Full-mouth adhesive treatment in bulimia-related dental erosions: a clinical case

Objectives  Dental erosion, which is defined as the gradual but irreversible loss of hard tissue is a major dental is­sue as it may be linked to system­ic diseases such as eating disor­ders or gastroesophageal reflux (GERD), giving rise to difficulties in diagnosis.

In both pathological forms, the presence of gastric juices in the oral cavity causes the erosion of the palatal surfaces of the upper elements, often associated with variable sensitivity; carious lesions are generally not associated. Ero­sions associated with gastro­esophageal reflux are often asso­ciated with mucosal irritation, oral ulcers and altered taste. It may be due to mechanical or chemical causes, which often lead to prob­lems in treatment.

Compared to traditional classifica­tions, the ACE classification sees these lesions divided mainly relat­ed to the anterior sector and to the therapeutic intervention strategy. Early diagnosis is crucial to maxi­mize therapeutic alternatives.

The treatment of erosions is closely related to the amount of enamel and dentinal tissue in­volved as well as to the vertical di­mension to be obtained in order to obtain satisfactory aesthetic re­sults for the patient. Best erosion treatment involves a multi-disci­plinary team and may range from direct composite reconstructions and fixed prostheses to innovative indirect reconstruction systems that aim at preserving as much tissue as possible. The new CAD/ CAM technology offers important advantages in terms of result forecasting, accuracy, precision and better patient-dentist com­munication.

The principle aims of treatment are aesthetic rehabilitation, recov­ery of functional mastication, es­tablishment of the correct vertical dimension and achievement of stable and reproducible out­comes. In this regard, a multidis­ciplinary treatment that involves various professional figures would seem to guarantee good and pre­dictable results.

Materials and methods  The present clinical report de­scribes the treatment of asymp­tomatic dental erosion in a patient with eating disorders associated with bruxism and cervical myal­gia. The patient requested esthet­ic rehabilitation without invasive interventions. A multi-disciplinary approach included esthetic analy­sis which was followed by posture assessment using a stabilometric platform and a podoscope.

A modified 3-step rehabilitation technique was supported by digi­tal technology. Composite resto­rations were inserted in the poste­rior areas and double veneers in the anterior. The outcome was stable and easy to monitor.

Results and conclusions  The main objectives of prosthetic rehabilitation are preserving as much residual dental tissue as possible and achieving stable oc­clusal rehabilitation with a multi­disciplinary approach, involving dentists, physiatrists and postur­ologists. Treatment depends on careful assessment of postural and temporal-mandibular abnor­malities, as well as tooth damage.

A multidisciplinary approach to­gether with the advantages of­fered by CAD/CAM technology provides acceptable, predictable outcomes when treating dental erosive lesions. It is often partic­ularly problematic to propose in­vasive therapeutic solutions, in the absence of relevant clinical symptoms.

New technologies, together with adhesive strategies in the pros­thetic field, allow the partial over­coming of this problem.

Clinical significance The proposed treatment rep­resents a valid alternative to more invasive prosthetic reconstructions and highlights the importance of the multidisciplinary approach to the treatment of dental erosions.

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Table of Content: Vol. 89 – Issue 05 – Maggio 2021