Occlusal rehabilitation through biological restorations, aesthetic, and functional restoration in a patient with severe bruxism: Case report

relato de caso

Abstract

Introduction: The technique of biological restoration, also known as fragment bonding, involves the selection, preparation, adaptation, and cementation of a fragment or a large portion of a tooth, whether it is from the patient themselves (autogenous) or from another individual (homogenous). It is used in teeth affected by loss or wear of structure. It has gained prominence over other techniques in functional and aesthetic restoration due to its advantages such as biocompatibility, similarity in physical and aesthetic properties, patient satisfaction, and affordability. Case Description: Male patient, 41 years old, suffering from severe bruxism and gastroesophageal reflux, with a loss of vertical dimension of occlusion (VDO) due to excessive dental structure wear. Aesthetic and functional recovery was achieved by increasing the clinical crowns and restoring the lost dimension. Initially, this was done through treatment with a 3mm myorelaxant splint, which was used until the patient's musculature adapted to the new VDO. Subsequently, dental elements 34, 35, 36, 37, 44, 45, 46, and 47 were prepared by regularizing the occlusal surface and interproximal separation using cylindrical diamond burs and pencil-point burs attached to a high-speed handpiece. Subsequently, the prepared area was molded with addition silicone, cast in plaster, and mounted on a semi-adjustable articulator with the aid of a facebow. The dental elements from the model used for cutting the fragments were sectioned using the Dowell pin technique. Afterward, in the Human Teeth Bank (HTB) of the Federal University of the Jequitinhonha and Mucuri Valleys (UFVJM), teeth were selected for making the biological restorations. Next, the dental fragments were cut, ensuring that the internal surface of the fragment was a negative copy of the occlusal surface of the prepared dental element. Following the best possible adaptation, marginal sealing was adjusted with composite resin and preliminary occlusal adjustments, both still on the models. Subsequently, the biological restorations were cemented onto dental elements 34, 35, 36, 37, 44, 45, 46, and 47 using dual resin cement as the cementing agent with the aid of rubber dam isolation to ensure the best performance of the system. In addition, anatomical reconstruction was performed with composite resin facings on elements 31, 32, 33, 41, 42, and 43, and provisional restorations with stock teeth and acrylic resin on the upper anterior teeth. The study was approved by the Institutional Research Ethics Committee under the number: 6.226.378. Discussion: Biological restorations emerge as an option for dental rehabilitation, offering several advantages, including wide social reach due to low cost, preservation of dental structure, preservation of natural characteristics (color, texture, light reflection, shape, surface smoothness, modulus of elasticity, expansion and contraction, and positive emotional aspects). The technique requires manual skill but is accessible and effective, demanding attention to details in the processes of isolation, adhesion, and cementation. Regarding longevity, studies show that it is long-lasting if all stages of the technique execution are rigorously followed, including respecting fragment hydration, using rubber dam isolation, applying a high-quality adhesive system, preserving enamel margins, and choosing an effective cementing agent. However, there are obstacles related to access to tooth banks, especially in cases of extensive restorations, and some patients' reluctance. Conclusion: Homogenous biological restoration, a technique of bonding dental fragments from other individuals of the same species, is viable in cases of significant dental structure wear, even in a large group of teeth, as in the case of severe bruxism combined with dental erosion due to gastroesophageal reflux. It is a restorative method with broad social impact due to its affordability, representing a vast opportunity for functional and aesthetic restoration by restoring the clinical crown and VDO, especially when combined with other restoration techniques such as reanatomization and composite resin veneers.