Among the challenges of restorative dentistry are erosion cases – and bulimia is part of that group. Bulimic patients, unlike other patients with diseases of compulsion such as chemical dependency, cannot abstain from eating. These patients must face the object of their compulsion every day. While many people recover completely from bulimia, others are "mostly" recovered; they have periods of relapse and then regain their recovery again.
As restorative dentists we are often faced with important questions: When is it safe to restore? Will my porcelain fail or become degraded by the corrosive exposure of regurgitated liquids?
This case was restored once many years ago and while there are some issues with the restorations themselves and with pathway wear and lack of overjet in this instance, the enamel continued to erode secondary to bulimic relapses.
The simple solution is in where the margins are placed. Had these restorations been placed slightly subgingival instead of in the middle of the palatal surface, the erosion of enamel from under the margin of the restoration would not have occurred.
Bulimics can be restored anytime as long as care is taken to protect the margins from exposure to gastric contents. I restored her again and although she has not had a relapse for several years, all of the margins were placed subgingival for long-term protection. She will be dentally stable for a long time.