We remain concerned, however, with the long-term biological success of this case due to ongoing bruxism and erosion that contributed to her presenting dental deterioration. The patient’s occlusal/incisal wear pattern at initial presentation reflected an anteriorly directed bruxism pattern. Our restorative plan was modified to include an occlusal scheme designed to distribute functional contacts over as many teeth as possible and allow freedom of movements along the pathways of her former wear patterns. We also modified the material selections to utilize those best able to tolerate increased force levels during parafunction. She has also been fitted with a fully adjusted occlusal orthotic device to be worn while sleeping. However, experience tells us that her potential for parafunctional occlusal trauma remains.
And finally, the causes of the patient’s significant dental erosion at initial presentation remain unclear. We have recommended traditional methods for increasing oral pH (baking soda rinses, pH 9.5 bottled water, and abrasive-free toothpastes). We have also a recommended medical evaluation to rule-out gastro-esophageal reflux disease or any other contributing medical factors.
We will continue to monitor the patient at future appointments with increased attention to these potential threats to her successful restorative outcome.
This case presented an opportunity to evaluate treatment options available to resolve excess dento-alveolar eruption. Orthodontic correction, periodontal therapies, and prosthodontic therapies were considered. We utilized the following analysis to determine the necessary treatment to achieve our esthetic, functional and structural goals.