Recently I was invited to be a guest in one of the local Spear study clubs and one of the dentists presented a case with severe wear on the lower front teeth and the patient is really unhappy about how they look. These cases are tricky to treat. Wear issues on the lower front teeth do not just happen over night. They happen over a long period of time. The wear facet is really a result of the functional path left by the patient’s years of mandibular jaw movement. They are unique.
However, because of the unique location of being in the lower front teeth, they often cause some concern to the patient, mostly for the aesthetic reason. They just don’t look that pretty. Or because they look so unpleasant some patients may think they will fall out and require intervention.
Trying to find a solution for these wear cases gets tricky. The usual textbook answer would be to correct the bite…orthodontically, surgically or whatever means….or consider full mouth reconstruction….or extract them and consider implant therapy.
In my personal experience, some patients are often not fond of these solutions…especially if they are not young….
When they do decline the first treatment option of correcting the cause of the wear, then I will try to offer another solution.
In this case, the patient was not happy with the localized wear of the lower anterior teeth due to his deep overbite. I had suggested orthodontic treatment multiple times. After going through the consultation, the patient decided not to have orthodontic treatment. So I told him that if I have to improve the appearance of the lower teeth, he will need some root canal treatment and periodontal treatment.
He also struggled with the ideas of root canal and periodontal treatment for several years….then finally decided to go with the treatment.
By no means do I think this is ideal treatment…the colour does not match the posterior teeth…but this is the treatment the patient had selected….frankly he was very happy….and grateful for the work I did for him.
I want to post the case here because I know many dentists see these cases in their practice and struggle the same way to help with their own patients. It would help to see the before and after treatment so we can appreciate the possibility. Looking at this case again, once the periodontal treatment has been done, another treatment option may be to do adhesive dentistry to improve the appearance of these teeth. The only downside to this is the possibility of post operative sensitivity if major recontouring is done to improve the alignment of the lower teeth. Occlusion is also tricky to provide the form that respects the functional path.
I hope you find this post helpful. Thanks for reading!
