Facelift Dentistry ®
Bruxism and Developmental Milestones
Our patient presented in our office with a host of dental issues that represented unusual and extreme, in some cases, wear and tear problems that actually began during his pre-adult years and adversely affected normal development of certain tooth structures.
The patient became a bruxer (night time teeth grinding) early in life… like many young adults do. Left untreated, the immense physical forces that are exerted interfere significantly with the normal eruption of vital tooth structures, in turn impacting on growing jaw structures and tmjoint functioning.
Tooth rotations, angular positioning, tmj pain and shifting teeth can be a common problem later in life. For a man in his early fifties, he had significant wear that exceeded what is normally expected for his age bracket.
As can be seen in the first pre-treatment photo, the patient had a severe diastema, accompanied by a mouthful of worn down.. short teeth. The loss of length of both upper and lower teeth creates the loss of Vertical Dimension (bite height – collapsing of the resting jaw position) that inevitably leads to what we normally associate with elderly patients.
The patient was aware of his smile becoming smaller. He was beginning to lose upper lip support and a sinking-in effect of both lip structures (an extreme example would be a toothless smile). Smiling and showing teeth was requiring more conscious effort.
Overall facial structures acquire a more squared-off or round appearance as the Vertical Dimension continues to lose height.
The patient’s goal was to have a full mouth of teeth with normal tooth height and to treat the wide gap between the front two (anterior) teeth.
A full Facial Orthopedic study and evaluation was conducted, utilizing diagnostic equipment that analyzed jaw positioning relationships (tomography studies) and occlusion (bite) characteristics.
The technical data revealed that the patient had lost a significant amount of Vertical Dimension that would require correction or normalization (a process where physical relationships are recreated to correctly proportional to a patient’s facial and jaw characteristics), using a combination of reconstructive and restorative dental products.
Dr. Muslin provided a menu of treatment plan possibilities that enabled the patient to select the degree of functional and cosmetic outcome that he wanted. Our patient selected custom porcelain crowns and veneers with proportional sizing that created a natural appearance in width and height… on a tooth by tooth basis.
The severe diastema was effectively treated with proportionalized restorations that would effectively eliminate the gap without creating the appearance of over sized front teeth.
Preparation and fitting with temporaries was achieved in one treatment. The extensive occlusal studies and diagnostic waxups enabled Dr. Muslin and the dental ceramist to create temporary structures that were worn and “tested” by the patient while the final restorations were being fabricated.
A sufficient amount of time, determined by the patient, was allowed to make sure all cosmetic and functional characteristics were altered to the patient’s satisfaction. Within 3 short weeks, our patient completed his “temporary tryout” and acquired his final custom porcelain products.
The patient’s bite was increased by almost 6mm …. indicating the degree of collapse he had at such an early age. The additional photography below effectively shows the degree of change in bite height. The significant change in upper and lower lip support is more easily observed here. The lips have been repositioned, no longer representing a “sinking in” effect.
You can also send questions directly to Dr. Muslin via our on-line Ask The Dentist form. Dr. Muslin will respond to you directly.