Patient did not like the unevenness of his front teeth. Upon close examination, I observed both #'s 8 & 9 have a palatal inclination. I can now add composite thickness to the incisal edges and give the patient a better arch form.
Uneven wear on the incisal edges has evolved into a reverse smile. Also, the mesial slant of #9 has given rise to a black triangle.
Patient bruxes anteriorly
Wide Brass band in place
Wide Brass band is placed around #9. #9 was prepped with a long enamel taper. Labial portion of the brass band has been cut away for access. The mesial cervical portion of the band has been burnished toward #8. The softer brass holds it shape and will mould a rounded emergence contour to reduce the black triangle.
Bonding agent placed
After etching and rinsing, bonding agent is placed. #'s 8 & 9 are very slightly pried apart with a bladed instrument and held there (think of it as an incisal wedge). Flowable is placed into the precisely contoured brass at the mesial cervical and cured. The cured flowable locks in the separation and bladed instrument can be removed.
A3 Filtek Supreme is snowplowed into A2 Filtek flowable to complete the composite placement. The incisal 1/2 is built labially in composite.
#8 prepped with a long enamel taper on the incisal 1/2 of the tooth.
Composite was placed in the same manner as was done for #9. A3 Filtek Supreme snowplowed into A2 flowable.
I kept forward excursions of the lowers against the lingual of the uppers and off the composite. Patient does not engage composite until he moves his mandible more forward. I realize #9 looks over contoured at the cervical. However, from speaking distance, it is not noticeable and the black triangle is closed. The Class V on #9 will be addressed in the future.
Patient to return for a complete exam. Will strongly encourage compliance with a night guard. Time will tell whether my conservative fix will survive.