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ePaper created 2017-05-10, 09:20:47 | version 1.38.0
case report _ aesthetic and restorative dentistry Fig. 2d Fig. 2e Figs. 2d & e_Pre-op diagnostic wax-up, creating a new and improved occlusal and anatomical posterior scheme. The full-mouth wax-up is made prior to treatment and establishes the new VDO. Silicone indexes can serve to build-up lingual and buccal cusps to the correct level if needed. Figs. 2f–l_Details of the reatment performed in the lower left and upper left quadrants, respectively. After rubber dam placement, amalgam fillings were removed and tooth surfaces prepared and cleaned with sandblasting, before applyingcomposite. to occur by combined supra-eruption of occlus- ally free teeth together with simultaneous alve- olar growth and intrusion of teeth maintaining contacts. It was shown that such phenomena would occur in a significant proportion of pa- tients treated according to this concept16 and the outcomes of such treatment have been corrob- orated by several recent papers and review arti- cles.15-19 Increasing the VDO is a key parameter for reversing and preventing the consequences of pathological wear and erosion.20-25 The passive eruption that accompanies the continuous tis- sue destruction and loss, tremendously restricts the space available for restorations, which due to their limited thickness, would be very fragile or otherwise require unnecessary removal of the residual tooth structure. Recent clinical re- ports have largely validated this treatment ap- proach.23-25 _Treatment outline and restorative options The decision regarding the optimal restor- ative choice is usually based on the pre-existing dental condition (presence of decay, restoration, vital or nonvital status), as well as the amount and localisation of tissue loss. This means that various restorative options have to be consid- Fig. 2f Fig. 2g Fig. 2h 16 cosmetic dentistry 2_2017 Fig. 2i