Restorative management of full mouth worn dentition

This patient was referred for the management of worn dentition. He suffered from alcoholism and parafunction for a number of years. Despite best efforts from his referring clinician who has used direct composite restorations to cover all his teeth, however these restorations have continued to fracture respectively.

Now that the patient has alcoholism under control, he would like to receive treatment to achieve a good aesthetic and functional long-term outcome to improve his self-esteem and to be ready for his job interview. Due to financial limitation, he can only complete treatment of his maxillary arch for now with view to complete the mandibular arch at a later stage.

He has chosen the option to rehabilitate his maxillary arch with indirect crown restorations which can provide him with excellent aesthetics, teeth protection and longevity. To minimise amount of tooth reduction required, we have proposed to increase his occlusal vertical dimension (OVD) by approximately 1.5mm (posteriorly) which means no occlusal/incisal reduction would be required. Based on this proposal, diagnostic wax-up was made.

This information was transferred intra-orally via a putty key stent using bis-acryl resin to simulate the final outcome.

Once the aesthetic, phonetic and intra-oral comfort parameters were met, teeth 16-25 were prepared for crown restorations. Teeth 17 and 27 were left as is, as 17 was not significant affected and 27 was already restored with a crown.

A 2-step full mouth impression was taken and successfully recorded all margins and gingival sulcus space.

During the provisionalisation period, the patient had no complications and have confirmed aesthetic, phonetic and comfort parameters at the increased OVD.

O11 units of porcelain fused to gold crowns were manufactured with particular attention to detail paid on anterior aesthetics and marginal fit.

These restorations were tried intra-orally and achieved patient satisfaction in all aspects. While there is marked colour difference between the crowns and his mandibular dentition, this was not a concern to the patient as he has planned to receive the same treatment for his mandibular dentition in due course.  

The outcome has provided the patient with significantly increased self-esteem as well as a stable long-term outcome.

He has received management for diurnal and nocturnal dental parafunction and has demonstrated excellent compliance.