Hi Folks,

I would be really grateful for an opinion on this case - photos attached as pdf.

Situation:

25 year old lady who is a new patient to the practice. She is really concerned about spaces opening up between her maxillary incisors. She feels the teeth are becoming 'splayed'. The problem only started this past 6 months - before then she had no anterior spacing. She mentioned that bleaching nightguards she had made only 1 year ago - no longer fit.

Background:

She has no history of trauma. She is aware of a grinding habit and previous dentists have treated her using soft nightguards. She had a CEREC ceramic onlay fitted on tooth #14 around 1 year ago - this tooth had cracked. She now wonders if this restoration may have contributed to her anterior spacing. She mentioned that tooth #14 is generally uncomfortable when she bites.

Clinically:

She has a well maintained dentition with only a couple of small sized restorations.

She has healthy periodontal support.

She has R/L canine guidance. NWS contacts are noted on #15,16.

There is an element of lateral contact on #14.

Wear facets are noted on #6 and #11

My thoughts so far...

I wonder if the onlay may have an occlusal interference and by avoiding this she is grinding on the incisors causing them to splay.
I wonder if the onlay may have distalised the molar - there is a more pronounced ridge on the distal of the onlay compared with the contralateral molar

HELP...

I would be grateful for any help/suggestions/advice....

Especially - what do you think is the likely cause ?

How would you manage the case?

Will she need Ortho to reposition the incisors?

Thanks a million!