Abstract

Full mouth reconstruction is one of the most effective methods to restore severe worn teeth that have suffered reduced vertical dimension. Although the use of the overlay splint restoration for a trial period allowing the patient to adapt to an increased vertical dimension is the recognized method, the specific protocol from the transitional splint to the fixed reconstruction is yet to be established. This case report describes a 50-year-old female patient who has severely worn teeth combined with an anterior deep bite and chewing pain. The protocol of the treatment process is described. 

1. Introduction 

Severe tooth wear causes great distress to many patients who can be classified into 2 groups on the basis of decrease or no decrease in the vertical dimension. The decrease in the vertical dimension not only affects the function but also affects the appearance of teeth and the temporomandibular joint symptoms [1, 2]. For these patients, reconstruction is a beneficial treatment plan [3]. Of the many reconstruction treatment programs, the use of overlay splint restoration for a trial period that allows the patients to adapt to an increased vertical dimension is the recognized method [2, 4–9]. After the transition period of treatment, two types of permanent reconstruction are used: a removable permanent reconstruction and a fixed permanent reconstruction. It is very important during the transition process from the transitional splint to the permanent reconstruction that the permanent reconstruction should be the same as the vertical dimension and the anterior guidance of the anterior teeth as that in the period of transitional restoration [8, 9]. Although these are generally accepted treatments, the specific protocol from the transitional splint to the fixed reconstruction is yet to be established. 

Introverted type deep overbite is usually caused during growth by genetics or by bad habits from the lingual inclination of the deep overbite of the anterior teeth. Because the position of the anterior teeth is incorrect, the posterior teeth do not have normal chewing function and protection function during the lateral and anterior protrusion movement of the anterior teeth. Consequently, the loss and wear of the posterior teeth will cause a deeper overbite, often accompanied by clinical symptoms of the temporomandibular joint [10, 11]. These factors make the treatment for severe worn teeth with anterior deep overbite even more complex. 

Maxillofacial surgery, orthodontics, and restorative dentistry can be performed to help gain the vertical dimension and correct the anterior guidance in these patients [10]. Orthognathic treatment with an anterior segmental osteotomy has been recommended to obtain normal anterior guidance [12, 13]. Thus, interdisciplinary treatments, combining, for example, posterior restorations, implants with ceramic overlays of consumed, and abrased teeth and orthodontic treatment, should be considered. This paper reports the case of a patient with severe worn teeth and an anterior deep bite undergoing a fixed reconstruction. The protocol of the treatment process is described.