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logo 39 • the CAMLOG Partner Magazine • November 2016 12 CASE STUDY Dr. Christopher Hermanns, Jan Märkle and Dr. Ralf Masur, Unterschleißheim. FULL REHABILITATION OF ABRADED DENTITION WITH IMPLANTS IN THE ESTHETIC REGION Fig. 1: The front view of the initial situation demonstrates clear abrasions with loss of the length-width ratio of the incisors. Both implant restorations in the esthetic region as well as full rehabilitation of abraded dentition are demanding challenges in the field of surgery and prosthetics. In the case of this patient, the complex task was the restoration of the esthetic appearance, stable occlusion and the correct vertical dimension, taking biological principles into account. Is a "conventional" stepwise procedure in both surgery and prosthetics an important element for success in this case? Unfortunately, the too frequently propagated ideally immediate implementation of all treatment steps in the shortest of times, can lead to a "therapeutic boomerang" in complex cases such as these. Proven materials, such as autologous bone, biological paradigms and experienced treatment procedures are the foundation for predictable therapeutic outcomes. The patient case The 30-year old patient, male, smoker, presented for the first time in our practice in September 2011. His primary wish was a new restoration of tooth 11. The patient had been experiencing complaints with this tooth for 2-3 years. The tooth had been endodontically treated and crowned after a hockey accident, and a few years later the root tips were resected due to acute pain. Furthermore, his girl friend, a dental assistant, recommended wearing a splint as he ground his teeth at night. During further examination the patient mentioned frequent headaches, and he was also unhappy with his appearance. Findings Clinical examination revealed moderate dental hygiene, an apical fistula for tooth 11 as well as advanced substance loss of all teeth. On this basis, tooth 11 was regarded as not being worth saving. The pronounced signs of abrasion both in the maxilla and mandible led to an unfavorable length-width ratio of the incisors and thus to a loss of vertical jaw relation (Figs. 1 to 4) . Compensatory mandibular advancement resulted in an end-to-end bite (Fig. 5) . Although one frequently refers to abrasion dentition, this case is a loss of substance due to attrition, to be precise, as a consequence of bruxism [1]. The periodontal findings indicated generalized slight gingivitis at a probe depth of max. 3 mm. The X-ray showed the expected apical radiolucency in regio 11 as well as several carious lesions in the posterior region (Figs. 6 and 7) . In terms of medical history, it should be mentioned that the patient is a heavy smoker. Treatment planning Together with the patient we discussed various therapeutic options. Due to financial restraints we decided on an implant restoration in regio 11 as a first step, followed by an initially temporary restoration under functional consideration of the remaining dentition. For the above mentioned reasons we refrained from Fig. 3: Pronounced abrasion in the mandible with exposure of dentine and an insufficient composite restoration can also be observed. Fig. 2: Pronounced abrasion with exposure of dentine on all teeth led to a loss of vertical jaw relation.