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.

 

Comments

Commenter's Profile Image Joel
October 2nd, 2013
What restorative material was used??
Commenter's Profile Image Alex Santos
October 3rd, 2013
I have the impression that by doing so the bur did the acid's job in a much shorter time and the biological cost for the patient could then be higher than simply providing her with means of preserving/remineralizing the exposed areas.
Commenter's Profile Image Steve Ratcliff
October 3rd, 2013
Joel, the material was lithium disilicate and Alex, it would be awesome to remineralize the areas, however, those teeth are eroded into dentin, I don't know how to remineralize that.
Commenter's Profile Image Gerald Benjamin
October 3rd, 2013
The newly restored case sets the incisal edge position slightly too far palatal and in the zone of function. Interesting to see how this case does over time
Commenter's Profile Image Benjamin Tubo
October 28th, 2013
Great case Steve. Just out of curiostiy, in what condition was the opposing dentition? Was there any siginificant effects from the Bulimia present? If so, was that one of the reasons why lithium disilicate was chosen as the restorative material due to it being "wear friendly" with natural dentition?