ABSTRACT
Introduction:Patients with severe parafunctional habits can have a reduction of their occlusal vertical dimension (OVD) and may create complex cases of oral rehabilitation, in which the patient may develop occlusal, masticatory and psychological problems. Objective: To report a clinical case of restoration of masticatory function and aesthetics from the production of tooth/implant-supported prostheses with conservative preparations, reestablishing the OVD and occlusal stability.Case report: Patient MVN, 55 years old, wheelchair user, presenting bruxism with a history of gastric reflux due to hiatal hernia, attended the clinic at the University complaining of dental sensitivity, difficulty in chewing and aesthetic smile commitment. At clinical examination it was found widespread wear of teeth. Radiographic examination showed good periodontal health and dental implants in good condition of osseointegration. The OVD was established from the VDR and confirmed by the metric method. The initial casts were positioned on the articulator for diagnostic waxing. From the waxing it was possible to make provisional fixed tooth/implant-supported prostheses. In the lower arch, the prosthesis was screwed on the implants #35, #37, #46, and #47, with the remaining teeth working as an auxiliary support, while in the upper arch two interim prosthesis were made, one for the elements #16 and #17 (tooth-supported) and one for the elements #13, #12, #11, #21, #22, #23, #24 (tooth/implant-supported). Thus, the OVD and the aesthetics lost by bruxism abrasion were restored. Conclusion:This case demonstrates the importance of the provisional prostheses for aesthetic and functional rehabilitation of patients with severe worn dentition.
ABSTRACT
Introduction:Dental hypomineralization such as dental fluorosis has increased in recent times leading to unaesthetic appearance of teeth. There are different treatment possibilities to improve the aesthetic appearance of hypomineralized enamel described in dental literature. The enamel microabrasion has been a feasible alternative, since it is a fast, safe, conservative, and easy to perform, which promotes good esthetic results. Moreover, this technique is a conservative method that improves the appearance of the teeth by restoring bright and superficial smoothness, without causing significant structural loss. The association of different techniques, such as direct composite resin, can provide good esthetic outcomes, but the etiology, intensity, and depth of stain should be considered to minimize dental structure loss. Objective: To describe an easy technique for managing dental fluorosis using enamel microabrasion in association with direct composite resin. Case report: A mixture of hydrochloric acid and silicon carbide was applied according the manufacturer's instructions. Subsequently, a direct composite resin was applied over the areas where the opacities were more evident. This conservative approach may be considered an interesting alternative treatment to remove fluorosis staining and to improve aesthetic appearance. Conclusion: enamel microabrasion combined with direct composite resin is a conservative and safe alternative method to treat enamel opacities from dental fluorosis. Therefore, this management provides satisfactory aesthetic results for the patient's smile.