as:

  • Tooth sensitivity
  • Difficulty in eating
  • Lack of a coherent bite
  • Aesthetic issues
  • Pain leading to root canal treatment in severe cases

Tooth wear, on the whole, can be prevented or at least treated with relative ease in the early stages. However, severe tooth wear is a complex subject and requires a dedicated and staged treatment process. Here is a smiling view of our patient before any treatment:

Severe tooth wear of the front teeth

Here, the upper and lower teeth have been worn to an extent that the bite has become edge to edge and almost all of the enamel has been worn away from the edges of the teeth and the inside surfaces. Now, as you may know, we believe in minimally invasive dentistry. In the past, all of the front teeth would have to cut down to stumps and crowns placed to 'restore' the bite and aesthetics. However, there is huge biological damage with this approach and untold issues await in the future. Our approach is very different. Initially, Dr Patel treated the tooth wear using the Dahl technique. This is a superb treatment where the tooth wear can be treated directly using composite materials to build the teeth back to normal levels WITHOUT having to cut them down. This does have an effect on the bite and adaptation can taken between 16-20 weeks. However, it is often only after a few weeks when the bite begins to feel normal again. The composite can be adjusted over time, repaired, replenished to maintain the effect. Our patient requested a more aesthetic yet natural outcome for the longer term after a few years. After a careful discussion of all the options, a plan of minimally invasive veneers was agreed. As the tooth dimensions were already, know with the Dahl treatment, we did not have to alter this a great deal. Provisional veneers play a huge part in the treatment. In fact, veneers should not be provided without a mock up and a period of time wearing temporary veneers. Once we were all happy with aesthetics, speech, lip profiles, occlusion (bite) and maintenance we could provide the veneers using minimal preparation only, with margins created in enamel only. Here is the final result:

A new smile, natural and fully functional

A beautiful natural smile that required only minimal preparation and hence minimal biological damage to the teeth. The long term prognosis is excellent. We have one happy patient! If you have tooth wear and would like a solution that is minimal and less damaging than the norm, come and see us. Why wait, you only have one set of teeth!

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