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 most of these cases restoring the teeth becomes a combined procedure with an occlusal adjustment or equilibration. Altering the occlusion allows us to manage and minimize the forces placed on the teeth as well as alter surface area of contacts to distribute the forces. These two factors will increase the success of the restorations and increase the longevity of the teeth. The equilibration often also creates the space we need to place restorative material and cover the dentin. The process begins for me on a set of models that have been mounted in Centric relation. I equilibrate the models making the occlusal changes as well as adding wax or composite to the lower incisors to mimic the planned restorations. Working on the models allows me to know with confidence I can perform the equilibration, accomplish my goals and do not need to alter my treatment plan. The adjusted models then serve as a template for the new incisal edge restorations. Most often I fabricate a silicone matrix on the model that will serve as a guide for placing the composites int he mouth. I have been using this protocol for many years and my experience is it is highly successful and highly predictable.
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