514 - Case study: Challenges in the management of a patient with severe pathological tooth wear

F Niazi
Presented by: Fatima Niazi
Cardiff Dental Hospital

The objective of this case report is to highlight the importance of the early detection and management of tooth wear by detailing the treatment of a 49-year-old female who presented to the restorative department with severe tooth wear and failing direct composite restorations. Her tooth wear was primarily attributed to attrition and erosion. She demonstrated a significantly reduced occlusal vertical dimension with compromised aesthetics and function. After all treatment options were given, the patient was committed to retaining her remaining maxillary teeth. To enable this a staged approach to treatment is required involving surgical crown lengthening, orthograde endodontic treatment followed by post-core-crowns and the provision of a partial maxillary denture and a complete mandibular over denture. Due to the limited tooth structure remaining surgical crown lengthening was required to achieve a ferrule of circumferential dentine at least 2mm in height and 1mm in thickness. This facilitated the placement of rubber dam for orthograde endodontic treatment and will enable the provision of indirect restorations with a more predictable outcome. As a sufficient ferrule has been shown to improve fracture resistance in teeth which have been endodontically treated. The benefits of surgical crown lengthening are already apparent and definitive indirect restorations will be provided six months after the procedure to ensure a stable position of the free gingival margin has been achieved. Conclusion: Patients suffering from tooth wear may delay presentation and seeking treatment for a number of reasons but it is essential that they understand the implications this may have on future management options. It is important to recognise that pathological tooth wear can severely impact a patients oral and psychological health.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers or the Editor of this journal..

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