Our patient’s main concern was the shortness of her upper anteriors. We asked her to bring historical photos and the loss of length was evident.
We filled the bleach carrier with resin and created an immediate provisional!! (Fig. 4)Provisionals were created to return her teeth to their original length.
The initial exam revealed extremely short upper anterior teeth (7.5 mm in length). (Fig. 1 & 2) We asked if she had a night guard. She said yes and presented us with a night guard and her bleach carrier made 10 years earlier! (Fig. 3) The visual and actual loss of tooth structure was astounding. The patient stated that she had a habit of rubbing the linguals of her upper anterior teeth with her tongue. The diagnosis of “perimylolisis” was given. (Abrasion caused by tongue habit such as rubbing the surface combined with acidic erosion).
These upper and lower photos display the amount of actual tooth loss. (Fig. 6 & 7)
The rehabilitation was accomplished by increasing the height of the posterior teeth which created an increased opening of the patient’s anterior teeth as well. Auto rotation thus created an increased vertical space and more over jet. (Fig. 8 & 9) Increasing the height of posterior teeth was accomplished in our provisionals and allowed both upper and lower anterior teeth to be lengthened.
Our patient wanted to eliminate her old full gold crowns and margins from previous restorative work. The total reconstruction accomplished by opening her occlusal vertical dimension allowed us to regain her normal lengths of anterior teeth. All work was done with E-Max Porcelain. (Fig. 10,11,12)
Of special interest is the changing of her smile contributed by the opening of her occlusal vertical dimension. In her original photos, her 7.5 mm centrals are tucked below her lower lip. Her restored 10.5 mm centrals are above her lower lip!! (Fig. 13 & 14)