Worn Teeth Restored While Looking Natural

The Patient's Journey

This patient came in because the edges of his lower front teeth had darkened and he had noticed the deterioration himself. He had been grinding his teeth for years without treatment. Several of the lower incisors were measurably shorter than they had been, with notched, irregular edges where the enamel had fractured away.

He wanted the deterioration stopped, and while that was being addressed he wanted his appearance improved. Restraint became the governing constraint on the design. Twenty-four restorations give a laboratory considerable latitude, and most of that latitude was spent reproducing proportions he would recognize as his own.

Understanding the Challenge

Teeth worn to this degree are a bite problem before they are an appearance problem. Grinding removes enamel at the contacts between the teeth, and because those contacts flatten progressively, the jaw locates new ones and the distribution of wear migrates across the arch until the pattern bears little resemblance to the one it started from. Reproducing the original shape without correcting the bite delivers new ceramic into the mechanism that destroyed the enamel.

Grinding is also not a condition that resolves. It can be diminished substantially by improving and balancing the bite, which was done here. The habit itself continues, and the restorations require protection from it afterwards.

That determined the sequence of treatment. The bite had to be analyzed and corrected first, and the appearance of the teeth had to follow from those findings rather than be developed alongside them.

How Dr. Mehdizadeh Approached Treatment

Treatment opened with an analysis of the bite, and its findings determined the shape and the length available to every tooth in the design. The contacts between the teeth, the movements they make across one another and the distribution of load are all measurable quantities, and those measurements established the limits that the smile design afterwards had to work inside.

Provisional restorations were placed across both arches and worn for several weeks while the corrected bite was tested in ordinary use. Provisionals are the only reliable test of a bite, because a design can be correct on a model, measured and articulated exactly as intended, and still remain uncomfortable for the person who has to live in it. Adjustments were made during that period, to the bite and to the appearance.

Once the provisionals were performing correctly, their shape was reproduced in the definitive restorations. Twenty-four units were fabricated in e.max, a pressed lithium disilicate: twelve porcelain veneers and twelve onlays, six of each in each arch. Veneers rebuild the front surfaces of the teeth that display, and onlays rebuild the biting surfaces of the teeth behind them, which had carried most of the grinding damage.

Everything was designed and fabricated in the practice's own laboratory by its master ceramist, in the same building as the treatment chair. Shade and shape were therefore adjusted against the patient rather than described to an outside laboratory.

The Result After Eight Weeks

The worn edges are rebuilt, the lower incisors have recovered their length, and the darkening he arrived with is gone. Six appointments across eight weeks covered the analysis, the preparation of twenty-four teeth, the provisional phase during which the corrected bite was tested in ordinary use, and the cementation of the definitive restorations. The completed restorations reproduce the proportions and the surface texture his own teeth carried before the deterioration began.

None of this eliminates the grinding. It protects the teeth from it. He wears a retainer at night so the load is absorbed by an appliance instead of by the new restorations, and that continues for as long as the grinding does.