Contemporary management of minimal invasive aesthetic treatment of dentition affected by erosion: case report

Abstract

Background: The paradigm shift obtained with new dental materials permits minimally invasive dentistry, by following a biomimetic approach. Erosion increasingly affects the adult population through dental substance loss by acid attack. Oral rehabilitation is often extensive and requires careful mouth examination and treatments codified in the literature.

Case presentation: This clinical report proposes a reasoned approach to erosion treatment for a 39-year-old male patient presenting several old fixed prostheses. These old restorations are all of correct quality and are retained. The temporomandibular joint was free from disorder. Only defective reconstructions are remade together with eroded teeth, according to a three-step technical protocol. In the first step, mock-up manufacturing is performed which occlusal vertical dimension increased to 1 mm provoking passive dental overeruption to the second and third molars. In all, one ceramic crown was remade, and two ceramic onlays and a resin composite were integrated on the posterior teeth. The last step consisted of palatal veneers on the maxillary incisor and canine, and an aesthetic resin composite on the incisor edge. After these treatments, regular assessments were carried out at 4 months then at 6 months with visual, photographic and radiographic examinations.

Conclusion: The present dental care philosophy is to preserve dental tissue as much as possible, even in large erosion cases, and to respond to the aesthetic and functional expectations of the patient. This methodology requires a thorough evaluation phase, compliance with the protocol and regular patient follow-up.

Keywords: Aesthetic; Biomimetic; Erosion lesion; Prosthetic rehabilitation.

Fig. 1

Clinical examination and Panoramic radiographic of the initial dental status

Fig. 2

Clinical observations. a Facial aesthetic analysis; b Analysis of the teeth shape; c Erosion level of maxillary incisors

Fig. 3

a Maxillary and mandibular silicon key; b Maxillary wax-up

Fig. 4

Realization mock-up steps. a etching spot; b Resin application with silicon key; c Full mock-up finish

Fig. 5

Photography of mock-up: b: maxillary arch; b: mandibular arch

Fig. 6

a Incisor table personalized; b Onlay positioned on the second maxillary left premolar; c Onlay preparation on the first maxillary right molar

Fig. 7

Clinical observations. a Facial aesthetic analysis; b Analysis of the teeth shape; C: Erosion level of maxillary incisors

Fig. 8

Final situation and Panoramic radiography