Anterior Teeth Wear - Treat or Ignore?

Anterior teeth wear usually exhibits a classic pattern where the canines will get ground down first, followed by the front four teeth. It is a challenge to restore and maintain this kind of bite profile. If we go by the belief that enamel is sacred and that we should never grind away teeth to restore them with porcelain,  then allowing the teeth to destroy themselves to tiny short stumps goes against this belief.

If we restore early enough and the patient is diligent with night guard wear, then the treatment can be predictable and effective.

Anterior bite problems dictate length, shape, and position of the anterior teeth.  Hence, on occasion where dentists and patients may mistakenly violate the mechanical principle of the bite at the expense of esthetics, then one can expect the bite to fight off anything that is in its pathway.

By choosing not to treat an anterior bite case, the teeth will wear themselves away.  In the case below we can see the actual opening of the nerve canals on the front teeth.  Severe wear cases also leave us with very little tooth structure to work with.  Hence, anterior teeth wear should not be ignored.

Smile Make Over for Men

Some of the fun artistic cases for me involve changing the smiles for men.  In the case below we used a combination of gum contour, resin bonding on the canines, porcelain veneers on the lateral incisors, and porcelain crowns on the central incisors to change the patient's smile. We replicated details like the patient's natural shade transition and the surface characteristics to make the restorations look as natural as possible.  When we try to achieve a natural look, length, shape, contour, are also intentionally made slightly imperfect because in the natural dentition perfect symmetry among the teeth rarely exists.

Actual patient images of Alex Nguyen, DDS are copyrighted and digitally embedded to prevent unauthorized use.

Digital Dentistry is Here !

Digital Dentistry is here for many different types of dental prosthesis. In this case we were able to convert an optical scan of the models of a denture-type prosthesis into 3D Digital images.  From there we modified the position of the teeth to enhance both the esthetic and functional components before milling out individual acrylic temporary prosthesis which fit precisely in the patient's mouth.  The prosthesis in this case will actually be held in place by dental implants in both the upper and lower arches.

By doing the refinement work digitally, we can eliminate extra appointments time required to perfect the result of all types of prosthesis.

The images below came from an actual case which we will deliver to our patient next week.  If you have the need for these types of implant retained prosthesis please contact our office for further information on treatment options.

What Does it Mean when a Tooth Fractures?

When posterior teeth such as the molars fracture, there is usually a correlation with anterior teeth wear and fracture as well. In the ideal bite, the anterior teeth length, contour, and position help guide the joints to move properly.  This front teeth feature called "anterior guidance" also helps prevent the back teeth from contacting when the patient grinds on the teeth from side to side.  When the anterior teeth are misaligned and/or have been ground down by the bite force, the posterior teeth can begin to come into contact during the grinding movements.  The excess bite force on the back teeth can then create fracture lines on the teeth over time, and eventually can cause the tooth to fracture.

In the case below, a patient presents with a fractured molar.  A close up look at the anterior teeth reveals multiple wear facets and fracture lines on the front teeth as well.  The bite force has taken a told on this patient's dentition, and fractures on the teeth and his restorations are inevitable.

In another case below the patient's bite simply split the molar into two halves:

In a different case below, the patient also presents with molars ground down significantly. The old porcelain crowns also have been ground down to expose the metal core inside.  A close up look of the anterior teeth profile allows us to match the shape of wear facets of upper and lower teeth together like pieces of a jig saw puzzle.

Uncontrolled bite force is one of many causes for the destruction of people's teeth throughout their life time.  If the above cases remain untreated, the teeth can eventually wear themselves down to little nubs over time.  If the cases are treated, they must be recognized as scenarios which require careful monitoring and adjustments during the patient's regular check-up appointments. Moreover, additional preventive measures such as night guards are crucial in helping the teeth from being destroyed when the patients grind uncontrollably in their sleep.

It is important to understand that bite related cases require a life time of maintenance and handling by the right clinician.  The over all picture of the bite must be evaluated and treated comprehensively rather than simple tooth by tooth treatment.

Happy Holidays !

May the spirit of the Holidays bring you and  your families great memories, laughter, and joy.  From our team to you, a big Thank You for choosing us to take care of your dental needs. Thank You for all the candies, home baked cookies, home made foods, wines, and greeting cards you have brought to our office in the last few weeks.  It really made our Holiday Season special, and we cannot thank you enough.  Cheers !