Contemporary management of minimal invasive aesthetic treatment of dentition affected by erosion: case report

Boitelle BMC Oral Health (2019) 19:123 https://doi.org/10.1186/s12903-019-0807-4 CASE REPORT Open Access Contemporary management of minimal invasive aesthetic treatment of dentition affected by erosion: case report Philippe Boitelle Abstract Background: The paradigm shift obtained with new dental materials permits minimally invasive dentistry, by following a biomimetic approach. Erosion increasingly affects the adult population through dental substance loss by acid attack. Oral rehabilitation is often extensive and requires careful mouth examination and treatments codified in the literature. Case presentation: This clinical report proposes a reasoned approach to erosion treatment for a 39-year-old male patient presenting several old fixed prostheses. These old restorations are all of correct quality and are retained. The temporomandibular joint was free from disorder. Only defective reconstructions are remade together with eroded teeth, according to a three-step technical protocol. In the first step, mock-up manufacturing is performed which occlusal vertical dimension increased to 1 mm provoking passive dental overeruption to the second and third molars. In all, one ceramic crown was remade, and two ceramic onlays and a resin composite were integrated on the posterior teeth. The last step consisted of palatal veneers on the maxillary incisor and canine, and an aesthetic resin composite on the incisor edge. After these treatments, regular assessments were carried out at 4 months then at 6 months with visual, photographic and radiographic examinations. Conclusion: The present dental care philosophy is to preserve dental tissue as much as possible, even in large erosion cases, and to respond to the aesthetic and functional expectations of the patient. This methodology requires a thorough evaluation phase, compliance with the protocol and regular patient follow-up. Keywords: Erosion lesion, Biomimetic, Aesthetic, Prosthetic rehabilitation Background The evolution of the constituent materials of prosthetic restorations and their assembly systems have led to a real paradigm shift in the field of fixed prostheses. Contemporary dentistry has freed itself from the principles of preparation and mechanical retention, which are always unavoidable for conventional fixed prostheses, causing the decay of the dental organ [1, 2]. The challenge, according to Magne et al. [3], is the maximum preservation of dental tissues by implementing this minimally invasive dentistry and replacing, almost exclusively, the lost dental tissues [4–7]. Since, indications relating to partial restorations have been considerably Correspondence: Department of Prosthodontics, Surgeon Dental Faculty, University Lille – CHU de Lille, Lille, France extended to cover even extreme cases of substance loss [2]. The biomimetic approach guides us towards reasoned and carefully thought out dental preparation based on the scrupulous analysis of the location, the architecture and the volume of the lost substance [8]. Dental erosion is now considered a public health problem. The prevalence of tooth structure loss is between 25 and 30% of the adult population [9, 10], and this rate increases with age because the effects of wear accumulate over the course of a lifetime [11]. The excessive intake of soft drinks is one of the etiological factors regularly observed. Clinical diagnoses are based on the compilation of index and use classifications [12]. When tooth brushing is performed well, the risk of caries is limited but teeth are always exposed to acid attacks. Wear can affect many teeth, leading to a decrease in the occlusal vertical dimension (OVD) and the supraeruption of teeth © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Boitelle BMC Oral Health (2019) 19:123 [13–16]. Full-mouth rehabilitation may be required in cases of severe erosion without early care. Clinical activity shows that old reconstructions next to worn teeth in certain patients are in relatively good condition. The “threestep technique” protocol, described by Vailati et al., has demonstrated that additive dentistry that minimizes iatrogenic acts is possible [17–19]. The daily application of all these guidelines must be pragmatic and carefully considered [20]. Indeed, given that these existing excellent restorations simply should not be remade, the treatment therefore consists in restoring them by adding material to the eroded teeth. This article illustrates a clinical situation in which a case of dental erosion was addressed using the principle of additive dentistry and the three-step technique in patients presenting several old fixed prostheses. Case presentation A 39-year-old man visited the dental clinic due to the evolution of his worn teeth, in particular the maxillary incisors. His medical history revealed massive soft drink consumption. Clinical and radiological examinations showed the presence of amalgam at the maxillary right first molar, and resin filling with carious recurrence at the maxillary right first and second molars. Moreover, the mandibular left first molar was subject to carious recurrence below its metal-ceramic crown, requiring its reconstruction (Fig. 1). The loss of non-carious substance affects the maxillary incisors, canines and pre- Page 2 of 8 molars. Severe erosion of type “grade 2” was detectible, with the loss of enamel and dentin surface exposure. The occlusion study underlined that the prosthetic space left by substance losses was not sufficient to obtain the necessary thickness of reconstitution materials. The examination showed no pain during temporomandibular joint and muscular palpation. The patient didn’t report elements suggestive of bruxism. However, the necessary increase in the OVD was estimated at 1 mm inter-incisal. Facial and dental aesthetic analysis revealed no facial asymmetry and no deviation of horizontal facial lines. Analysis of the shape of the maxillary incisors confirmed the loss of substance at the free edge of the incisors and canines, which was the cause of the disturbances of the curvature of the aesthetic frontal curve (Fig. 2). In this clinical context, the complete rehabilitation of the mouth was proposed to this patient. After discussion with the patient, the decision was made to take a very conservative and reasoned approach to the treatment. The integrity of the residual dental tissues was preserved using adhesive techniq (...truncated)