Hi All -

Was wondering about getting your take on this case. This patient came to me due to a fractured tooth and then we started talking about other issues, obviously. SO. Right now I am in the exploratory and diagnostic phase and looking for differential diagnoses and treatment options. This family is interested in getting to the root of the problem and is willing to explore any path of treatment.

First, I am looking at the erosion that is primarily on the patient’s right side. My df/dx is potential acid reflux with the patient generally sleeping on his right side. Patient has had a history of being on acid suppressors in the past but is on none currently. He has gone for a scope with a GI doctor and is awaiting the results.

Secondly, I notice that the fractured tooth on the upper right side is probably due to traumatic occlusal interference due to the patient’s occlusal scheme as the brunt of the occlusion lies mainly on the premolars and forward.

Thirdly, I notice the posterior open bite which is concerning since the patient has a past history of having orthodontics in his teen years. Patient states that he has not had any appliance therapy, no habits in the posterior. I am assuming that these teeth could have been in occlusion at some time due to the appearance of some wear on the posterior teeth - especially on #19 (lower first molar left side) when this tooth is completely out of occlusion.

Orthodontic consult has been scheduled - problem I see here is that the posteriors could be ankylosed?

Poss treatment options?

1. Restore the erosive lesions and call it a day

2. Restore the posterior teeth only with crowns to try to obtain posterior support leaving the left second molars alone due to the large crown to root ratio that would occur

3. Full Mouth Restorations also leaving the left second molars alone

4. Ortho to try to bring the teeth closer to ideal occlusion and then restore

5. Other options - patient does not want to undergo surgical intervention

Thanks for taking the time to look at this and I would love to know what you are thinking.

Chad

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