Smile Makeover for Worn Down Teeth and Bruxism

This a case of a patient with severe wearing down of the teeth approximately 3 months ago. Patient A came to visit Dr Bashar Al-Naher with severe wearing down of his teeth to the point that over half the length of his front teeth had disappeared. The initial photograph shows the extent of the wear and the discolouration of the teeth.
Dr Bashar gave the patient an extensive examination and from the history and examination, it was apparent that the wearing down of the teeth were as a result of a combination of bruxism, which is a habit of constant grinding of the teeth. The patient also had some molar teeth missing and thus had a limited area of teeth to bite on.

Bruxism or grinding of the teeth is a common habit among many people. It is often an unconscious activity of clenching or grinding the teeth most often at night but also during the day. It results in considerable tooth wear over the years and allows teeth to lose their length, sometimes as in this case, in a quite a dramatic way.
In addition to this, if patients have some molar teeth missing as it the case with this patient, then all mastication will take place on the teeth that are more anterior. This places severe forces of attrition on the front teeth and again allows the loss of the height of the teeth.

In the case of patient A, the loss of tooth length, especially in the front upper and lower teeth had become so advanced that if there was anymore delay to treatment, it would have been difficult to carry out dental crown treatment on what’s left of the remaining teeth, due to the lack of sufficient tooth structure available.
In addition to this, the patient was quite concerned about the unaesthetic appearance of the heavily worn down teeth as it made him look much older as well as the colour of the teeth looking quite dark too.

The options for treatment were either to do nothing with dire future consequences or to cover all the upper and lower teeth with dental crowns to protect the existing teeth as well as restore the original height and appearance of the teeth.

This was explained to the patient and the patient opted to go ahead and save the teeth with crown coverage.
A technique called smile makeover or smile design was used, whereby the size and length of the teeth were designed digitally on a computer and a 3D model was prepared. This 3D model was used to make temporary crowns after the teeth were prepared for crowns. The patient was given a few days to decide if he wanted any changes made to the temporary crowns so that the design of the final crown could be decided.

Finally, the patient had the permanent crowns placed on the teeth and after approving their appearance, the temporary crowns were fitted with very adhesive cement. The crowns used were highly aesthetic Zirconia crowns that are also very strong and thus will withstand any severe forces on the teeth. Zirconia crowns are also resistant to wearing down as a result of the forces of mastication as well as any grinding by the patient.

All treatment sessions were carried out using our very own and unique Enjoyable Dentistry Technique using a combination of nitrous oxide and oxygen sedation as well as relaxation instructions and guided imagery. This guarantees that the treatment is not only totally pain-free but also comfortable, relaxing and even enjoyable.
The patient was extremely happy with the end result as can be seen in the photo. His google review is also available to read below.
‘I have been with Dr Bashar for more than 10 years. He is very professional and a very caring dentist, I’m going through the process of smile design and I did not feel any pain during the procedure. I feel that I can smile again and be confident again, thank you so much for my new smile. I have the best smile thanks to Dr Bashar. Also the team are very helpful, friendly and knowledgeable’



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