When Life Hands You Lemon-Suckers …
Odds are you’ve seen a significant amount of tooth wear in your practice. They are all out there—the lemon-suckers and the night-grinders—and they all seem to wind up in your chair. The truth is that the eruptive process continues throughout life and teeth will continue to contact each other possibly causing more and more damage. It’s important to know what the different levels of severity there are in tooth wear and how to treatment plan in order to address the situation correctly.
Loss of tooth display from anterior wear without secondary eruption: If the teeth wear away and they don’t erupt, it will result in minimizing tooth display dramatically. Even when this patient smiles as big as they can, there will be minimal tooth display, if any.
Short teeth and excess gingival display from anterior wear with secondary eruption: As teeth wear away, they erupt and bring the gingiva and bone with them resulting in a “gummy” smile.
Uneven tooth lengths and gingival levels: In this case, there is an irregular amount of tooth wear and very uneven gingival levels. There are many causes and solutions to these kinds of cases, but since the teeth have moved out of position, it’s mandatory that you address what caused the teeth to wear in this manner.
Irregular length incisal edges due to patterns of wear: One of the simplest wear cases to fix, but the uneven wear causes a very unattractive smile. It’s necessary to base this solution on esthetics because tooth position, gingival levels and the correct incisal edges need to be established before you even touch occlusion.
Excess posterior tooth and gingival display from posterior over-eruption: When a patient’s teeth wear in the posterior they can significantly erupt compared to their anterior teeth resulting in a caved in look.
Incisal plane to occlusal plane discrepancies from wear and secondary eruption: This is caused by a patient bruxing forward and sliding the jaw to either the left or right or both. Whichever direction they slide their jaw, there will have much more wear on them resulting in an uneven smile.
So when you come across significant tooth wear, your treatment planning will be widely based on esthetics. It’s important not to rely on the models alone but to utilize the patient’s actual face and lips to help guide where the teeth and gingiva need to be positioned.