Name: Complex Esthetic and Functional Rehabilitation with Minimally Invasive Restorative Approach

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The treatment of the patient with extensive tooth wear presents complex challenges, due to diagnosis of often a multi-factorial etiology, and the definitive management of the patient.

Patients may seek dental care to improve their esthetic appearance, without fully comprehending the complexity or problems associated with tooth wear. Typical symptoms that patients present with include poor esthetics, chipping/thinning of teeth, dentinal hypersensitivity, reduced occlusal vertical dimension, and minimal tooth height.

Historically the management of patients presenting with extensive tooth wear was with conventional fixed prosthodontics. This would involve preparation with crowns on the teeth where tooth structures were already compromised. This would increase the biomechanical risk to the dentition due to the reduction of tooth structures, which negatively impact the structural rigidity of the teeth.

Edelhoff and Sorenssen [1] found that 62% to 73% of tooth structure can be removed undertaking the preparation to receive either a full coverage all-ceramic crown or porcelain fused to metal crown. Additionally a conventional approach could result in a loss of pulpal vitality of the teeth. Teeth requiring fixed prostheses have a 6-11% requirement for endodontic treatment. This approach is more invasive and is irreversible. [2, 3]

Clinical case overview
The patient is a 26-year-old female who presents with her chief concern being that of the short nature of her teeth and the ensuing poor esthetics.

A comprehensive history and examination was performed. Her concern was the extensive loss of tooth structure and the chipping of her upper front teeth. The patient had a history of Bulimia Nervosa. This condition consists or recurrent episodes of compulsive binges (consumption of large amounts of food) with or without self-induced vomiting or purgation.

Author: Dr Christopher CK Ho, Australia

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