Restoring Esthetics, Health, and Function in Severely Worn Dentition

Fig 1. Preoperative, the patient’s existing anterior dentition appeared short proportionally. To esthetically redesign her smile, smile design study was used in determining the ideal proportion, shape, size, color, and style of the restored dentition.

Fig 2. Although the patient had previously completed clear aligner therapy to achieve an improved occlusal scheme, at diagnostic work-up it was evident that the worn dentition required reconstructive treatment to replace severely worn enamel.

Fig 3. Upon evaluation, it was noted that the patient had worn off all functional guide planes, such as anterior guidance, lateral excursion, and protrusive function.

Fig 4. The severe wear required the replacement of missing enamel with a restorative treatment material that would provide optimal strength and occlusal toughness for long-term success.

Fig 5. Teeth preparation for both arches (upper arch shown) was performed to remove broken, decayed, and decalcified enamel, leaving a base of healthy enamel.

Fig 6. After final impressions and treatment records were taken, esthetic temporary prototypes were hand-sculpted to develop the patient’s new occlusion and smile design.

Fig 7. Prior to sending the temporary prototypes for final restoration fabrication, the smile design and occlusal scheme were refined to meet the patient’s esthetic demands and occlusal comfort.

Fig 8. Full-mouth cosmetic and restorative restorations were masterfully sculpted to match the size, proportion, and smile design of the esthetic temporary prototype contours. Following the prototypes eliminated any guesswork.

Fig 9. After isolation and decontamination protocols were performed, All-Bond Universal was placed and light-cured for optimal adhesion to promote long-term success.

Fig 10. The anterior porcelain veneers were bonded with Choice 2 luting resin and light-cured. Margins were then refined with a No. 2 scalpel and fine carbide finishing bur.

Fig 11. All-Bond Universal adhesive was then placed on the lower anterior teeth to create a hydrophobic surface ideal for long-term success of bonding.

Fig 12. For all molars, full-contour zirconia crowns were bonded using Z-Prime Plus on the intaglio surfaces of the crowns and TheraCem luting resin cement.

Fig 13. Anterior guidance and canine-protected function was re-established to help ensure long-term success. Optimal tooth position was attained to match the patient’s smile line.

Fig 14. The health, function, and esthetics of the patient’s dentition was restored, and a more youthful smile was achieved.