Lengthening teeth worn from bruxism - Replacing lost tooth length and Creating uniformity

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Replacing lost tooth length - Custom Smile Design

New porcelain technology has an answer for nightime grinders.  E Max porcelain can be used in a monolithic form (one layer) that is very strong and unlikely to chip. This resident of Chicago's Gold Coast was referred to Dr. Fondriest by her general dentist for a second opinion and treatment. She wanted very specific tooth shapes and took an active role in designing how her new smile was to look. She also wanted to have little or no tooth structure removed during the process. Her treatment consisted of crowns to replace her old crowns, minimal preparation (Prepless) veneers on her incisors, and normal veneers to replace her old veneers on her eye teeth.  Her goals to have a more symmetrical smile with teeth that had more uniformity of color and were not worn.  She was happy she chose to get a second opinion.  See her portrait.

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Nighttime grinding and bruxism cause tooth wear

This patient was a heavy bruxer.  She guestimated that she had worn at least 25 night guards over most of her adult life. Even though she was faithful with wearing her nightime appliances, she still occasionally would fall asleep without protection and would grind her teeth aggressively. She really wanted a nicer smile but was worried that she would break her dentistry just like she did her natural teeth.  Over the years, this patient had many dental procedures done including composite bonding to fix a chip, veneers on her cuspids (eye teeth) to brighten them, and crowns on both the upper right and left posterior teeth.  The dental work was all competently done and was capable of lasting for many more years of service.  The problem was that the old restorations did not look nice.  They did not match and did not compliment her smile.  She also wanted the length and feminine tooth shapes back that she had lost many years ago from the nightime bruxism or tooth grinding. 

 

E Max Monolithic Porcelain is ideal for replacing lost tooth structure due to bruxism (nighttime tooth grinding).

The newest porcelain to enter the dental world is EMax. Normally, like all of the other non-metal ceramic restorations, it comes in two layers, a strong coping substructure that has a tensile strength of 400 megapascals (MPa), and layered on top of the supporting coping is a veneering porcelain that allows custom characterization that averages 85 MPa tensile strength. Normally, 85 MPa porcelain is plenty strong for long term service restorations.  Occasionally, this veneering porcelain can chip and fracture when a patient grinds heavily.  All of the strongest ceramic non-metal restorations (e.g. Procera, Zirconium, InCeram, etc.) rely on a less attractive supportive ceramic coping simply for strength and not esthetics.  The above referenced ceramic choices all rely on the stacked veneering porcelain to cover the unattractive coping substructure and to simulate the optical characteristics of natural teeth.  The E Max pressed coping substructure has beautiful natural optical characteristics on its own and does not have to be covered over with the weaker veneering layer.  Beautiful and very strong one layer restorations (E Max Monolithic) without the veneering porcelain can be made.  Recent studies show that even the most aggressive bruxers do not been break the monolithic coping porcelain.  The restorations in the featured case above were created with 95% EMax Monolithic with only a small buccal window of veneering porcelain used.