Rehabilitation of a Severely Worn Dentition using Fixed and Removable Partial Overdenture Prostheses

Occlusal wear is most often attributed to attrition, which is defined as the wearing away of one tooth surface by another tooth surface. However, there are several etiological factors that can result in excessive loss of tooth structure. Common factors are enumerated as congenital anomalies, parafunctional occlusal habits, abrasion, erosion or loss of posterior tooth support.1 Tooth wear can also be attributed to a coarse diet, to rituals such as filing down teeth and to environmental factors.2 Excessive occlusal attrition can result in pulpal pathology, occlusal disharmony, impaired function and esthetic disfigurement.3 The reasons for undertaking occlusal rehabilitation may include the restoration of multiple teeth which are missing, worn, broken down or decayed. In certain cases, treatment of temporomandibular disorders (TMD) may also be considered an indication of full mouth rehabilitation, but great caution is advisable in such cases, as the relationship between occlusal rehabilitation and TMD is controversial.4,5 Management of the worn dentition is a common problem in the practice of dentistry in terms of both the difficulty and expense of providing a functionally comfortable and cosmetically acceptable treatment of the patient.6 Stressinduced grinding habits can seriously compromise mastication and esthetics, and a reduction in the occlusal vertical dimension (OVD) can result in reduction of facial height and initiate angular cheilosis with gradual foreshortening of musculature.7 Multiple choices are available for rehabilitation of such patients. Regardless of the clinical reason, the decision of carrying out any treatment should be based upon achieving oral health, function, esthetics and comfort. The patient in the following case report had presented with severe attrition of all the teeth. The attrition was more severe in the anterior teeth as compared to posterior teeth. There was loss of OVD as determined by various methods, like phonetic evaluation (Pound8 and Silverman9), measurement of interocclusal space (Niswonger).10 The anterior lower facial height was found to be collapsed on evaluation of facial appearance. Therefore, according to Pindborg’s classification of tooth surface loss (TSL), he was diagnosed to have noncompensated tooth surface loss. According to this classification of TSL, features of non-compensated TSL include tooth surface loss leading to loss of OVD. This is often confined to anterior segments and associated with a lack of posterior occlusion. In such cases, the collapse of anterior facial height necessitates an increase in occlusal vertical dimension to restore the subjects to their presumed, original OVD.11