It is routine to see patients with lower incisal edges that are worn into the dentin. The wear can be from attrition or from erosion, and is often a combination of the two. When dentin is exposed and the wear is progressing at a rate that is not age appropriate I want to do something to protect these teeth and slow the progression of the damage. When I think about possible restorative options I want to do what is appropriate, stay conservative if possible and manage the restorative challenges that are present with lower incisors due to their size and shape. These factors combined with the fabulous properties of our new composites have me using direct composite more and more in these situations.
In yesterday’s post I looked at some of the esthetic decision points in anterior tooth form and incisal embrasures. The consensus is that esthetic design is about what we and our patient find pleasing, not about specific rules related to embrasure form. On the other hand incisal embrasures serve a very critical functional role. When we violate this functional space in order to alter esthetics the consequences can be broken composite or porcelain.
There are many pieces of altering a patient’s bite that can be challenging if they are unknown. The first question that comes up for me, is why is the patient experiencing a change in their occlusion. The answer could be related to a change at the level of the joints, muscles or teeth, but having an understanding of the cause allows the patient and I to understand the risks and benefits.