Sameer Puri D.D.S. This past week, I had the opportunity to sit through the Treating the Worn Dentition course with Dr. Frank Spear and the rest of the Spear faculty. He showed some amazing examples of systematically restoring severe wear cases. There were many pearls to take away from the seminar, but one in particular is burned in my mind.
If a patient is going to brux and grind – and we decide to restore that patient, chances are they will not stop bruxing no matter what type of porcelain we put on the teeth. I know there is a ton of controversy on bruxing and wear, but suffice it to say that I agree with Dr. Spear: If that patient has worn down their teeth, worn away the linguals or just ground stuff away, chances are that they will do the same to the porcelain that we put on them. Changing their occlusion or putting them in a night guard will cause them to simply grind on the guard, but won’t stop their destructive behavior.
But you have to differentiate patients who have pathologic wear from those patients who have some form of erosion going on – whether it’s from GERD or other some form of acid, such as the soda they are drinking. These patients will need to be treated very differently. How do we determine if a patient has worn their teeth from acid reflux or from simply grinding? Which do you think is going to be safer to treat?
One key that you can look at is the wear facets – are they shiny or are they cupped and dull? Shiny means that the patient has been grinding – and after treatment, they will most likely continue to grind, breaking all that beautiful porcelain that you placed. However, if that wear facet is cupped – not shiny and flat – most likely it’s from some form of erosion or acid damage to the teeth.
The former will be a nightmare for dentists, as you don’t know what the patient will do to your work in the future. The latter is easy – fix the teeth, address the erosive agent and chances are the patient will be just fine.
How does this apply to CEREC? The type of wear and the type of wear facets will play a large role in the material you choose. If my patient has shiny facets, lots of wear – I better use the strongest material with perfect bonding and appropriate reduction. If the patient has wear from erosion, then material strength is not as critical.
