Case presented by Dr Russell B Tant, BDS (Hons) U.Lond DGDP.UK Specialist in Endodontics founder and lead dentist at the Hertfordshire Dental Specialists, Harpenden, for over forty years.
This patient was referred to our multidisciplinary specialist practice in regard to the severe erosion and wear of all teeth, together with the loss of posterior support. After a full treatment plan including a full wax up, the therapy and fees were agreed with the patient.
A summary of treatment involves building up of the upper anterior and premolar teeth with composite to retruded contact position, crown lengthening of the six anterior teeth by our specialist periodontist, Dr Rupal Patel, who in fact was able to undertake this palatally. Placement of four implants in the upper right, lower left quadrants by our implant surgeon, Dr Will Murphy, build-up of the lower anteriors with composite to the new vertical and finally restoring the anterior teeth with lava crowns and the implants with bonded crowns.
This patient is a 47 year old male and was referred to me by his GDP as the patient was unhappy with the appearance of his teeth and also his speech was now being affected.
The patient was medically fit and well. He drank at least two cans of a high sugar, carbonated drink per day and also was aware that he grinded his teeth.
The patient had very little posterior support and the remaining posterior teeth had over erupted. Periodontically his gums were healthy with no concerns.
On examination he suffered with severe tooth erosion. His upper right central incisor was non vital and required root canal treatment along with the upper right lateral incisor. We also discussed the need for crown lengthening of the upper anteriors in order to be able to successfully restore them.
Due to the loss of tooth height as a result of the erosion, there had been a compensatory growth of the jaw bone and an overclosure of the bite.
The patient was also keen to improve the appearance of his lower anteriors as these had also been affected by the erosion.
We had to plan to increase the vertical dimension in order to be able to affectively restore the posterior back to retruded contact position.
In order to restore the upper anterior teeth, a crown lengthening procedure was successfully carried out by our periodontist, Dr Rupal Patel.
The patient eventually had four posterior dental implants placed by our implant surgeon, Dr Will Murphy. Two dental implants were placed in the upper right and two in the lower left. The implants in the lower left support a three unit bridge to replace the missing lower left first molar. We also placed eight crowns in order to restore the upper anteriors.
I addressed the patients concerns regarding the appearance of his lower anteriors by carrying out composite build-ups of the mandibular anterior teeth. He was very pleased with the result.
This was a case requiring a multidisciplinary team approach. The patient found that he could now eat things he had not been able to for many years, his speech was improved and he now has a lot more self-confidence as a consequence of the treatment. I have constructed a bite guard for the patient to wear at night.