Worn dentition; The Full mock up concept
The Mock-up is not always a tool with an aesthetic purpose, it is an excellent predictor of the functional result and an excellent guide for minimal invasive preparations while giving perfect space.
The purpose of this article is to suggest a precise and consistent method that simplifies the treatment of worn dentition. A wax-up and a mock-up are mostly used for designing esthetic outcome, and then used as a preparation guide. As described by the authors, it can as well be used on the posterior occlusal surfaces of the teeth. This not only provides the exact new vertical dimension of occlusion but lets the dentist use it as a guide for precise control of occlusal preparation.
1. Aesthetically, teeth are too short
2. Biologically, we need the tooth structure to be healthy and as intact as possible
3. Functionally, new occlusion arrangement is mandatory in order to lengthen the anterior teeth.
Which kind of treatment planning can we propose to fulfill the previous requirements? Also when a dentist faces these flat smile lines because of the wear process, it is important to have a preview of the case, in order to understand the “white” modification (dental) to let the new smile line appear. This can be predicted digitally with pictures or with a device as ditramax to mark with extreme precision on the model with the facial references .
– cover the cusps if they are already too thin
– get to the edge of the vestibular cusp if needed aesthetically (lengthen the cusp for the smile line )
– preserve the marginal ridge (1 mm on the inside) or cover the top of the ridge if worn.
– a smooth and flat design should be created between the cusps
Why 0,5 mm instead of the 1,5 mm of a traditional overlay? Because when considering the sole occlusal surface, the loadings are axial: thus, restorations will only be loaded in compression, on a vertical axis, while overlays are loaded both in compression and tension. The natural marginal ridge will keep on doing its job instead of the material.
Worn dentition is a challenge for the dentist. Contemporary concepts must be used to fit with the minimally invasive philosophy. Clinical protocol must fit as well with the reality (feasible, teachable and repeatable). That is why a prep less method instead of no prep is more useful for every day practice.
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