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.
