5 - Wear 2 Flashcards
What forms the basis of the immediate treatment planning of tooth wear cases?
- deal with pain and sensitivity
- can involve desensitising agents (fluoride), pulp extirpation, smoothing sharp edges, XLA or addressing TMJ pain
What forms the basis of the initial treatment planning of tooth wear cases?
- stabilise existing dentition
- prevention derived from wear diagnosis is key
- deal with caries
- deal with perio
- oro-mucosal
- wear progresses slowly so deal with any other issues first
What is involved in preventative treatment of tooth wear?
- baseline recordings and photos
- identify is wear is historic or progressing
- remove the cause (change toothpaste, change habits, change toothbrushing)
How do you treat cervical toothbrush abrasion with prevention?
- GI or composite restorations are considered preventative as they prevent further tissue loss
- require no prep
- patient wears through restoration vs enamel
How do you treat attrition with prevention?
- CBT and hypnosis for parafunction
- splints
What different type of splint are available?
- soft
- hard
- Michigan
What are the benefits of a soft splint?
Can be used as diagnostic device to show wear facets
What are the benefits of a hard splint?
More robust and lasts longer
How do splints treat parafunction?
- wear away preferentially to tooth tissue
- cause no damage to opposing teeth
- can break the habit but inhibiting the feedback loops from grinding
What is a Michigan splint?
- type of hard splint
- provides ideal centric occlusion when worn
- has a canine rise which provides disclusion
When are splints contraindicated?
Patients with erosion as the splint holds the acid in place
How do you treat erosion with prevention?
- fluoride (toothpaste, mouthwash, tooth mousse etc)
- desensitising agents (not prevention but symptomatic relief)
- dietary management
- habit changes (rumination, using a straw, too much fruit)
- change in medication where possible
How do you treat abfraction with prevention?
- consider occlusal equilibration
- fill cavities with low modulus restorative materials (RMGIC or flowable)
What is passive management?
- prevention and monitoring
- first 6 months
- required before any definitive treatment, may result in no definitive treatment is prevention successful
What is active management?
- intervention threshold
- simple restorative intervention so that the restoration is worn instead of tooth
What is the threshold for intervention in wear cases?
- wear leading to further complications
- aesthetics are beyond patients acceptability
- not intervening may lead to more complex treatment needs (ie localised anterior can become generalised)
What are the goals surrounding active management of wear?
- preservation of remaining tooth tissue
- improvement in aesthetics without compromising function
- stability (do not build up teeth beyond capability of TMJ)
What are the factors that impact active management of wear of the maxillary anteriors?
- pattern of tooth wear
- inter-occlusal space
- space required for restorations
- quality and quantity of tissue, esp enamel
- aesthetic demands
What are the patterns of maxillary anterior tooth wear?
- palatal only (vomit habit)
- palatal and incisal edges with reduced clinical crown height
- labial only (sucking sweets)
Describe the active management of maxillary anterior tooth wear with adequate inter-incisal space.
- uncommon as usually slow process with alveolar compensation
- can be used in AOB or class II div 1
- composite buildups are usually successful and do not change OVD
Describe the active management of maxillary anterior tooth wear without adequate inter-incisal space.
- surgical crown lengthening
- dahl technique
Describe surgical crown lengthening.
- exposes more of the crown for retention of final restoration
- repositions gingivae apically with some removal of bone (can cause black triangles where papilla have receded)
- can cause sensitivity
- crown-root ratio decreased
Describe the Dahl technique.
- removable CoCr anterior bite plane or composite placed palatally
- creates posterior open bite and encourages alveolar compensation so that posterior teeth erupt and increase the OVD to allow space for anterior restorations
Who is the Dahl technique not suitable for?
- active perio
- TMJ problems
- post orthodontics
- bisphosphonates (relies on good bone turnover)
- dental implants (implants are ankylosed to bone)
- conventional bridges
