The Use of Zirconium and Feldspathic Porcelain in the Management of the Severely Worn Dentition: A Case Report

ABSTRACT

The management of the interim phase of a complete oral rehabilitation in patients with severely worn dentition is often challenging due to the loss of occlusal vertical dimension, loss of tooth structure, uneven wear of teeth creating an uneven plane of occlusion, and para-functional habits. This case report describes the management of excessive tooth tissue loss in a 45 year old woman with a history of bruxism, esthetical complaints in anterior teeth, and impaired dental function due to reduced tooth height. The patient used occlusal splint for a month and than resection of the alveolar bone was performed on the vestibular sides of the maxillary anterior teeth, except the interdental alveolar crest. Maxillary anterior teeth were restored with zirconia porcelain. Feldspathic porcelain was chosen to restore remaining teeth in both jaws; the patient also was given an occlusion guard to protect the restoration against future bruxism. Regardless of the cause of occlusal instability, it is important that the restorative dentist should be able to recognize its signs such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement, and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P’s: proper planning prevents poor performance. (Eur J Dent 2009;3:75-80)

Key words:

Loss of vertical dimension - Bruxism - Fixed partial restoration - Zirconia - Wear

• REFERENCES

• 1 Bartlett D. The implication of laboratory research on tooth wear and erosion. Oral Diseases 2005; 11: 3-6
• 2 van ’t Spijker A, Kreulen CM, Creugers NH. Attrition, occlusion, (dys)function, and intervention: a systematic review. Clin Oral Implants Res 2007; 18 Suppl (Suppl. 03) 117-126
• 3 Phuhong DD, Goldstein GR. The use of a diagnostic matrix in the management of the severely worn occlusion. J Prosthodont 2007; 16: 277-281
• 4 Guttal S, Patil NP. Cast titanium overlay denture for a geriatric patient with a reduced vertical dimension. Gerodontology 2005; 22: 242-245
• 5 Steyern PY, Carlson P, Nilner K. All-ceramic fixed partial dentures designed according to the DC-Zirkon technique. A 2-year clinical study. J Oral Rehabil 2005; 32: 180-187
• 6 Komine F, Iwai T, Kobayashi K, Matsumura H. Marginal and internal adaptation of zirconium dioxide ceramic copings and crowns with different finish line designs. Dent Mater J 2007; 26: 659-664
• 7 Williamson EH, Lundquist DO. Anterior guidance: its effect on electromyographic activity of the temporal and masseter muscles. J Prosthet Dent 1983; 49: 816-823
• 8 The Glossary Of Prosthodontic Terms. 8th Edition J Prosthet Dent 2005; 94: 10-92
• 9 Standlee JP, Caputo AA, Ralph JP. Stress transfer to the mandible during anterior guidance and group function eccentric movements. J Prosthet Dent 1979; 41: 35-39
• 10 Ramfjord SP. Dysfunctional temporomandibular joint and muscle pain. J Prosthet Dent 1961; 11: 353-374
• 11 Manns A, Miralles R, Valdivia J, Bull R. Influence of variation in anteroposterior occlusal contacts on electromyographic activity. J Prosthet Dent 1989; 61: 617-623
• 12 Koutayas SO, Kern M. All-ceramic posts and cores: the state of the art. Quintessence Int 1999; 30: 383-392
• 13 Hsu KW, Shen YF. Esthetic restoration of infra-occluded retained primary mandibular incisors with all-ceramic crowns in adult dentition. Chang Gung Med J 2004; 27: 911-917
• 14 Gargiulo AW, Wentz F, Orban B. Dimensions and relations of the dentogingival junction in humans. J Periodontol 1961; 32: 261-267
• 15 Lanning SK, Waldrop TC, Gunsolley JC, Maynard JG. Surgical crown lengthening: evaluation of the biological width. J Periodontol 2003; 74: 468-474
• 16 Wang HL, Greenwell H. Surgical periodontal therapy. Periodontol 2000 2001; 25: 89-99