cosmetic dentistry_ beauty & science International

I 09 special _ MiCD I cosmeticdentistry 3_2011 problems for social reasons. She had congenitally missing lateral incisors, a history of multiple tooth fracture and was unhappy with the spaces and shape of her upper anterior teeth. With the ex- ception of her upper right second molar, all upper molars and second premolars were lost owing to fracture. Her posterior support was derived solely from her first premolars because she had a missing lower right second molar (Fig. 3) and did not have an upper denture. Although her upper right first premolar was crowned and her left first premolar was “pristine”, both teeth were cracked. Earlydetectionanddiagnosisofdisease The patient’s aesthetic problems were exacer- bated by developmental anomalies (congenitally missing laterals) and environmental factors, in- cluding occlusal disease (OD). Occlusal disease is defined as “the process resulting in the noticeable loss or destruction of the occluding surfaces of the teeth”.14 The disease process is caused primarily by parafunction, especially sleep bruxism. The detri- mental effects of OD could have been greatly min- imised by early detection and management with abruxismsplint.Occlusalconsiderationsarepartic- ularly important in MiCD because they have a sig- nificant impact on restoration success. The clinical and radiographic signs and symptoms of OD are listed in Table II. As part of the diagnosis process, quality of life issues must be explored in addition to the usual history taking, examination and special tests (e.g. electric pulp test, salivary function test). Discussion of quality of life issues should focus on patients’ wants, needs and expectations with regard to: _appearance; _tooth sensitivity; _tooth or restoration fracture or failure; _soft tissue discomfort; _loosening or moving teeth; _bite problems; and _jaw pain and dysfunction. IfMiCDisplannedinthepresenceofOD,patients mustbeeducatedontheadvantagesanddisadvan- tagesofMiCDtoconventionaltherapy,thepossibil- ity of failure and need for protection. The patient concerned was aware of her occlusal problems but wanted a quick, non-invasive and economical so- lution to improving her anterior aesthetics in view of a social commitment. Fig. 4a_Pre-treatment. Fig. 4b_Post-treatment. Table II_Signs and symptoms of occlusal disease. Fig. 4bFig. 4a Clinical signs Radiographic signs Symptoms Increasingtoothmobility Angularbonydefects Sensitive,painfulorsoreteeth Fremitusandmigrationofteeth Increasedwidthofperiodontalligamentspace Uncomfortable,unevenor“lost”bite Crackedorfracturedteeth/restorations Increasedwidthoflaminadura Occlusion-relatedperiodontalpain Abfractioncavities Changesinalveolarbone Symptomsoftemporomandibulardisorders Occlusalwearandheavyocclusalcontacts Verticalreductionofinterdentalseptum Occlusaldiscrepancies Rootresorption Softtissueindentations Furcationdefect Signsoftemporomandibulardisorders Table II