Full-Mouth Reconstruction for a Bruxer

Bruce W. Small
Author: Bruce W. Small
Date: 05/16/2013 10:27am
Share |
Rate this Article:

A 46-year-old male presented to my practice with this chief complaint: “My teeth are getting smaller.” After a comprehensive exam, I determined that a lifetime of bruxing had caused significant wear. Over time, he had lost his anterior guidance, including his canine guidance.

The patient had no pain or periodontal involvement, and the clinical crown length was adequate to retain crowns. He also had developed Class 5 lesions, some of which had been restored with direct composite.

After constructing a diagnostic wax-up, I slightly increased the patient’s vertical dimension of occlusion. I observed the wax-up in all excursions and confirmed that the occlusal deficiencies were corrected.

We constructed the acrylic provisional from the wax-up. I then prepared all of the teeth and placed the provisional. After a few weeks of wearing the provisionals as a trial run for the case, the patient was completely comfortable, reporting no speech or temporomandibular joint problems.

After taking final impressions, the final restorations were made and seated. Cast gold crowns were made for the second molars, and gold occlusals were suggested for the remaining posterior teeth, but they were rejected by the patient. A nightguard was constructed, which the patient was instructed to wear nightly and during times of stress.

After 6 years of maintenance, the patient’s periodontal condition is excellent. The patient has reported no problems, and none are clinically evident.

Case Before After

Case uneven surfaces

Case lateral excursion

Case View of Crown

Category TagsOcclusion, Restorative Dentistry, Acrylics, Crown and Bridge, Impression Materials, Mouth Guards, Restorations, Restorative Materials, Temporization

Article Related Content Type

Surefil SDR flow A Revolutionary Solution for a Complex Problem

Author: Scott Parker, DDS
Date: 10/25/2011 07:10pm

Surefil SDR flow A Revolutionary Solution for a Complex Problem

We have been using flowable composites in dentistry for several years. It is common practice to line a filling with a flowable resin for a handful of valid reasons; however, some clinicians use flowables for reasons that are questionable. For instance, using a flowable composite to fill the box of a Class II filling is not recommended because of the higher shrinkage of flowable materials. Also, flowable materials typically have a higher concentration of resin compared to more viscous traditional composites.

Read more