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Special Issues
July/August 2017
Volume 38, Issue 2
Peer-Reviewed

Treating the Worn Dentition in a Predictable Manner

Zachary S. Sisler, DDS

When patients present with worn or broken teeth, as depicted in this case, it is critical for dentists to understand the role of occlusion within the entire masticatory system. Before attempting to place restorations, the clinician needs to properly assess and diagnose the patient for occlusal issues that may have led to the damaging environment. At The Dawson Academy (dawsonacademy.com) dentists are taught the concept of a complete examination, predictable treatment planning, and the role of occlusion throughout the process. By following the principles of stable centric stops coinciding with centric relation (CR) and posterior disclusion through anterior guidance, dentists can design an occlusion and place restorations to withstand the test of time.

Key Takeaways

• Predictable long-term success starts with consistent record taking and methodical treatment planning of the entire masticatory system.

• Silicone matrices can be made from the diagnostic wax-up and then transferred intraorally as preparation guides to ensure uniform thickness, helping to prevent under- or over-preparation of the teeth.

• Proper material selection plays an equal part in the decision tree of treatment. Improper selection could result in damaging effects to surrounding teeth, as seen in this case.

• Form follows function: When proper function has been established in harmony with the temporomandibular joints and muscles of mastication, esthetics fall into place naturally and effortlessly.

About the Author

Zachary S. Sisler, DDS
Private Practice
Shippensburg, Pennsylvania

Fig 1. This patient had been treated with porcelain-fused-to-metal (PFM) crowns on teeth Nos. 8 and 9 more than 30 years ago. Now, just before her 60th birthday, she had significant wear and wanted a new smile that would last for the rest of her life.

Figure 1

Fig 2 through Fig 4. The PFMs on teeth Nos. 8 and 9 had begun to wear down the lower incisors, resulting in a compromised anterior guidance, which, in turn, led to bruxing of the posterior teeth, causing accelerated wear and further breakdown. Re-establishing immediate disclusion of the posterior teeth with a new, customized anterior guidance would enable this patient to regain the lost function and esthetics that deteriorated over time.

Figure 2

Fig 2 through Fig 4. The PFMs on teeth Nos. 8 and 9 had begun to wear down the lower incisors, resulting in a compromised anterior guidance, which, in turn, led to bruxing of the posterior teeth, causing accelerated

Figure 3

Fig 2 through Fig 4. The PFMs on teeth Nos. 8 and 9 had begun to wear down the lower incisors, resulting in a compromised anterior guidance, which, in turn, led to bruxing of the posterior teeth, causing accelerated

Figure 4

Fig 5. Beginning with a complete examination and set of facebow mounted casts in CR, the amount of interocclusal space that would be gained by allowing the condyles to fully seat into CR became clear.

Figure 5

Fig 6. Silicone preparation matrices made from the diagnostic wax-up allowed the clinician to visualize the targeted tooth form in the final restoration.

Figure 6

Fig 7 through Fig 9. With adequate reduction, the laboratory could fabricate beautiful restorations that also provided the patient with a stable occlusion to prevent further breakdown.

Figure 7

Fig 7 through Fig 9. With adequate reduction, the laboratory could fabricate beautiful restorations that also provided the patient with a stable occlusion to prevent further breakdown.

Figure 8

Fig 7 through Fig 9. With adequate reduction, the laboratory could fabricate beautiful restorations that also provided the patient with a stable occlusion to prevent further breakdown.

Figure 9

Fig 10. New occlusal foundation with stable centric stops on all teeth, coinciding with CR.

Figure 10

Fig 11. Because this patient had high esthetic demands, pressed lithium disilicate was utilized with microlayered porcelain on the facial aspect for a natural surface texture.

Figure 11

Fig 12. The final full-face photograph showed a happy patient with her new, confident smile, designed to withstand the test of time.

Figure 12

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