Advanced Palatal Erosion Case - AV March 2024

Advanced Palatal Erosion Case

This young lady presented with concerns about the appearance and sensitivity of her front teeth due to extrinsic erosion from a past eating disorder.

Treatment followed the Dhal technique to restore tooth length and occlusal vertical dimension (OVD). A minimally invasive approach using Bioclear composite root overlays and crowns would provided aesthetic and functional restoration while preserving tooth structure.

Pre-treatment photos reveal advanced palatal erosion, visible pulp chambers, and shortened tooth lengths. Vitality tests confirmed positive results. Minimal preparation and an additive treatment approach were deemed essential.

Retracted view before treatment
Front teeth with contraster before treatment
Upper arch occlusal view before treatment

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Bioclear Root Overlays were applied to restore palatal tooth loss prior to rubber dam placement. Biofilm was removed from the palatal surfaces, and Root Overlays were created using 3M™ Scotchbond™ Universal Plus Adhesive, heated 3M™ Filtek™ Supreme Flowable, utilizing inverted Bioclear Black Triangle matrices. The overlays were then sculpted with diamond burs.

Afterward, a rubber dam was placed.

After injecting UL1 root overlay using inverted Black Triangle matrix
After shaping upper 2-2 palatal root overlays
Rubber dam isolation after palatal root overlays

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Biofilm removal was completed with aluminum trihydroxide powder and Aquasol (Aquacare). Bioclear matrices were then placed, a combination of Anterior and Black Triangle matrices were used in this case.

The Bioclear Injection Moulding technique, using 3M™ Scotchbond™ Universal Plus Adhesive, warmed 3M™ Filtek™ Supreme Flowable , and 3M™ Filtek™ Supreme XTE Universal composite (shade A1), was applied to the first central incisor. The tooth was shaped and refined with diamonds and 3M™ Sof-Lex™ discs. The process was repeated for the second central incisor.

Matrices in situ UR1
After injection over-mould UR1
Matrices in situ UL1 after shaping UR1

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The rubber dam was removed, and the ICP occlusion and anterior guidance for the central incisors was established.

A new rubber dam was then placed, and the matrix placement and injection overmolding process were repeated for the lateral incisors. The ICP occlusion for the laterals was established using the centrals as a reference.

Matrices in situ UL2 after shaping upper 1s and confirming proportions
After shaping upper 2-2
Immediate after polish upper 2-2

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Treatment for the upper canines and premolars in subsequent visits followed a similar approach, starting with the placement of palatal Root Overlays. This was followed by injection overmoulding of the canines and premolars using a combination of direct crowns or onlays/overlays.

Occlusion was established with ICP contacts between the upper premolars, anterior guidance on the upper central incisors, and bilateral canine guidance.

This was then finished with the Bioclear Rock Star Polish, using Magic Mix and SS White Jazz Polishers.

After shaping UR3 and UR4
After injecting UL4 root overlay using inverted Black Triangle matrix
Immediate after polishing uppers

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She was delighted with her new smile, expressing renewed confidence and a sense of reclaiming her old smile!

Photos highlight the additive effect and the seamless, monolithic composite surfaces.

Retracted view after treatment
Front teeth with contraster after treatment
Upper arch occlusal view after treatment

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At her review, her periodontal health and home care were excellent. She now attends annual reviews for monitoring, which may include radiographs, photos, and Bioclear maintenance, like re-polishing with the Jazz polisher.

The additive nature of Bioclear allows for future treatment options, including re-Bioclear.