Keep It Local: Treating a Patient with Worn Dentition

Treating a Patient with Worn Dentition

By: Krysten Jackson, DDS

One of the most difficult challenges that the restorative dentist will face is the patient with severe wear. This patient presented to me with a chief complaint of her back teeth breaking, as well as a cosmetic complaint of her teeth looking short. On initial exam, severe generalized wear was seen on anterior and posterior teeth. Using the “Global Diagnosis” treatment planning and protocol (by Dr. Robbins and Dr. Rouse), I was able to reach a diagnosis of dentoalveolar extrusion. Knowing that this was the diagnosis, I knew that a collaborative, multi-disciplinary approach would be needed to restore her dentition.

The original treatment plan was for orthodontic intrusion and full mouth zirconia restorations. However, this plan was unable to be carried out because the patient did not have enough tooth structure remaining to bond brackets to. Knowing this, the patient was sent to the periodontist for functional crown lengthening. Fractured teeth were removed, implants placed into edentulous sites, and functional crown lengthening performed. After the patient healed from functional crown lengthening, the patient was brought in for a records appointment. Gingival contours were evaluated, and scans were taken for a wax-up. Next the patient returned from tooth preperation and long-term provisional crowns were placed. These were used to evaluate esthetics, function, and phonetics. Once the patient felt comfortable with the provisionals, I moved on to final impressions. The temporary crowns were removed and all preps were refined. Final scans were taken. The provisionals were able to be used as the guide for the final crowns. At final crown delivery, the patient’s tissue was healthy and the crowns functioned well for the patient. Treatment and management of severe tooth wear can be extremely difficult. It is of upmost importance to identify the etiology of the wear, so that pathologic factors can be identified, eliminated, and prevented. This case called for a comprehensive approach, and by doing so, we were able to restore her OVD, as well aschieve the patient’s goal. This case was treatment planned and completed by Krysten Jackson, DDS and Adam Cohlmia, DDS. Crown lengthening and implant placement by Jacob Hager, DDS.

ABOUT THE AUTHOR Dr. Krysten Jackson is from Lawton, Oklahoma. She attended Cameron University, and earned a BS in Cell and Molecular Biology with a minor in chemistry in 2014. She attended the University of Oklahoma College of Dentistry, and received her Doctorate of Dental Surgery in 2019. After graduating the University of Oklahoma College of Dentistry, she continued on to complete a residency in Advanced Education in General Dentistry (AEGD). She practices at her private office in El Reno, Oklahoma.

Figure 2. Patient at post-op for functional crown lengthening.

Figure 3. Patient after initial prep and temporization.

Figure 1. Patient presented with generalized severe wear, and with little remaining coronal tooth structure. As a result, she had several fractured non-restorable posterior teeth and loss of OVD.