A “real"smile

“For the last step of the rehabilitation, we keep our progressive and prudent approach", states the head of department. The dentist removes the transitional resin prostheses by milling. He replaces them by facets and ceramic overlays which have been made in the prosthetics laboratory. These prostheses are bonded to the teeth. The new elements placed in the mouth continue to raise the worn teeth, to reconstitute them just as the previous resin did.

He continues, “We only proceed by dealing with 2 or 3 teeth at a time. This precaution allows us to keep our occlusal bearings”, he adds. In extreme cases of wear, as with this patient, the restorations involved both sets of teeth. However, it is possible to envisage a situation where only the most affected set of teeth are affected.

Then... the dentist’s work is finished and the patient has got back a real esthetically pleasing smile as well as adequate function.  Nevertheless, when the origin of the problem was an abrasion, the wearing of a protective night splint remains obligatory. After so much time-consuming, delicate and very expensive work (up to several thousand Euros), it would indeed be a “costly” to restart a process of tooth wear...

"The ceramic prostheses which have been fitted to the teeth are not intended to be subjected to excessive erosion. They are fitted on teeth that are fragile to start with. Continuing to take risks would be all the more regrettable because fresh erosion would rule out bonding techniques. The patients must therefore be aware, motivated and be actively involved in the follow-up to the development of their treatments", states the practitioner. In the case described by the article, one year after the treatment no complication was reported by the patient…

Current statistics show that this three-stage approach yields good results for up to five years, with a success rate comparable to the prosthetics techniques that were used before bonding changed the face of dentistry . “The numbers show that, even on very damaged teeth, bonding does not risk failure", insists Prof. Vanheusden. Are the techniques described here superior to “traditional" procedures ? For the moment, in the absence of sufficient experience, we cannot say yes. However, the head of the dentistry department is convinced that they are. “A crown is much more aggressive procedure than bonding: in order to fit a crown you need, for example, to remove 3 times more tissue near the gum than for a facet bonding. From a biological point of view, the bonded facets are much less aggressive. They represent immense progress making it possible to achieve great things even in very advanced cases”.

Currently, faced by the difficulties of treating cases of very advanced tooth wear, a large number of dentists prefer to send the patients concerned to university services such as that of Prof. Vanheusden. Others follow the training and retraining offered (for example in Liege), in order to become familiar with the procedure that needs to be scrupulously followed. Some are already applying this procedure. In all cases, what is important is that the message gets through: tooth wear or erosion must be treated as soon as possible in dental practices or by a specialized service. And even for critical situations there are efficient solutions. A demonstration perhaps that tooth wear does not win.