Treating a patient who has bruxism and clenching and there is no restorative space
by Carlos Castro, DDS, FACP, Board Certified Prosthodontist | Georgia Prosthodontics
Joan was referred to us with a history of multiple fractures, bruxism, clenching, short clinical crowns, and a severe lack of restorative space. The patient’s aesthetics was compromised, and that was affecting her overall health.
The referring general dentist assessed Joan, but due to the severity of her tooth wear, she trusted us to seek a prosthetic solution. Previously to visiting us, the only alternative she was offered was having endodontic therapy.
Generally, we proceed by planning a multi-stage workflow that is beneficial for both the patient and us.
- Endodontic assessment and vitality tests
- Diagnostic wax-up to evaluate space and options to restore canine guidance
- Laboratory processed provisionals following wax-up at an increased Vertical Dimension for a Dahl appliance.
- Crown lengthening
- Healing and re-evaluation6. Definitive restorations using Lithium disilicate ceramics. A short clinical crown adjacent to a canine was splinted to reduce decementation risks
What was challenging about this case?
The main challenges were the lack of space for restorative material, the short clinical crowns, and high esthetic demands. Additionally, being the most conservative and avoiding endodontic therapies provided a biological goal.
It was remarkably important in the process to have the patient adapt to a new occlusal scheme with canine guidance at an increased Vertical Dimension.
The purpose of the Dahl appliance is to provide a combination of intrusion and extrusion resulting in a gain on restorative space.
At Georgia Prosthodontics, this is a condition that we have treated on numerous occasions with a high rate of success, and we knew that the recommended path for Joan was quite different from what she has been told in the past.
Choosing the right path is as important as selecting the appropriate materials that will ensure a successful process.
Fortunately, the treatment for her bruxism and clenching went excellent, and Joan recovered her oral health along with her confidence. Two years have passed since we first met Joan, and she still trusts our professionals to take care of her oral health.
During our patient’s treatment, we dealt with a fracture in one of her teeth due to constant bruxism and clenching; the only solution was to remove it. In the surgery, we grafted a DPTFE cytoplast TXT200 membrane and after 4 weeks the membrane was removed. Then, after 12 weeks, the crown was placed on the tooth.
Do you have a patient in a similar situation or that is experiencing a complex case?
We are specialized in complex cases as Joan’s case, if there is a case that you would like to work collaboratively on, please submit the enclosed referral form, and we will contact you at the earliest convenience.
We receive complex case referrals regularly and thrive on seeing your patients recover successfully.
For additional information, please visit our website www.ImplantOption.com
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The Reconstructive Dentistry Team
Georgia Prosthodontics is focused on Implant, Cosmetic, and Reconstructive Dentistry. Drs. Carlos Castro & Norberto Delgado have the training and private practice experience that makes treatments of complex cases more successful, including patients:
• With severely worn/damaged teeth, missing all teeth, or with ill-fitting dentures can receive a full arch of natural-looking teeth to restore function & esthetics.
• Congenital defects, a chronic condition, or traumatic injury can receive oral prostheses, which may be a combination of dental implants, crowns, bridges, or veneers.
• Patients with difficult anterior cases in the esthetic zone can receive single or multiple dental implants to replace missing teeth, or veneers or crowns to improve the appearance of their smile.
In addition, they have a private dental laboratory called Prostho Dental Lab. An in-house, experienced, and certified dental technician creates each custom restoration for referred patients from the best materials using the latest technology. To send an implant case to our dental lab, please visit: www.prostholab.com