Compensating Extreme Occlusal Wear With Composites – A Photo Essay

Male patient in late 40s with extreme wear and awareness of habit of heavy teeth grinding.

The patient is interested in repairing the damage but does not have the financial resources to take on this large a reconstruction all at once.

I am uncertain and unsure of what I can place in his mouth that he will not destroy. In 40+ years he has managed to destroy his natural dentition.

Things in favor are his commitment to follow any and all instructions to prevent accruing damage. He has reasonable good periodontal health, does not have any other damage causing habits like smoking or sugary drink consumption.

So the treatment plan was to rebuild the occlusion with composites in Centric and make provisions for patient innate tendency to be heavy on the chewing and excursive movements from centric. Provide him with an Occlusal guard for night time wear.

The results were more than we both hoped for but at this point both of us knew that the longevity and prognosis of the restorations were very guarded.

This was the design of the occlusal guard delivered. Occlusal guard was modified with an incisal flat table and adjusted for even mandibular teeth contact.

Case completed in Oct 2014

1 Year later: Nov 2015

Some chipping of composite on the mandibular teeth and some wear on the incisal of # 10

All credit to the patient for being extremely careful in his eating habits and also being extremely diligent about the occlusal guard use. His other claim that his sleep had improved I had to discount but gladly accepted the credit for it though!

With his heavy chewing and grinding habits, I was skeptical if these would have survived past the first few months let alone a year.

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