Anthony Ponzio Just thought I would share a case I completed on Friday where I previously succumbed to the definition of insanity-doing the same thing over and over and expecting a different result! Patient is a 46 year old male(neighbor of mine) who has a clear history of bruxism and has had his lateral incisors bonded many times(including by me) over the years. Here is how he presented:
Now, the last couple of times I really tried to make sure there was no pressure on the laterals...we have had discussions about a more comprehensive treatment plan but that is not really in the cards for him at this time. He was looking for a more definitive solution for the laterals, and I was trying to figure out why he keeps snapping his bonding off. Well, trying to think about things a little more thoroughly, I took a look at his maxillary canines and his lateral movements-here is what I saw:
Obviously, he has lost his canine guidance and has been whacking on the laterals, which has caused him to ruin any bonding he had done. I probably could have bonded this 100 more times and still had the same problems. So, we decided to try something I picked up at a composite course from Dr. Ron Jackson(great instructor, by the way), and restore the canine guidance with composite-now, this will likely wear back down over time, but we can monitor it at his recare appointments and "refresh" the composite as needed-and since an overhaul isn't a possibility right now, this is a nice compromise. So, we prepared 7 and 10 for all porcelain crowns, keeping the lingual margin above the cingulum to preserve as much tooth structure as possible, and built up the incisal edges of 6 and 11 with composite:
We restored 7 and 10 with e.max A-3 MT with some white at the mesial line angle(Kris:)) and a little sunset at the gingival...added some texture to try and get the appropriate light reflection. The patient was happy(as was I), and hopefully this gives him some stability in that area. I have had many frustrating cases over the years where I have bonded an anterior tooth only to have it get chipped a few months later...especially when I have stayed in the "single-tooth" mindset. Probably could have saved myself a lot of headaches just by thinking about things differently, as in this case...hopefully this helps someone else who has faced the same situation!
