hybrid ceramic

severe anterior teeth erosion

Restorative management using hybrid ceramic of a patient with severe tooth erosion from swemming : a clinical report

START

Index

9. material.

1. patien..

5. treatme..

10. tooth p

2. history..

6. decision

7. prep&im.

11. final im.

3. examina..

4. figs

8. provisin..

12. lap fabr

13. try in

14. post tre

15. conclusi

introduction

what is dental erosion ?

Dental erosion occurs when acids dissolve away part of the enamel surface of your teeth. its usually caused by acidic drinks or medicins, excessive vomiting or acid reflux. Erosion is not caused by bacteria, so it is different to tooth decay. Dental erosion can occur at any age. But it can be particularly severe in elderly people with dry mouths if they don’t produce enough saliva to flush out and neutralise acids.

signs of enamel erosion

1. dents on teeth
2. discoloration or yellowish teeth
3. chipped teeth
4. sensitivity

the aim of this case

is to describe the clinical apperance and treatment approach in a case of severe dental erosion caused by swimming in a poorly maintained swimming pool with low pH pool water by using Hybrid ceramic material to examine its durability and longevity.

MATERIAL AND METHOD

1. Patient Background

• 48-years old male with chief complaint of hypersensitivity and easthetic concerns of anterior teeth.
• Visited a private clinic for dental treatment.

2. Patient History

• No obvious intrinsic or extrinsic causees of erosive lesion.
• Rarely consumed acidic foods or beverages
• No signs of acid regurgitation.
• Routine swimming for 3 months.
• Anterior teeth erosion noticed after swimming.
• Extreme sensitivity led to discontinuation of swimming.

3. Examination Findings

• loss of enamel on labial and incisal surfaces of maxillary anterior teeth .
• Mandibular incisors with enamel loss on facial surface and excessive reduction of incisal edges .
• Diastemas and uneven incisal plane.
• Well-defined finish lines resembling veneer preparation.
• No dental caries or periodontal issues.
• Normal pulp vitality.
• Anterior open bite due to loss of tooth structure.

Preperation and Impression

To fabricate diagnostic casts, irreversible hydrocolloid impressions will be taken, and a face-bow transfer will be made. The casts will be mounted in maximum intercuspation on a semi-adjustable articulator. Then, a diagnostic wax-up will be made on the casts with the optimal tooth proportion and with 1 mm horizontal and vertical overlap

The wax-up will be transferred to the patient’s mouth using the direct intra-oral mock-up procedure with bis-acryl provisional material We will adjust the mock-up to obtain desirable esthetics, phonetics, and function, and it will subsequently be duplicated for use as a guideline for fabricating provisional restorations

Provisional Restoration

Splinted provisional restorations made with heat-polymerized polymethyl methecrylate before the tooth preparation

Material Choice

Insufficient remaining tooth structure for composite resin or veneer

Complete coverage metal-free crown restorations made from Vita Enamic will be chosen as the treatment of choice for long-term durability and esthetic satisfaction. The minimum thickness required to ensure clinical success of restorations made from VITA ENAMIC is at least 0.8 mm circumferentially. Therefore, the amount of tooth reduction required is less than tooth preparation designs for other all-ceramic materials.

Tooth Preparation

Maxillary incisor and canine teeth will be prepared for full coverage metal-free crowns

• Maxillary incisors and canines : 1mmwide chamfer finish line
• Mandibular incisors : 0.8 mm wide chamfer finish line
• Rounded internal line angels.

final impressions and shade selection

Definitive impressions will be made with addition silicone

• Shade selected using Vita 3D Master System

lab fabrication

Pindexed casts sent to an outside laboratory Final restoration received

Clinical Try-in and Adjustment

Comprehensive esthetics, function and phonetic were evaluated. The edge-to-edge occlusal relationship was established in this case .The intaglio surfaces of the restorations were treated with 5% hydrofluoric acid (VITA CERAMICS ETCH, Vita) . The etching gel was completely removed. Silane was applied to the intaglio surfaces of the crowns and dried completely.

Post Treatment Result

• Disappearance of discomfort and tooth sensitivity.
• Patient advised on swimming pool maintenance and oral hygiene care.
• 6-months follow-up with no complications.

discussion

Previous clinical case reports and in vitro studies have indicated that low pH swimming pool water can contribute to enamel erosion, particularly on the anterior teeth. In this particular case, the patient had a habit of frequently swimming in an improperly chlorinated pool, which aligned with the clinical findings of dental erosion caused by exposure to poorly chlorinated pool water. To restore the patient's teeth, full coverage restorations were chosen for optimal esthetics, function, and long-term durability. A hybrid ceramic material called Vita Enamic was selected due to its conservative tooth preparation requirements and resistance to chipping. The restorations were cemented using adhesive resin cement, which forms a strong bond with the hybrid ceramic material. This approach has shown to exhibit higher fracture loads compared to conventional cementation methods. The esthetic outcome of the hybrid ceramic restorations was satisfying for the patient. Additionally, the patient received oral hygiene instructions and was educated about the detrimental effects of swimming in a poorly-maintained pool, which can lead to severe tooth surface loss. Long-term clinical performance will be monitored for this case

Expected result

• Diagnosis and treatment procedure for severe anterior teeth erosion presented.
• Hybrid ceramic restorations provided desirable easthetics, phonotics, and function.
• 6-month follow-up with no complications.
• Long-term follow-up and monitoring planned for at least 3 years.

fig(7) aesthetics characteristics.

thank you

any questions ?