Tunkiwala Aliasger, Chitguppi Rajeev
Prosthetic Dentistry, University of Mumbai, Mumbai, India; Clinical Practice, Mumbai, India; Director, Impart Education, Mumbai, India.
Periodontics, University of Mumbai, Mumbai, India; Consulting Periodontist, Mumbai, India; Director, Perioindia, Mumbai, India.
Compend Contin Educ Dent. 2017 May;38(5):289-294; quiz 296.
This article demonstrates the clinical application of biomechanical and occlusal principles to conservatively provide optimal clinical outcomes in restoring an eroded anterior dentition. The authors manage a challenging case involving limited palatal clearance (ie, deep bite) coupled with palatal erosion and wear by combining the centric relation (CR) and Dahl principles to create anterior interocclusal space to reduce the need for more invasive palatal reduction. The combined use of adhesive restorations-resin composites on the palatal surface and indirect porcelain veneers on the facial/incisal surfaces-through enamel and dentin bonding helped optimize esthetic and functional/biomechanical aspects. This ultraconservative approach enabled the desired esthetic and biomechanical outcomes to be achieved through the treatment of localized anterior tooth erosion and wear. In short, when treating eroded maxillary anterior teeth with deep bite, adequate restorative space should first be created by conjoining CR and Dahl principles before using adhesive dentistry to restore with bonded composites and porcelain veneers.
本文展示了生物力学和咬合原理在保守治疗磨损前牙列以实现最佳临床效果方面的临床应用。作者通过结合正中关系（CR）和达尔原理，成功处理了一个具有挑战性的病例，该病例存在腭部间隙受限（即深覆合）以及腭部磨损和侵蚀的问题，从而创造前牙间咬合间隙，减少了更具侵入性的腭部磨除需求。通过在腭面使用粘结修复体——树脂复合材料，并在唇面/切端使用间接瓷贴面，借助釉质和牙本质粘结，综合运用有助于优化美学以及功能/生物力学方面。这种超保守方法通过治疗局部前牙磨损和侵蚀实现了预期的美学和生物力学效果。简而言之，在治疗伴有深覆合的上颌前牙磨损时，在使用粘结牙科技术用粘结复合材料和瓷贴面进行修复之前，应首先通过结合CR和达尔原理来创造足够的修复空间。
