Serving all of Central and Western Montana ~ Located in Missoula

Case Study 4: Full Mouth Reconstruction

Examination of the teeth demonstrates moderate tooth wear into the dentin (the soft part of the tooth) on some teeth.  Questioning of the patients medical and dental history reveals previous bulimia,  and presently gastric reflux and tooth clenching/grinding.  The clinical presentation of the tooth wear was consistent with this history.  In lieu of the tooth wear etiologies, the patient had experienced some minor bite collapse and slight shifting of teeth, which caused an uneven bite.

  • Examination of the teeth demonstrates moderate tooth wear into the dentin (the soft part of the tooth) on some teeth.  Questioning of the patients medical and dental history reveals previous bulimia,  and presently gastric reflux and tooth clenching/grinding.  The clinical presentation of the tooth wear was consistent with this history.  In lieu of the tooth wear etiologies, the patient had experienced some minor bite collapse and slight shifting of teeth, which caused an uneven bite.
     

  • Examination of the teeth demonstrates moderate tooth wear into the dentin (the soft part of the tooth) on some teeth.  Questioning of the patients medical and dental history reveals previous bulimia,  and presently gastric reflux and tooth clenching/grinding.  The clinical presentation of the tooth wear was consistent with this history.  In lieu of the tooth wear etiologies, the patient had experienced some minor bite collapse and slight shifting of teeth, which caused an uneven bite.

  • Examination of the teeth demonstrates moderate tooth wear into the dentin (the soft part of the tooth) on some teeth.  Questioning of the patients medical and dental history reveals previous bulimia,  and presently gastric reflux and tooth clenching/grinding.  The clinical presentation of the tooth wear was consistent with this history.  In lieu of the tooth wear etiologies, the patient had experienced some minor bite collapse and slight shifting of teeth, which caused an uneven bite.

  • The most appropriate treatment to address this patient's problems, is a full mouth reconstruction with crowns, to re-establish proper esthetics, function, and bite stability.  Before any irreversible treatment was performed, an esthetic "mock up" was made out of plastic, and tried over the patient's front teeth, to get an idea of how much tooth length would need to be added  to provide an appropriately youthful smile.  Notice how the curve of the patients front teeth now parallels her lower lip.
     

  • Once the patient elected to proceed with treatment, all of her teeth were prepared for crowns and temporary crowns simulating the same length and contours of the future permanent crowns  were cemented.  This step is very important to ensure that the patient was happy with the appearance, was able to accommodate from a perspective of speech, and was able to tolerate slight opening of her bite.  Typically these temporary crowns are worn over a several month period of time, before permanent crowns are placed.  

  • Because the patient demonstrated a past history of tooth grinding, the major chewing surface of the upper back teeth was made in metal (a gold alloy), as to have a higher strength and longevity in a patient who tends to place heavier forces on her teeth.  The particular design, however, prevents esthetics from being compromised.  The four lower teeth receive porcelain veneer restorations.

  • Final crowns/veneers in place.

  • Rehabilitated smile.

  • Current dental ceramic technology allows natural internal color effects and translucency of natural teeth to be closely mimicked.

  • Because the patient demonstrated a previous grinding history, she was provided with a hard night guard to be worn nightly during sleep, to protect her crowns from damage if she continues to grind - we always assume that a patient who has ground their teeth in the past, will continue to do so in the future!

  • Final Smile!

Dentist: