Restorative Case With Severe Dental Erosion of the Two Front Incisors

There are different causes for losing tooth structure. One cause is from very acidic solutions that can dissolve away enamel. Many times this manifests on the tooth surface, which will show the biting surfaces flattening out and appearing darker as the lighter enamel vanishes exposing the darker colors of the dentin underneath. Another place for the phenomenon to occur is at the gum line of the teeth. Biting into citrus is one common way to dissolve away enamel, and it has a very distinct look. It’s as if someone carved away the enamel and left a darker dentin underneath. Pretty wild!

 

On the particular patient, there was a lot of enamel missing, 70% from the gum line toward the biting edge of the tooth. Also, the dark dentin was showing through. Even her children were asking why her teeth were so dark in that area.

A nice conservative treatment is to place composite resin in the area. In this case there was enough tooth missing that the thickness was of filling material did cover and mask out the dark areas. With a nice polishing of the material, the patient was extremely happy with such a great result without resorting to extreme dentistry.

The other options for this patient are dental veneers or possibly a dental crown. Dental veneers require that some enamel be present to help with the bonding procedure. The cements that are used in bonding have only 20% of the strength when bonding to dentin as opposed to enamel. So the more surface area that has no enamel has a greater likelihood of debonding, ie, falling out. For these patients a dental crown is a good option. The way the cement works for crowns is somewhat different and does not require enamel to be there.

The dentist has to listen to the patient and any wishes she may have from a cosmetic standpoint. The dentist also has to address structural issues that the patient will not be aware of. In this fashion the patient can get the best outcome to satisfy cosmetic and structural demands.