Restoring severely worn teeth can be extremely challenging. It takes proper engineering of the case to allow the chewing muscles, joints, jaw position, and teeth to all be in harmony. We completed this case seven years ago. Our patient had moved out of the area ever since, but he returned this week for me to check on a back molar which was fractured from chewing a "Jaw Breaker" candy. In the Pre-Treatment condition, the teeth were severely worn down due to uncontrolled grinding. After the patient had gone through proper orthodontic treatments, we began by adding composite resin to reestablish new length, contour, and contacts of the upper teeth. We let the patient function in the added resin for some time, and watched for stability in all aspects of the dentition. We then prepped the teeth for porcelain restorations. This case was done with minimal reduction of tooth structure to ensure the strongest possible bond strength between porcelain and enamel.
The shade chosen for this case was intended for a natural realistic look. Proper contour, length, and surface characteristics created seven years ago still looked great today. With proper coordination between the clinician and ceramist team; as well as the cooperation of the patient, a difficult case can be completed with optimal result. Normal conversational distance cannot discern the teeth from being real or porcelain.
It is important to note that when a bite can wear down a patient's natural teeth, it can also wear down restorations that are placed in the mouth. To prevent further damage and destruction of the dentition, whether restored or not, a night guard is an absolute essential in a patient's daily routine.