tooth wear & loss of tooth structure case
TRANSCRIPT
ToothWear&LossofToothStructureCaseDrNeilWilsonSpecialistinProsthodontics
©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
Referred to Ne i l Wi l son
Background:LadyinherfiftiesreferredbyherGDPbecauseofseverewearandlossoftoothstructuretoposteriorlowerteethandlackofrestorativespaceinwhichtoplaceanydefinitiverestoration.
©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
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©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
Onexaminationthelowerright1stmolarwasmissingandthelowerright2ndmolarwaspatchedwithglassionomer.Therewasverylittlecoronaltoothstructureremaining.
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©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
Onthelowerleftagain,the1stand2ndmolarswereagainpatchedwithglassionomer,againwithverylittlecoronaltoothstructureandtherehasbeenalveolarcompensationleavingnorestorativespaceonwhichtoplacerestorations.
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©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
Therearealsolargecompositesintheupperleft1stand2ndpremolarsandalargecavityintheupperleft2ndmolar.
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©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
Theinitialtreatmentwastoremovetheglassionomerintheremaininglowermolarteethtoconfirmthattheteethwererestorable.
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©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
ThediagnosticwaxupwasundertakenusingupperandlowerimpressionstakeninImpregumsoftimpressionmaterialandafacebowrecordingwastaken.Dr.Wilsonusedthediagnosticworktoconsidercompositebuild-upstothepalatalofthefront6teeth,asintheDahlapproach.Ratherthanleavetheposteriorteethtoover-eruptfurther,thespacecouldbeusedtoplacefullcontour
E-maxonlays.
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©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
TheanteriorrestorationswereplacedusingFiltecSupremecomposite.Theywereplacedpalatallyonallsixupperanteriorteethmakingsurewehadgoodcaninedisclusion.Inquadrantstheteethwerepreparedfortheonlays.
Theremainingtoothstructurewasselectivelyetchedontheenamelonlyandthen3Muniversaladhesivewasusedwithitscorrespondentadhesivecalled‘Ultimate’toallowbondingoftherestorationswithoutcuringthebondfirst
toovercometheproblemofpossiblepoolingofadhesive.
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©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
Oncethelowerposteriorrestorationswerecompleteditwasthendecidedthattheupperleft1stand2ndpremolarshadsuchlargecompositesinthatwehavenowhadanopportunitytoundertakethesametypeofrestorationtoallowthemtobeas
conservativeaspossibleandonremovaloftheserestorationsitwasevidentthattherewasverylittletoothstructureremaining,soagainfullcontourE-maxonlayswereplaced.
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©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk
Thepatientwassenttothehygienisttomakesureshewascomfortableinmaintainingtherestorations.Thesehavenowbeeninfunctionforover18monthswithnoproblems.Sheunderstandstheprognosisofsomeoftheteethareunknown,butnowthatwehavespaceifweweretoloseoneoftheteethitwouldberelativelystraightforwardtoreplacethiswithadentalimplant.
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Advancedrestorative
Complexdentalimplantwork
Prosthodontics
Referra ls to Ne i l Wi l son
©2016Toothwear&lossoftoothstructurecase-January2016www.centralenglandreferrals.co.uk