Initial Diagnosis
A female patient presented to Dr Sahar Shakibaei Kesheh at Balgowlah Dental Clinic with extensive abfraction lesions across the buccal surfaces of her teeth. She also had significant tooth wear, cracking, gaps, and erosion.
The patient wanted a natural-looking result rather than teeth that appeared heavily restored. The treatment plan therefore needed to address the structural damage while preserving a natural overall appearance.
The case presented two main clinical challenges:
- The abfraction lesions needed to be addressed before preparation could begin.
- Moisture control was also critical because the new composite needed to bond to sound tooth structure rather than the existing composite.
These factors made the treatment workflow especially important. Dr Sahar needed to create a stable foundation for the definitive restorations without requiring extensive preparation around the existing subgingival undercuts.
Treatment Plan
The case was digitally scanned and sent to Avant Dental Lab for a digital wax-up. The lab created the proposed design and supplied a putty key for the temporary trial. The wax-up established the planned tooth form and provided a clear reference for the patient’s requested natural aesthetic. Before preparing the teeth, Dr Sahar restored the buccal abfraction lesions with composite. Preparation before composite placement would have made the subgingival undercuts difficult to manage. It may also have required more extensive preparation to work around them.
Restoring the lesions first allowed Dr Sahar to avoid extensive preparation around the subgingival undercuts. Careful moisture control helped ensure the new composite bonded to sound tooth structure rather than existing restorative material.
Once the abfraction lesions had been restored, the teeth were prepared. Dr Sahar used the lab-supplied putty key to fabricate the temporary restorations and transfer the planned form chairside.
A scan of the prepared teeth was then sent to Avant Dental. The final restorations consisted of layered zirconia crowns and bridges with aesthetic buccal layering. The layering supported the natural appearance requested by the patient.
The workflow followed a clear sequence:
- Case planning: The case was scanned, and a digital wax-up was requested from Avant Dental.
- Digital design: The lab created the proposed design and supplied a putty key for the temporary trial.
- Abfraction restorations: The buccal lesions were filled with composite prior to tooth preparation.
- Preparation and temporaries: The teeth were prepared, and the putty key was used to fabricate the provisional restorations.
- Definitive restorations: A prepared scan was sent to the lab for layered zirconia crowns and bridges.
- Protection: A splint was provided after cementation to help protect the completed restorations.
According to Dr Sahar: “Honestly, this case couldn’t have gone smoother. Everything fit perfectly the first time – contacts, occlusion, all of it. What could have been a complex case turned out to be completely straightforward.”
Treatment Summary
This case required careful sequencing due to the abfraction lesions, existing restorative material, and the patient’s aesthetic expectations:
- The patient presented with extensive buccal abfraction lesions, wear, cracking, gaps, and erosion.
- Moisture control was important to support bonding to sound tooth structure.
- A digital scan and wax-up were completed before treatment.
- Avant Dental supplied the digital design and a putty key for the temporary restorations.
- The abfraction lesions were restored before tooth preparation.
- The prepared teeth were scanned for layered zirconia crowns and bridges.
- A protective splint was provided after cementation.
The Outcome
The final restorations achieved the natural appearance the patient had requested. The layered zirconia crowns and bridges fitted accurately at the first appointment. The contacts and occlusion required no further correction.
The result was significant because the original presentation included extensive abfraction lesions, existing restorative material, and several forms of tooth damage. The subgingival undercuts also had the potential to complicate preparation.
Restoring the lesions first created a controlled foundation for preparation. The digital wax-up and putty key helped transfer the planned form into the provisional stage. Clear communication between Dr Sahar and Avant Dental maintained that information through to the final restorations.
The splint completed the treatment pathway and provided protection for the cemented restorations. For a case with several potential complications, the successful outcome demonstrated the value of careful workflow planning and effective communication between Dr Sahar and Avant Dental.
See what’s possible with complex restorative support
Want to discover how Avant Dental’s digital planning and laboratory support can help dentists manage complex aesthetic and restorative cases? Visit our dental laboratory or call 1800 287 336 to explore what’s possible for your patients.
All case studies presented by Avant Dental are done so with permission from the ordering dentist. No patient details are shared, and all representations are true and accurate to the case.