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A lady with extrinsic acid erosion was referred to the restorative department at Bristol Dental Hospital by her General Dental Practitioner (GDP) for restoration of worn maxillary first molar teeth. These teeth were both causing symptoms of dentinal sensitivity and two attempts had been made to restore them with composite by her GDP. The restorations failed because there was insufficient space to bond the composite in place, which was due to dento-alveolar compensation of the first molars into the space created by the wear. Following relevant preventive advice, the maxillary first molar teeth were restored with ‘high’ direct composite resin, which allowed for adequate strength in bulk for retention while acting as fixed intrusion devices. These cured the patient's sensitivity and within four months her occlusion compensated for the composites and had re-established.
Clinical Relevance: Direct composite can be used as both a fixed intrusion orthodontic appliance and routine restoration if placed to act under compression.
Article
A fixed composite intrusion device acts like an orthodontic appliance. It is a direct composite restoration bonded to a tooth so that the tooth's coronal height is increased, thereby preventing the remaining dentition from contacting in intercuspal position (ICP). These devices can be used to bring about intrusion movements. This movement has been achieved on posterior teeth using removable1 and fixed gold crowns2 and nickel chromium appliances,3 and occurs owing to the controlled intrusion of teeth with ‘high’ restorations and eruption of the remaining separated teeth.
Intrusion can also be induced in the anterior dentition with both fixed and removable appliances.4 The main problem associated with restoring worn molars is restoration retention due to the lack of bulk of composite material.5
This patient received preventive management for erosion and the maxillary first molar teeth were restored with ‘high’ direct composite bonded to induce intrusion movements. In this case, the patient adapted to the changes to her occlusion without any symptoms or other problems and the occlusion re-established within 4 months.
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