Restoration of Severely Worn Maxillary and Mandibular Canines
Minimally invasive treatment achieves excellent esthetics while reestablishing guidance to improve function and eliminate pain
March 1, 2025
Volume 21
,
Issue 2
,
March 2025
Page(s): p. 24
Patients who seek esthetic dentistry treatments can benefit from a conservative approach to preparing the teeth to achieve their desired results. The goal of minimally invasive dentistry is to reduce the biologic cost that accompanies the execution of dental treatments while delivering high quality and long-lasting results. Nowadays, thanks to the development of new materials and techniques, as well as the increased availability of educational centers that provide the training needed for successful treatments, clinicians can achieve remarkable results for patients seeking esthetic improvement.
Case Report
The patient presented with excessive wear of her maxillary and mandibular canines, loss of function, and the development of muscle pain that she experienced every morning. The patient was very unhappy with the sharp pointy shape of her canines created by the wear pattern and had also considered onabotulinumtoxinA (BOTOX®) injections to alleviate the muscle pain. After evaluation, we decided to restore the shape of the canines using a purely additive approach.
Because these teeth had lost a significant amount of dental hard tissue already, it was important to both the patient and the clinician to preserve what was left with as minimal an intervention as possible; therefore, no preparation using burs or disks was performed. In order to accomplish the best bond possible using this approach, it is of the utmost importance to remove all of the biofilm from the surfaces of the teeth to be restored. In this case, we used a disclosing solution and an air abrasion unit (Blaster, Bioclear) that uses an aluminum trihydroxide slurry to remove the biofilm. When the surfaces were clean, the enamel was etched with 35% phosphoric acid etchant for one minute to achieve an optimal etch pattern and ensure a long-lasting bond. After etching, a universal adhesive (Scotchbond™ Universal, 3M) was scrubbed over the entire etched surface for 20 seconds, air dispersed for 15 seconds, and then light cured for 20 seconds.
The composite selected (Filtek™ Easy Match Universal Restorative, 3M™) features a "simplified shade" system that results in restorations with a bright, natural, and warm shade. The blending capabilities of this composite facilitated a good shade match with the natural tooth structure without the need to prepare a bevel. The development of composites with simplified shade systems like the one used in this case provides clinicians with a happy medium between the complex kits and the single-shade universal composites, enabling them to deliver imperceptible restorations.
As result of the treatment, the patient's canine guidance was restored. She reported that her muscle discomfort disappeared the next morning and that she has been pain-free ever since. To maintain the restorations, a dual-arch splint (Dawson B-splint) was fabricated and delivered 2 weeks after they were completed.
