Good morning from Penallt Wales.

I have had two individuals attend this week both with what appears to be anterior wear with compensatory over eruption of the anterior teeth. Both cases appear to have reasonable face height and have no incisal display at rest. They have been used to reactionary dentistry in the past at a other surgeries restoring units as they fail and feel that a better approach would be to treat their dentition now as a whole.

I would like some advice on the best way forward, I have produced DSD mock ups for them and patient A is considering it as he understands the concept. I have not pitched it to patient B as yet but his wife has had veneers 20 years ago and wonders if it would be suitable for him.

The first pictures are Mr A. He is an international business man and is nearly on board.[image:IMG_9568.jpg][image:IMG_9570.jpg][image:IMG_9575.jpg][image:IMG_9574.jpg][image:IMG_9571.jpg][image:IMG_9578.jpg][image:MG_4748.jpg][image:IMG_9577.jpg][image:MG_4753.jpg][image:IMG_9580.jpg][image:MG_4751.jpg][image:MG_4747.jpg][image:MG_4752.jpg]

I am very comfortable offering orthodontics so was considering levelling and flattening the lower arch closing the space and intruding the anterior segment and restoring the upper with conventional crown and bridge after whitening and then building lower anteriors with composite to begin with. Am I miles out with this approach?

Mr B is simular but I am going to struggle with anchorage in the lower. He is wanting implants to replace the lower missing units and the lower left second molar is unrestorable (decay distal due to food packing). I guess i could place the implants and use these as anchorage to level and intrude the lowers and then restore agin the upper with conventional crown work and the lower again with composite after bleaching. Again am I miles out?

I would appreciate any input. Many thanks Jay.

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