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Tooth	Wear	&	Loss	of	Tooth	Structure	Case	
Dr	Neil	Wilson	
Specialist	in	Prosthodontics	
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
Referred	to		
Neil	Wilson	
Background:	
Lady	in	her	fifties	referred	by	her	GDP	because	of	severe	wear	and	loss	of	tooth	structure	to	
posterior	lower	teeth	and	lack	of	restorative	space	in	which	to	place	any	definitive	restoration.
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
PRE	-	TREATMENT
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
On	examination	the	lower	right	1st	molar	was	missing	and	the	lower	right	2nd	molar	was	patched	with	glass	ionomer.		
There	was	very	little	coronal	tooth	structure	remaining.
PRE	-	TREATMENT
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
On	the	lower	left	again,	the	1st	and	2nd	molars	were	again	patched	with	glass	ionomer,	again	with	very	little	coronal	tooth	
structure	and	there	has	been	alveolar	compensation	leaving	no	restorative	space	on	which	to	place	restorations.
PRE	-	TREATMENT
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
There	are	also	large	composites	in	the	upper	left	1st	and	2nd	premolars	and	a	large	cavity	in	the	upper	left	2nd	molar.
INITIAL	TREATMENT
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
The	initial	treatment	was	to	remove	the	glass	ionomer	in	the	remaining	lower	molar	teeth	to		
confirm	that	the	teeth	were	restorable.
DIAGNOSTIC	WAX-UP
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
The	diagnostic	wax	up	was	undertaken	using	upper	and	lower	impressions	taken	in	Impregum	soft	impression	material	and	a	face	
bow	recording	was	taken.	Dr.	Wilson	used	the	diagnostic	work	to	consider	composite	build-ups	to	the	palatal	of	the	front	6	teeth,	
as	in	the	Dahl	approach.	Rather	than	leave	the	posterior	teeth	to	over-erupt	further,	the	space	could	be	used	to	place	full	contour	
E-max	onlays.
TREATMENT
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
The	anterior	restorations	were	placed	using	Filtec	Supreme	composite.	They	were	placed	palatally	on	all	six	upper	
anterior	teeth	making	sure	we	had	good	canine	disclusion.	In	quadrants	the	teeth	were	prepared	for	the	onlays.	
The	remaining	tooth	structure	was	selectively	etched	on	the	enamel	only	and	then	3M	universal	adhesive	was	used	
with	its	correspondent	adhesive	called	‘Ultimate’	to	allow	bonding	of	the	restorations	without	curing	the	bond	first	
to	overcome	the	problem	of	possible	pooling	of	adhesive.
TREATMENT
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
	Once	the	lower	posterior	restorations	were	completed	it	was	then	decided	that	the	upper	left	1st	and	2nd	premolars	had	such	
large	composites	in	that	we	have	now	had	an	opportunity	to	undertake	the	same	type	of	restoration	to	allow	them	to	be	as	
conservative	as	possible	and	on	removal	of	these	restorations	it	was	evident	that	there	was	very	little	tooth	structure	remaining,	so	
again	full	contour	E-max	onlays	were	placed.
RESULT
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk
The	patient	was	sent	to	the	hygienist	to	make	sure	she	was	comfortable	in	maintaining	the	restorations.	These	have	now	been	in	
function	for	over	18	months	with	no	problems.		She	understands	the	prognosis	of	some	of	the	teeth	are	unknown,	but	now	that	
we	have	space	if	we	were	to	lose	one	of	the	teeth	it	would	be	relatively	straightforward	to	replace	this	with	a	dental	implant.
Click here to refer or:
Call 0121 478 3770
Email info@centralenglandreferrals.co.uk
	
Advanced	restorative	
Complex	dental		
implant	work	
Prosthodontics
Referrals	to		
Neil	Wilson
©	2016
Tooth	wear	&	loss	of	tooth	
structure	case	-	January	2016www.centralenglandreferrals.co.uk

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Tooth Wear & Loss of Tooth Structure Case