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logo 39 • the CAMLOG Partner Magazine • November 2016 18 CASE STUDY The loss of tooth substance in this case was caused by bruxism. The etiology of bruxism is subject to controversial discussion in the literature. Social stress and burden at the workplace are often described in this context [7]. The additional effect of acids, for example due to excessive intake of acid-containing drinks or food, can enhance the occurring attrition. A variety of methods are de- scribed for corresponding diagnosis, many of which are quite elaborate and involve high costs (e.g. polysomnography) [8]. Due to the apt self-description by the patient and the clinically present hard tooth substance defects, we decided not to employ further diagnostics in this case. A long-standing myoarthropathy led to a massive loss of physiological bite height and represented both functional and esthetic impairment for the patient. The indication for prosthetic restorative treatment is given according to the DGFDT (German Society of Functional Diagnostics and Therapy) bulletin (2013). In addition, pre-treatment based on functional analytic measures with occlusion splints and/ or long-term temporary restorations to simulate the modified jaw relations, is recommended prior to final therapy. The presented patient case confirms this stepwise approach. The patient adapted well to the rather extended temporary phase – due to financial restrictions – of adjusting the patient-specific bite position and height. The fact that no loss of the temporary restorations occurred and that no repairs were necessary, appears to confirm this approach. Direct insertion of onlays/veneers made of lithium disilicate would have been a therapeutic alternative to the two-phase final restoration with full crowns. This type of restoration is quicker and more gentle on teeth, but would not have proven expedient in this case due to unstable occlusion, extensive fillings and carious lesions [3,9]. AUTHORS Dentist Jan Märkle Jan Märkle studied dentistry at the University of Würzburg. In 2001, he received his licence to practice dentistry and worked in private practice until 2005. From 2003 to 2004 he absolved the Curriculum Implantology (DGI) and founded the joint practice with Dr. Ralf Masur in 2005 with a focus on implant dentistry, periodontology and prosthetics. Since 2012, Dr. Ralf Masur, Jan Märkle and Dr. Christopher Hermanns jointly run the implant center in Unterschleißheim. Jan Märkle is a member of numerous associations and is active as speaker on implant dentistry and prosthetics, both internationally and nationally. Dr. Christopher Hermanns After training as a dental technician in 2004, Dr. Christopher Hermanns studied at the Friedrich-Wilhelm-University in Bonn. In 2010, he passed his state examination and received his doctorate in the same year. Until 2011, he worked in general practice in Munich and then joined the Masur Implant Center in Unterschleißheim. Since 2012, he manages the joint practice with Dr. Ralf Masur and Jan Märkle. Dr. Christopher Hermanns received the Focus on Implantol- ogy (BDIZ) and is a specialist for implantology (EDA) since 2016. He is active as national and international speaker on implant dentistry and prosthetics. Contact details Masur Implant Center Unterschleißheim Dr. Masur, Märkle, Dr. Hermanns Einsteinstraße 14 D-85716 Unterschleißheim Tel: +49 (0) 89 / 321 526-15 unterschleissheim@masur-implantatzentrum.de Dr. Ralf Masur, M.Sc. After studying dentistry at the University of Erlangen-Nuremberg, Dr. Ralf Masur received his licence to practice dentistry in 1992 and received his doctor's degree in the same year. After two years in private practice he spent one year in the Department of Implantology at Harvard University in Boston. Until establishing his practice with a focus on implant dentistry and periodontology in 1995, he worked at the Institute for Periodontology and Implantology in Munich. Dr. Ralf Masur is active as an international and national speaker in the field of implant dentistry and prosthetics. Since 2001, he is a specialist for implant dentistry (EDA). In 2005, he established a joint practice with Jan Märkle in Bad Wörishofen. Dr. Ralf Masur runs seven implant centers and is an active member in numerous national and international associations. He is a specialist for orthodontics and received a Master of Science in this field.