|Year : 2011 | Volume
| Issue : 1 | Page : 33-36
An interdisciplinary approach to restoration of the severely worn dentition
Anurag Dani1, Sridhar N Shetty2, Chethan Hegde3
1 Dani Hospital, Durg, Chattisgarh, India
2 Department of Prosthodontics, A.B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka;Center for Advanced Dento-Facial and Gnathological Science (CADSS), A.B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
3 Department of Prosthodontics, A.B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
|Date of Web Publication||4-Mar-2011|
Dani Hospital, Durg, Chattisgarh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Dental literature supports the concept that vertical dimension of occlusion is normally not lost in severely worn dentition, and the bite should generally not be opened to facilitate dental reconstruction. Many of us think that an excessive worn dentition results in loss of vertical dimension of occlusion, and that this loss should be regained during reconstruction. However, restoration of a periodontally sound but severely worn dentition, at existing vertical dimension, frequently presents unique challenges in patient management, diagnosis, treatment planning, and restorative methodology. This report reviews and demonstrates a planned approach to this complex treatment situation that can lead to a favourable and predictable prognosis i.e. restoration of a functional occlusion and esthetics along with endodontic treatment, at existing vertical dimension of occlusion.
Keywords: Esthetic, functional occlusion, vertical dimension of occlusion
|How to cite this article:|
Dani A, Shetty SN, Hegde C. An interdisciplinary approach to restoration of the severely worn dentition. J Interdiscip Dentistry 2011;1:33-6
|How to cite this URL:|
Dani A, Shetty SN, Hegde C. An interdisciplinary approach to restoration of the severely worn dentition. J Interdiscip Dentistry [serial online] 2011 [cited 2020 Feb 25];1:33-6. Available from: http://www.jidonline.com/text.asp?2011/1/1/33/77201
A severely worn dentition in the presence of sound periodontium presents unique challenges in the patient management, diagnosis, treatment planning, and restorative methodology. However, a systematized and planned approach facilitates development of optimum oral function, comforts, and esthetics, resulting in a satisfied patient. 
In cases of severe parafunctional abrading activity, such as a long-term habit of betel nut chewing, dental eruption keeps pace with dental wear. Therefore, the vertical dimension of occlusion is not reduced. 
This report illustrates an interdisciplinary approach to restoration of severely worn dentition at existing vertical dimension of occlusion.
| Case Report|| |
A 60-year-old man visited to dental office with the chief complaint of one missing tooth in his lower left posterior region and severely worn dentition in maxillary and mandibular arches, [Figure 1],[Figure 2],[Figure 3].
The systematized approach for rehabilitation is as follows:
1. Patient evaluation
Findings of the recent medical examination revealed a healthy individual with no contraindication for any potential dental corrections. Diagnostic data was gathered in the form of personal history, clinical examinations, periodontal charting, radiographs, study cast and photographs.
Patient had a habit of about 15-20 pan and betel nut chewing per day since 20 to 25 years. On intra-oral examinations shown all the teeth presents except maxillary right and left side third molar and mandibular left second molar. While all teeth demonstrated significant pathologic wear, no clinical mobility was detected except grade I mobility with maxillary first molar, mandibular second molar and grade II with mandibular third molar. The irregular pattern of occlusal wear had resulted in balancing interferences during eccentric mandibular movements.
Absence of overt circumoral symptoms, such as angular cheilitis or profile deviation revealed there was no loss of vertical dimension of occlusion. The vertical dimension at rest and vertical dimension of occlusion revealed around 3 mm interocclusal rest space; this conclusion was reinforced by the phonetic method of recording jaw relation.
On periodontal examinations, gingival recession was present with maxillary right first molar, maxillary left second molar, mandibular left second molar, and mandibular right third molar. On radiographic examinations, mild to moderate bone loss was present with maxillary right first molar, maxillary left second molar, mandibular left second molar and moderate to severe bone loss with mandibular right third molar.
2. Comprehensive treatment planning
The goal of treatment is to improve the functional efficiency, cosmetic result as well as to improve the psychological well being of the patient. An interdisciplinary approach involving an oral and maxillofacial surgeon, a periodontist, an endodontist, and a prosthodontist was planned.
- Oral prophylaxis including scaling and polishing.
- Extraction of mandibular right third molar with grade II mobility and severe bone loss.
- Advised intentional root canal therapy in relation to all the severely attrited teeth except maxillary right second molar.
- Rehabilitation with all the severely worn dentition by porcelain fused to metal (PFM) fixed crowns to enhance the function, esthetic and proprioception. 
3. Planned and systematic reconstruction
After the required investigations and preliminary treatment, the definitive prosthodontic treatment was started. An integrated treatment plan is first developed on one set of diagnostic cast, properly mounted on a semiadjestable articulator using jaw relation records. This is accomplished by modification of teeth on diagnostic cast and diagnostic wax up for fabrication of final restoration.
After extraction of mandibular right third molar and intentional root canal therapy with all the remaining teeth, prosthodontic rehabilitation is initiated. Preparation of all the four posterior quadrants with flat end taper diamond burr (TF-21, and TF-EF21, Mani, Dia-Burs, Japan) was done. Final impression was made with elastomeric impression material (Sofex, GC, Tokyo, Japan). Centric and eccentric bite registration was done at existing vertical dimension of occlusion (Sofex, GC, Tokyo, Japan). After metal try-in and bisque trial, final cementation of glazed ceramic prostheses on the prepared teeth with consideration of functional and esthetic aspects was done. Then preparation of maxillary and mandibular anteriors was done with flat end taper diamond burr (TF-21, and TF-EF21, Mani,Dia-Burs, Japan), [Figure 4]. Then again final impression was made with elastomeric impression material (Sofex, GC, Tokyo, Japan). After metal try-in and bisque trial, final cementation of glazed ceramic prostheses on the prepared teeth was done with consideration of esthetic and functional aspects, [Figure 5],[Figure 6],[Figure 7]. The type of occlusal scheme provided is mutually protected occlusion with removal of all the centric and eccentric interferences.
| Discussion|| |
Restoration of the severely worn dentition at existing vertical dimension of occlusion was done, because this dimension of facial height is constant in the adult. Gradual tooth wear is compensated by continuous active eruption of the dentition at a rate equal to the loss of incisal and occlusal tooth substance throughout the life of a tooth.  In the absence of any pathology, this process keeps the facial height constant. In other words, the vertical dimension of occlusion remains constant. It has shown that a long-term habit of parafunction, such as bruxism, will not reduce the vertical dimension of occlusion.  Concomitantly, under favourable conditions bone will continue to be replaced at the free borders of the alveolar process even into old age.  Continuous apposition of alveolar bone as a tooth erupts to compensate for wear can seriously reduce interalveolar space. 
Worn dentition has been categorized  as follows: (1) excessive tooth wear with loss of vertical dimension of occlusion; (2) excessive tooth wear without loss of vertical dimension of occlusion and with adequate interalveolar space for reconstruction of dental material; (3) excessive tooth wear without loss of vertical dimension of occlusion and with extremely limited space for reconstruction of dental materials. The second and third categories result from continuous eruption and varying degrees of bony apposition on the alveolar ridge.
| Summary|| |
Restoration of the severely worn dentition presents a substantial challenge to dentist. Since vertical dimension of occlusion in the adult is considered to be an individual constant, the severely worn dentition should be reconstructed to that dimension to avoid causing pathology by opening a patient's bite. In such cases, the correct diagnosis is vital so that an interdisciplinary treatment approach can be established for successful treatment and the longevity of the restoration for the patient. 
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]