Treatment of severely worn teeth

When teeth are severely worn, it is necessary to replace the structure which has been worn away with an artificial material which is at least as hard as the missing enamel. The two materials best suited for this are gold alloys and porcelain. The gold used to restore teeth ranges from 10 to 18 carat gold depending on the application. Gold of greater purity is too soft to resist new wear. Often porcelain is used to cover the gold to make the restoration appear lifelike. Using crowns or fillings which are all-porcelain is not reccommended in patients with severe wear since the porcelain is prone to breakage when not bonded to a gold substructure. Most gold alloys used with porcelain appear silver in color due to the palladium and platinum which must be added to the gold to raise its melting point past the temperature neded to fuse the porcelain to the crown. (See crowns for a description of how crowns are made and how they work.)

The first step when treating a patient with severe wear is to determine how much the vertical height of the face has been lost due to shortening of the teeth. When wear is rapid or occurs evenly on all the teeth at the same time, the jaws must close farther before the teeth touch.

Loss of verticle height of the face. (22K jpeg)

This image shows a patient with severe loss of vertical face height. Note the sunken upper lip and creases at the corner of the mouth.

Restored vertical height of face.

Here the same patient as above has had the teeth restored. Note the improved profile and decrease in creases in the lips.

Same patient as above from the front before and after restoration.

Here the same patient as above has had the teeth restored. Note the improved lip contour, appearance of the teeth and decrease in creases in the lips.

Casts of teeth veiwed from the side. Plaster models, called casts, are made of the patient's teeth to allow visualization of the mouth from all angles. In this case the vertical height has been severely reduced. The loss of lower back teeth has allowed the upper back teeth to continue to grow down. This is a common occurence and is called "extrusion". It can happen to any tooth when the opposing tooth is extracted and not replaced.

Worn teeth without loss of vertical face height.

Occasionnally wear will occur only in the front teeth and the teeth and gums will slowly extrude as the wear occurs. When this happens the teeth get shorter and no loss of vertical face height occurs. When this happens it becomes much more difficult to restore the teeth to the proper height because if only the worn teeth are made longer, they are the only teth that will contact when the patient closes. Either all the teeth must be lenghtened with crowns, the extruded teeth must be pushed back into the gums with orthodontics, or some of the gum tissue must be removed to make the exposed portions of the extruded teeth long enough to be crowned without increasing their height.

Plastic splint made over the upper teeth to test the amount of increase needed..

Whenever it is determined that an increase in the vertical face height is needed to make the teeth longer, the amount of increase should be tested by the dentist before proceeding with the crowns. This is most easily accomplished using a plastic splint which fits over the upper or lower teeth. The splint is made such that it mimics the amount of increase in height anticipated by the final result of the crowns. If the patient can wear the splint comfortably for a week of two with no increased clenching, headaches, TMJ problems or muscle soreness, then the treatment can procede. If the patient developes any of the aforementioned symptoms, it is possible the patient can not tolerate the amount of height increase required. Although this is not usually the case, it is best to know if a potential problem will ocur before thew teeth are prepared for the crowns.

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