Case 152 | The Award 2017 | Mexico/Spain
Jair Rodrivich DDS MDS CDT / J.Daniel Suárez DDS MDS
Conservative Treatment in a Patient with Severe Bruxism Associated with Dental Corrosion
Introduction and objectives
A mayor issue in oral health is bruxism. Among its clinical signs we can find incisal edges wear and enamel fractures. After years of suffering this pathology, the result can become an aesthetic and functional problem for the patient. For this reason an early diagnosis is vitally important.
The challenge today for dentists is to perform a treatment that restores dental functionality and aesthetics in combination with a conservative approach, in those cases where toothwear is in a very advanced stage.
In this clinical case we sought to preserve the greatest amount of dental structure by means of rehabilitating adhesive techniques in a patient with severe toothwear, caused by bruxism associated with dental erosion.
In the initial appointment a 60-year- old male patient complained of inhability to masticate certain foods and discomfort about the aesthetic appearance of his teeth.
The first stage is the making of a diagnosis wax-up, in order to make a mock-up afterwards. This way we can check aestethic, function and phonetic test in the patient, and improve the patient´s emotional state.
After the mock up we began the polishing of tooth enamel in order to improve future insertion of ceramic prosthesis, and subsequently take addition- reaction silicone impressions. Regarding the laboratory process, several monolithic lithium-disilicate pressed pieces (inlays and onlays) were devised, and for anterior teeth a coping with reduction as regards the total volume was stratified with feldespathic ceramic. The prostheses were cemented individually in accordance to adhesive cementing techniques and to this purpose a dual resin cement was employed. Once the cementing was complete the contacts were confirmed in a centric relation and the desocclusion guides were checked, and later an occlusal splint was made.
The outcome of this clinical case was a maximum dental preservation treatment. The most significant advantages are: lack of operatory sensitivity, high adhesion to enamel (with all the advantages this entails), reduction of clinical time, absence of anaesthetic and, as a long-term advantage, this adhesive technique allows for a simpler resolution of an eventual problem than other more invasive techniques.
Oral rehabilitations with a maximum preservation approach regarding dental structure can be considered a successful treatment in order to restore function and aesthetics in patients with bruxism. The selection of material and techniques is crucial for the highest preservation of dental structure. Equally relevant is an accurate diagnosis to know which factor contributes the most to toothwear (erosion, attrition, abrasion).
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