A change of philosophy

Dr Vanheusden’s article concerns a clinical case (case report): that of the complete restoration of the mouth of a 34 year old man. He was affected by severe generalized  wear (see photos). As well as the unseemly aspect which this gave to his smile, the patient suffered from dental sensitivity: this sensitivity increased when he ate or drank cold foods.  

The patient didn’t smoke and did not take any medication that might explain the worn state of his teeth. On the other hand, during his anamnesis (the questions asked by the practitioner) it was revealed that the patient consumed large quantities of a well-known sweet soft drink-up to one liter per day. Added to the erosive lesions caused by the drink in question, the patient used a hard tooth brush and an inadequate brushing method. To complete the picture, this man also had the bad habit of gritting his teeth during moments of stress or tension.  

Prof. Vanheusden’s treatment plan aimed to restore the anatomy, function and esthetic aspect of the worn teeth. It was also neccessary to protect the latter against any further tissue wear. This vast program was not the only objective set by the practitioner: “Recent developments in dentistry have led us to focus, where possible, on having a conservative approach. This means limiting any further reduction in the tissue levels that are already present”, he explains.  

At this stage, in order to fully understand how this approach is partially new it will be necessary to take a look at the recent history of dentistry. This historical detour concerns the “traditional” therapies suggested to patients suffering from this kind of problem. “When confronted by the problem of tooth wear, some practitioners try to temporize. For example, they suggest compensating for the wear by placing a composite (a kind of  dressing) on the tooth in order to fictitiously reconstruct it”, says the practitioner.

“In reality, this solution is similar to putting plaster on a wooden leg”, says Prof. Vanheusden. “The composite is far from being a solid enough material to resist problems. It certainly answers the sensitivity problem felt by patients but this is its only contribution. In addition, the composite placed on the tooth is quite voluminous and is often associated with renewed decay (under the dressing). Obviously, this causes the tooth to deteriorate even more”.

The other option with regard to more “traditional” dentistry consists of waiting while doing nothing... Once the wear is well-advances, the dentist suggests placing crowns on the teeth in question. These are kinds of shells (generally ceramic) which cover the teeth entirely and are designed to compensate for wear by giving a new external anatomy to the teeth.

However, in order to place crowns, it is necessary to cut into the tooth tissue. “Therefore it is a process that necessarily causes a further reduction in the tooth tissue. Very often, root canal work is also necessary requiring the fitting of a screw into the root which makes it more fragile and involves a risk of future fracture”, explains Dr. Vanheusden. For a long time, there was no other choice: in order to reconstruct teeth and give them back some “height”, only crowns were possible. But times have changed thanks to the appearance and development of a technique known as bonding.

A binding future

From here on, dental bonding techniques, which have been developing since the 1990s have made it possible to adopt another approach which is considered to be minimally invasive. “By using bonding techniques, we succeed in reconstructing teeth, restoring their anatomy and all this without reducing the tissue levels of the tooth any more than is absolutely necessary. Our objective consists in placing implants that are as light as possible, preserving teeth that are already worn and fragile without harming them any further”, explains Prof. Vanheusden.  In dentistry, this minimally invasive approach is a veritable revolution which is of great benefit to the patient.