Replacing Worn Composite Restorations With Porcelain

The young female patient who presented in this case had suffered from undiagnosed acid reflux for many years, which resulted in the development of erosive facial lesions on her maxillary teeth. More than 10 years prior, they had been covered with composite. Although the composite maintained her risk prognosis and prevented further loss of enamel, the material displayed some pitting from chemical and mechanical wear that had occurred over the years. After presenting treatment options, the decision was made to replace the composite material with porcelain in a manner that would avoid any further preparation. The erosive lesions on the patient's lower arch would be covered with composite utilizing the injection mold technique in a transitional bonding approach.

First, a smile design was completed to determine where the teeth belonged within the framework of the face and lips. The centrals would need to be lengthened in order to create a more pleasing smile curve. To fill the buccal corridor, it would have been ideal to extend the span of porcelain restorations to the second premolar or first molar; however, to meet the financial treatment goals of the patient, the decision was made to work with only the teeth that had suffered significant loss of enamel volume. The resulting treatment plan involved placing porcelain restorations on teeth Nos. 5 through 12 with the goal of filling the buccal corridor as much as possible until she was ready to add prepless veneers to her second premolars and molars in the future.

Although the patient demonstrated acceptable function, over the years, the chemical wear had outpaced the mechanical wear, which created areas of deep dentin exposure.

Amanda Seay, DDS
Fellow
American Academy of Cosmetic Dentistry

Director of Outreach and Engagement
Seattle Study Club

Clinical Instructor
Kois Center
Seattle, Washington

Private Practice
Mount Pleasant, South Carolina