Keith

We're guessing that due to the amount of wear your teeth have undergone your dentist feels that they need more available space/clearance in order to place upper front crowns.

This would have to do with where your upper and lower front teeth touch. When placing a crown, the tooth needs to be trimmed a certain amount to accommodate its thickness. We would think that your dentist feels that doing so might expose the nerve of your teeth, or else result in tooth nubs so short that the crowns wouldn't stay in place well.

As a solution a dentist will "open the patient's bite." They do this by making the back teeth taller (hence the crowns you mention) so there is more clearance available (front-tooth separation). That way the front teeth don't have to be trimmed so much to accommodate the crowns' thickness.

We get your longevity point. We would also mention that if a person's bruxism is not controlled that placing crowns may offer some benefits short-term but over the long-term will fail and/or cause problems (such as wear) with other teeth.

You seem motivated in your attempts to control your bruxism. And if you were 100% successful the concerns about future wear with or without crowns would be drastically reduced.

You don't mention how successful your efforts seem to have been over the last 10 years. If there are still some issues, have you considered including some daytime use of you guard to further reduce the level of wear that is occurring?

Only you and your dentist can make a decision about your treatment. If aesthetics aren't a big factor and further wear isn't occurring at a great rate, not placing crowns means less expense, less maintenance of restorations (crowns can come off, break, need replacement), usually it's easier to brush and floss natural teeth (thus reducing potential for gum disease), opening a person's bite can cause TMJ problems/issues, crowns that are not polished well can cause extensive wear of opposing teeth with bruxers, when heavy bruxing forces are involved porcelain crowns can break, crown wear can occur in bruxers. Ask your dentist but it seems naive to think that within the next 30 years of your life that this work wouldn't need serious maintenance or outright replacement.

Obviously this isn't an easy choice. Clearly everything depends on the level of bruxing activity that can be expected to continue. Good luck.

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