New patient came in with chief complaint: "I don't like my front teeth. I know I grind them at night and I catch myself grinding and clenching during the day. I don't like the U-shape that's forming from where the teeth are chipping."

Health Hx: Pt states he was diagnosed with GERD and took meds in the past, but weaned himself off after changing his diet. He says he may snore occasionally, but doesn't think it's consistent. He also denies being tired/drowsy during the day, so I don't think OSA is an issue here. He reports using store-bought nightguards, but says he grinds through them pretty quickly.

Clinical exam revealed chipped incisal edges on #8, 9, 24, 25. Lower centrals are mildly crowded

In MI, centrals appear to occlude. I tried getting pictures of him in excursives, but they're not the best photos. As you can see (or maybe not) he has decent canine rise, so his centrals don't occlude during lateral movements. They also seemed to separate in protrusive. The only time I could get the centrals to touch were in MI and extreme lateral excursives where he is almost in a class 3 position. I don't think he would go that far with his grinding motions, so that may be unlikely, but I'm not sure.

My initial thought was to try composite bonding to rebuild the centrals, but after hearing that he goes through OTC nightguards so quickly, I think ceramic may be a better long term option. My plan would be emax veneers on #8,9 and composite on #24,25 (or maybe veneers also).

I am mainly worried about whether there is some other occlusal pattern that I'm missing that may contraindicate restoring these teeth. Therefore, I open it up to all of you who are much wiser for guidance.

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