A clinical case by our Community member Dr. Muhammed Bahadeen
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Dental erosion is generally understood to be the irreversible loss of dental hard tissues brought on by a chemical reaction without the presence of microbes. Either internal or extrinsic agents can be the sources of this process. On one hand, acidic substances, foods, drinks, medications, and environmental exposure to acidic compounds are examples of extrinsic agents. On the other hand, intrinsic causes of erosion include frequent vomiting related to the eating disorders or bulimia as well as due to the regurgitation of gastric contents.
In this article, a case of enamel erosion due to acidic consumption (lemons) will be highlighted. A loss of enamel and a rough surface will be shown on the labial surface of the incisors.
Complete intra-oral view of the initial situation. A loss of enamel structure can clearly be seen.
A lateral view gives a better visualization of the enamel breakdown on the centrals which has led to dentinal exposure.
After planning out the treatment for the anterior centrals and laterals, a wax-up was performed by the clinician to aid in the creation of the silicon index for restoration, and to help in the capacity to visualize the end result before the final restoration.
In order to begin the restorative process on the centrals first, isolation was made using a rubber dam. Further, the clinician retracts the gingiva using a floss ligature.
To have better gingival retraction without moisture contamination, rubber dam isolation is beneficial.
Enamel was etched for 30 seconds, and after that, the dentin was etched for 3 seconds (Selective dentin etching for 3 seconds as described by Hardan et al.,).
Next, a universal adhesive was applied on the entire buccal surfaces using an active rubbing motion to ensure proper penetration of the adhesive. Light curing was then carried out for 20 seconds to ensure a complete photopolymerization of the bonding agent.
In order to be able to create incisal translucency at the end of the restoration, the palatal shell was created using a translucent composite. This was made using the silicon index obtained from the wax-up.
The mesial and distal walls of the centrals were created with A2 enamel shade composite.
To avoid any white line formation between the layers, the final enamel layer was applied with one step.
The centrals were finished with abrasive discs. Further, the final outline form of the tooth is shown in this picture.
The ligature of the laterals was achieved and the restoration process was made following the same steps described for the centrals.
The finishing process of the laterals is shown in this picture.
Final result showing the symmetry of transitional line angles.
Enamel erosion due to acidic consumption requires restorative treatment and motivation for the patient to avoid further damage to the remaining teeth. As for the anterior teeth, restorative treatment should follow the esthetic protocols and morphology of the natural teeth.
1. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
2. Riquieri H. Dental anatomy and morphology. USA: Quintessence Publishing; 2019.
3. Hardan L, Orsini G, Bourgi R, Cuevas-Suárez CE, Nicastro M, Lazarescu F, Filtchev D, Cornejo-Ríos E, Zamarripa-Calderón JE, Sokolowski K, Lukomska-Szymanska M. Effect of active bonding application after selective dentin etching on the immediate and long-term bond strength of two universal adhesives to dentin. Polymers. 2022 Mar 11;14(6):1129.