Systematic Management of Severe Anterior Tooth Surface Loss using Provisional Onlay and Permanent Overlay Removable Prostheses: A Case Report

Management of severe tooth surface loss presents a growing difficulty that is encountered increasingly in everyday practice. Loss of posterior support has been identified as the causative factor in severe anterior tooth surface loss, leading to a reduction in the occlusal vertical dimension and complex tooth wear, which can affect the quality of life.

The purpose of this report is to show the systematic approach utilized in the management of severe anterior tooth surface loss in a partially edentulous old patient.

This report describes the management of a 59-year-old gentleman with a complaint of short anterior teeth as well as inefficient function. Clinical examination revealed short anterior teeth and multiple missing teeth posteriorly, which resulted in the loss of posterior tooth support. The management of this case involved reorganizing the occlusion to create the restorative space, which was achieved by a combination of fixed and removable restorations. The short- and medium-term management consisted of an occlusal splint, endodontic treatment, composite build-ups, provisional onlay acrylic dentures, and metal copings. Single crowns and removable cobalt chrome partial dentures were the definitive treatment for the maxillary arch, while a modified overlay cobalt chrome partial denture with cast facings and custom-made porcelain teeth was fabricated for the mandibular arch.

The patient was able to function well with the provisional onlay denture, and at the same time, the increased vertical dimension and the patient’s tolerance and compliance to partial denture treatment were evaluated. The permeant overlay partial denture restored the patient’s aesthetics and function, with minor adjustments needed. At the 2-year review appointment, the patient denied experiencing any muscular or temporomandibular joint soreness or dental complaints except for minor sensitivity. The patient was compliant and satisfied with the overall performance of the dentures.

A systematic approach to the management of a patient with a complex presentation can lead to a predictable and favourable prognosis. Onlay and overlay removable partial dentures are regarded as treatment alternatives that are non-invasive, reversible, and conservative.