Aims

In recent years, tooth wear from nighttime grinding habits seems to have become more and more prevalent. For this gentleman, the issue of grinding came to the forefront after his lateral incisor kept repeatedly fracturing.

The goal was to predictably restore the fractured tooth, and prevent further wear and tear to the others which had visibly shortened over time. He also wanted to maintain the original natural character of his smile, in particular his mid-line diastema (space) between his upper front incisor teeth.

In treating cases where other dental treatments have failed, we have to ask ourselves why is the filling repeatedly failing? Well, one of the consequences of long-term tooth wear is that teeth will begin to drift as they shorten. If this drift leads to uneven biting plane or clenching forces at the wrong angulations, we only need time before we see wear and tear in the form of fractures.

Treatment

To accomplish his goals, we embarked on a redesign of the way his upper and lower teeth met; correcting any uneven pressure points using a white composite filling material. Here each of the six restorations were handcrafted simultaneously in one appointment, enabling us to dictate biting and clenching forces on each tooth. We also took the opportunity to increase the widths of the teeth to ensure they are the correct shape & proportion in keeping with his smile.

Early detection and intervention of long term tooth wear from grinding is key to success in these cases. Should the wear have been picked up at later stages, it is highly likely alternative avenues such as crowns would have been needed to treat this case.

Initial Presentation

Besides from the fractured upper right (patients right) lateral incisor.

The upper front teeth appear shorter, and there are some spaces between the teeth.

Closer inspection

The tips of the upper and lower teeth are flattened, this is likely from a grinding/clenching habit.

Similar to taking to stones together and rubbing them, over time they become flatter and worn down. For the patients age this wear rate is higher than would be expected.

Clenching together

When asked to bite on the edge of his teeth, we can see the wear facets perfectly match up with his opposing lower teeth- highlighting his tooth on tooth wear.

Lack of vertical height

If we look closely at the fractured tooth, there is only a small amount of space available to place a filling when his teeth are brought together. A

In the current situation the filling would have to be shorter in order to avoid excessive forces from the lower canine tip bearing too much chewing pressure upon it.

Immediately After

We have placed six restorations on the upper teeth, built to a new height, as we had discussed the midline gap has been preserved- in keeping with the patient’s original smile characteristics.

Clenching

When biting edge to edge, the forces are now even across the 6 teeth.

Biting normally

When biting together the teeth meet well, the restorations are blended well with his natural tooth.

Back to its original height

The lateral incisor has been repaired, and the high-pressure spot from the opposing tooth has been overcome by evenly distributing biting loads to neighbouring teeth.

We have successfully brought back this patients smile and reversed the wear and tear from grinding habits. Next on our agenda will be the use a mouthguard to stop further wear and tear from grinding.