His Front Teeth Were Half the Height They Had Been at Twenty

Quick answer: Worn-down front teeth can usually be rebuilt by adding material rather than cutting them down for crowns. The condition for that working is finding what caused the wear and stopping it first — otherwise the rebuild wears away as well.

The call

He brought a photograph from his wedding, twenty-two years earlier, which turned out to be the single most useful piece of diagnostic information in the file.

Yigal, 47, from Nachala U'Menucha, had upper front teeth that were short, square-edged, and yellower than they used to be. He thought they had stained. What had actually happened was that the enamel had worn through and the dentine underneath was showing.

What we found

Wear across the biting edges of all six upper front teeth and the four lower incisors. Crown height on the upper centrals was 7.5mm against the 10 to 11mm you would expect. The wedding photograph confirmed the change was real and quantified roughly how much had gone.

Exposed dentine across the worn edges — yellower, softer, and the reason his teeth had appeared to darken. The edges were flat and matched precisely against the opposing teeth, and the enamel at the very edge had become thin and translucent.

Working out the cause matters more than anything else, because there are three and they usually combine:

Attrition — tooth against tooth. Grinding and clenching. Produces flat, shiny, matching facets that fit together exactly when you slide the jaw into that position. His did.

Erosion — chemical. Produces cupped hollows, rounded margins and fillings standing proud. He had two amalgams standing slightly proud, and cupping on the lower molars.

Abrasion — something external. Toothbrush, or a habit like holding pins or opening things with the teeth. Not present here.

So: attrition plus erosion, which is the usual combination and is more destructive than either alone. Acid softens the enamel; grinding then removes the softened layer. Together they progress several times faster.

The history filled it in: he had been a heavy clencher for years, with masseter tenderness and a scalloped tongue, and he drank two litres of sparkling water a day, usually sipped at his desk.

The other question that has to be answered: is there still enough space between the arches to add material, or has the bite closed down as the teeth shortened? We measured. In his case the teeth had over-erupted as they wore — the jaw had compensated — so there was very little clearance at the front.

What we did

Cause first, for four months. A hard night guard, properly adjusted at a second visit. Sparkling water moved to mealtimes and drunk rather than sipped, with plain water at the desk. No brushing within an hour of it.

Casts at four months confirmed the wear had stopped. Nothing gets rebuilt until that is demonstrated.

Then the rebuild, additively. With limited clearance, the options were to cut the teeth down for crowns — removing more of an already-depleted tooth — or to create the space by opening the bite slightly and building up with composite.

We chose the second. Direct composite build-ups on the ten worn teeth, restoring height and edge shape, done freehand over two long appointments from a wax-up he had approved.

Adding material rather than removing it is the significant point. Crowning worn front teeth means cutting down teeth that have already lost half their structure. Composite adds to what is left, removes nothing, and can be repaired or replaced without escalating.

A new night guard made over the rebuilt teeth, because the old one no longer fitted the new shape — and because the grinding had not gone anywhere.

The outcome

Crown height restored to about 10mm. Sensitivity resolved once the dentine was covered.

At three years the build-ups have needed two small repairs and one polish, which is expected. He wears the guard nightly.

He describes the change as looking less tired, which is a fair description of what restoring worn front teeth does to a face.

What to do if this happens to you

1. Find an old photograph. It establishes how much has been lost and over what period.
2. Get the cause identified before any rebuilding. Attrition, erosion and abrasion look different.
3. Ask for casts as a baseline and a period of monitoring to confirm the wear has stopped.
4. Ask whether the rebuild can be additive. Crowning worn teeth removes more of what little remains.
5. Expect to wear a night guard indefinitely if grinding is involved.
6. Accept that composite needs maintenance. Repairs and polishing are part of the arrangement.

Front teeth looking shorter than they used to? Ramat Beit Shemesh Urgent Dental Care finds the cause before rebuilding. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.