Alternative Methods for Betel Nuts Consumers With Long-Lost Vertical Dimension and Posterior Teeth Combined With Severe Attrition of Lower Anterior Teeth

Objectives: To restore the vertical dimension of severe anterior teeth attrition patients with prolonged history of betel nuts consuming with a combination of removable dentures, composite overlay and porcelain fused metal crowns.
Methods: Two middle-aged aboriginal Taiwanese with long history of betel nuts chewing presented with chief complaints of missing lower posterior teeth and severe attrition of lower anterior teeth. Conventional methods of restoring vertical dimension with interim denture often leads to anterior open bite and excessive occlusal load at the posterior region. To evenly distribute the occlusal force, composite overlay on the lower anterior teeth and crowns with metal palatal surfaces of upper anterior teeth were designed along with an interim denture to restore the vertical dimension. The posterior edentulous area was permanently rehabilitated with a removable partial denture afterwards.
Results: Both patients reported satisfied with the treatment 3 months after full mouth rehabilitation. No TMJ or alveolar ridge pain were noted. Articulating paper showed that the occlusal contact points were evenly distributed and similar to the day of delivery.
Conclusions: Composite overlay on anterior teeth with severe attrition can facilitate restoration of vertical dimension while preventing excessive occlusal load on the posterior partial denture.