How do we currently treat tooth erosion?

Dental erosion is the loss of tooth substance due to chemical causes.

The chemical causes are usually acids, which initially damage the enamel and, in advanced stages, the dentin.

In the oral cavity, acids are usually the result of frequent vomiting due to eating disorders or acid reflux.

Oral acids can also be caused by external factors. Carbonated soft drinks and energy drinks or acidic fruits can be disastrous if consumed in large quantities.

Sometimes other substances are involved in tooth erosion, such as the chlorine in swimming pools where professional athletes swim.

Erosion causes gradual changes to the teeth, the results of which take time to be noticed by patients. Initially, the changes occur in the upper teeth and later in the lower teeth.

Patients usually seek professional dental help when they notice:

Changes in the morphological characteristics of the teeth. Teeth lose their anatomical characteristics, become thinner and more fragile, especially on the incisal edges of the upper incisors.
Colour changes. Loss of enamel due to erosion, allowing the more intensely coloured dentin to show more, resulting in teeth that appear more yellow.
Sensitivity to hot and cold liquids and foods.
The following picture shows teeth with significant erosion due to excessive vomiting during our patient’s two pregnancies. The teeth have lost their shape and have turned yellow in the areas where the enamel has been lost.

In the past, dental erosion problems were treated with dental crowns, which required further removal of tooth structure before being placed on each tooth.

In some cases, endodontic treatment of the teeth or surgical elongation of the teeth was required to obtain the amount of tooth structure necessary to support the porcelain crowns.

Below you can see a case I treated 15 years ago with porcelain crowns covering the entire surface of each tooth.

Preparing eroded teeth for crowns is a useful procedure, but it is quite aggressive on teeth that have already suffered considerable deterioration due to erosion.

In recent years, the development of adhesive cementation techniques in dentistry has made it possible to cement thin porcelain or composite resin restorations that do not require further removal of tooth structure. Such restorations are ceramic or resin onlays and porcelain veneers.

The following is the case of a patient who suffered significant loss of tooth substance due to erosion and was treated with this contemporary protocol.

The patient was unhappy with her smile and also had difficulty chewing as the teeth reacted to all thermal stimuli, hot or cold.

The main reason she sought dental treatment was the aesthetics of her smile. Her teeth looked small and had rough incisal edges, which often broke, making the problem worse day by day.

Most of the teeth had lost their enamel and a significant amount of dentin. The teeth had also lost their anatomical features, while the height of the lower third of her face had decreased.

Old fillings protruded from her teeth and some of the teeth were decayed.

Erosion had affected most of the teeth in the upper and lower jaw.

With a restoration such as this, it is necessary to have guidance before proceeding with the actual dental work.

We always start with a mock-up, a diagnostic procedure that allows us to show the patient the smile we can offer.

We can find out if the patient is happy with the result and at the same time produce a useful guide for the provisional and final restorations we will place on her teeth.

Patients with erosion want beautiful teeth from day one.

However, it is difficult to work only on the buccal side of their front teeth. The reason for this is that the teeth are mainly affected from the palatal side and, as the erosion has taken a long time to develop, the teeth of the other arch usually move and close the space needed to place the restorations.

This is why eroded dentition restorations usually involve a lot of teeth. Not only because there are many teeth involved, but also because there is not enough space to cement the restorations themselves to the teeth.

In our patient, we started the treatment with composite restorations on the posterior teeth to change the Vertical Dimension of Occlusion (VDO) to create the space needed for the anterior restorations.

The composite build-ups were left in place for some time to ensure that the new VDO was well accepted by the patient.

At the same time, space was created between the upper and lower teeth to accommodate new restorations.

Resin veneers were fabricated for the palatal side of the anterior teeth, and porcelain veneers were fabricated for the labial side of the same teeth.

Δημιουργούμε ένα είδος sandwich από αποκαταστάσεις, που στο εσωτερικό τους περιέχουν το δόντι της ασθενούς, χωρίς να αφαιρούμε από αυτό επιπλέον οδοντική ουσία.

Η εικόνα των πρόσθιων δοντιών της άνω γνάθου μετά την τοποθέτηση αυτών των αποκαταστάσεων, φαίνεται στην ακόλουθη φωτογραφία.

We create a sandwich that contains the tooth itself, without further removal of the tooth structure that has already occurred due to erosion.

The following picture shows the same teeth after cementation of the palatal and labial restorations.

The following images show the occlusal surfaces of maxillary and mandibular teeth before and after cementation of our additive restorations.

The treatment is time consuming and technique sensitive.

It requires delicate and precise dental handling, patience and time from the patient.

The end result is impressive. The patient smiles with confidence and the teeth are no longer sensitive to thermal stimuli.

The main advantages of this adhesive additive rehabilitation with all-ceramic restorations are

• Minimal tooth structure reduction
• Metal-free restorations
• Coverage of exposed dentin and replacement of eroded enamel
• Preservation of interproximal tooth structure
• Restoration of lost functional elements of the mouth
• Eroded teeth can now be successfully rehabilitated with adhesive cementation, giving our patients the confidence and functionality they are looking for, without the need for further tooth structure removal.

Are you suffering from tooth erosion? Are you considering seeking professional treatment for your condition?

We are here to help you with state of the art prosthetics.