From Volume 46, Issue 3, March 2019 | Pages 230-236
Although managing the consequences of tooth loss is not easy, the desired outcome can be achieved with collaboration by the patient, clinician and technician. The ultimate objective is not to reverse the effects of ageing but to improve the quality of life of an affected individual by adhering to biological procedures as much as possible and replacing missing teeth in the most appropriate way.
In the past, many patients felt that the loss of teeth was inescapable and prepared themselves to a certain extent for that outcome. Nowadays, patients' expectations have changed and many perceive tooth loss as a deleterious event. A complication of loss of posterior teeth is overloading of the remaining anterior teeth, thereby increasing the potential for tooth wear, predominantly by attrition.1
Tooth wear (TW) may lead to a number of clinical problems. Therefore replacement of missing teeth and management of TW is essential in order to maintain quality of life. The following case describes the management of a patient with anterior tooth wear as a consequence of loss of posterior teeth in the lower jaw.
A 61-year-old male was referred to the Dental Institute, Colombo for the management of pain and an abscess associated with two upper central incisors. His past and current medical records revealed that he was on anti-hypertensive and anti-diabetic drugs from 2013. His past dental history included extractions of teeth due to caries. He had been chewing on his front teeth for the last 10 years. He brushed his teeth once per day and didn't use any form of tobacco or alcohol. After questioning him and his wife, the habit of nocturnal bruxism was excluded. A diet sheet helped to exclude dietary erosive influences on his dentition. His lower facial height was reduced, with prominent nasolabial grooves. There were no signs and symptoms of temporomandibular joint disorders. The occlusal vertical dimension (OVD) was significantly reduced and the patient's free way space was 9 mm. Soft tissue examination revealed an abscess in relation to UL1. The mandibular edentulous alveolar ridges were broad and prominent with moderate undercuts. In the maxillary arch, all teeth except UR4, UR8 and UL8 were present. In the mandibular arch LL1, LL2, LR1, LR2, LR3, LR4 and LR5 were present with good periodontal support. The roots of LL4 and LL5 were present. The patient's maxillary and mandibular anterior teeth were attrited with the pulp exposed. Drifting of UL4 and UL6 and a varying degree of overeruption of maxillary unopposed posterior teeth were evident (Figures 1 and 2).
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