Localised tooth wear Flashcards
contraindications for buildups for anterior wear
short roots
reduced periodontal support due to periodontal disease
why is lower anterior tooth wear more difficult to treat than upper anterior tooth wear?
less enamel
smaller bonding area
localised posterior tooth wear features
unusual on its own
erosive in bulimic and alcoholic patients
if localised and asymptomatic:
- prevention and monitoring are appropriate
occlusal erosive wear can be filled directly without impacting occlusion
occlusal considerations when treating localised posterior wear
aim to provide sufficient canine guidance to ensure posterior disclusion
composite resin can be added to palatal aspect of upper canines to increase canine rise and disclude posterior teeth during lateral and protrusive excursions
- as in many cases there is canine wear which has removed guidance, leading to posterior wear
*correcting canine wear saves posteriors from further damage
methods of composite build up
alginate impressions
wax up
putty matrix
clear vacuum formed matrix
how is a clear vacuum form matrix used in composite build ups?
alginate impression
diagnostic wax up
impression of this poured in stone
- vacuum formed clear plastic matrix formed on this
cut to size and used as mould for build-up
composite build ups - success
generally good patient satisfaction
posterior occlusion normally re-achieved
seldom TMJ problems
no detrimental effect on pulpal health
no worsening of periodontal condition
composite build ups - longevity
viable medium term option
requires repair and maintenance
maxillary restorations last better than mandibular
- increased bonding area
no definitive figures - around 70% success over 10 years
BUT - if they fail they can be replaced or repaired with no tooth destruction occurring over placement
information to give patient prior to placing composite build up
front teeth will receive tooth coloured fillings to cover exposed and worn tooth surface
- to prevent further wear
procedure will be carried out with LA
- as there will be no or minimal drilling
- adding onto tooth, not removing tooth structure
an improvement in appearance of teeth should be possible
bite will feel strange for a few days - may have difficulty chewing
- will take over a week to become accustomed to new bite - may initially have to cut food into smaller pieces
- only front teeth will touch together
- back teeth will gradually come back together over 3-6 months
change in shape of front teeth may cause lisping for a few days
front teeth may feel a little tender to bite
may initially bite lips and tongue
crowns bridges or partial dentures at back of the mouth are likely to need replacing
information for patients regarding longevity of composite build ups
longevity should be good however small potential for restorations to debond and fall off
-can be replaced with no damage to remaining tooth structure
restorations require maintenance
- margins will require occasional polishing
- occasional chipping may occur
generalised tooth wear - features
most cases of generalised tooth wear begin as localised
if not treated localised tooth wear can progress involving whole mouth
- treatment more complex in these cases
- cases much rarer but increasing
treating excessive generalised tooth wear with loss of OVD
easiest to treat but least common
splint can be used to assess patient’s tolerance of new face height
ideally half OVD increase should be maxillary and half mandibular
often a mixture of adhesive and conventional restorations required
dentures may be required to provide posterior support at new OVD
Treating excessive generalised tooth wear without loss of OVD but limited space
complex to treat
can involve re-organisation of occlusion
splint should be considered
- as increase in occlusal face height is required
restorations are carried out at new occlusal face height
- should involve minimal preparation adhesive restorations
Treating generalised tooth wear without loss of OVD with no space available
most severe type
most difficult to treat
most likely requires specialist opinion prior to treatment
attempt to increase OVD by use of splints and/or dentures if lack of posterior support
crown lengthening surgery
orthodontics
crown lengthening surgery in tooth wear
used to increase amount of coronal tooth substance available
may result in ‘black triangles’ between the teeth where interdental papillae is further down
can lead to unfavourable crown:root ratio
often post op sensitivity
any subsequent crown prep will be further down the root
- greeter chance of pulpal damage
