NCTTL Flashcards
NCTTL
3 types?
Attrition / erosion / abfraction
NCTTL categorised by
Severity - mild / moderate / severe
Distribution - localised / generalised
Physiological / pathological
Abrasion caused by?
- tooth brushing - tooth hard / abrasive tp
- habitual - tongue piercings / pen / nail biting / pipe smoking
- industrial iatrogenic - abrasive particles in atmosphere / dental prof
Erosion caused by?
Extrinsic
- diet
- medication
- lifestyle
- environmental
Intrinsic
- gastric reflux
- vomiting
- rumination
Predisposing factors
- saliva rate
- buffering capacity
Diagnosis - tooth wear
How to prevent further tissue loss - erosion
EROSION
• Reduction of the frequency and severity of the acidic attack
(diet analysis/advice)
• Enhancement of the natural oral defence mechanisms
(sugar free gum- increase saliva flow)
• Enhancement of recovery from/resistance to acid attack
(F, tooth mouse)
• Substitution of alternative low erosive foods and/or drinks (straw)
• Minimization of mechanical factors that exacerbate tooth surface
loss following an acidic challenge (delay brushing)
• Mechanical protection of susceptible surfaces (BRA, FS, restore)
How to prevent further tissue loss - abrasion and attrition
ABRASION AND ATTRITION
• Correct tooth brushing technique
• Avoid hard tooth brush
• Avoid abrasive tooth paste
• Avoid para functional habits (pen/nail biting etc)
• Soft splints
• Stabilization Splint
How to monitor tooth tissue loss
- study models
- photos
- radiographs
- silicone index
Localised anterior tooth wear
- how is it measured and classified?
• Simplified index based on Smith and Knight and BEWE
• Classified by severity in relation to the patients age
Localised anterior tooth wear - implications
Resulting in limited space for restoration
• Dentoalveolar compensation
• Compensatory eruption of worn teeth
• Forward posture of mandible
• Occlusal contacts maintained
THEREFORE OFTEN NEED TO CREATE SPACE IF LOCALISE
Restorative intervention - biological / functional / aesthetic
BIOLOGICAL
• Irregular tooth surface/trauma
• Sensitivity
• Pulpal exposure likely
• Structural integrity of the tooth threatened/risk of #
• Difficult to clean / plaque accumulation
FUNCTIONAL
• Location of lesion compromises the design of
removable partial denture
• Decreased mastication
AESTHETIC
• Aesthetically unacceptable to patient
• Alteration in appearance / decreased OVD
Treatment options
TREATMENT OPTIONS
• Crowns
• Veneers
• Over dentures
• Onlay dentures
• COMPOSITE RESIN (DIRECT OR INDIRECT)
CONCERNS re FULL MOUTH REHAB
ONCERNS re FULL MOUTH REHAB
• Further reduction of already worn teeth
• ↓Retention/resistance of crowns (bonding)
• May require crown lengthening
• Frequently involves reorganisation of the occlusion
• Longevity
• 19% (1-5) crowned teeth (with presumably pre-op vital
status) has radiographic signs of peri-radicular disease
DIRECT COMPOSITES - DIRECT DAHL EFFECT
DIRECT COMPOSITES - DIRECT DAHL EFFECT
• Direct application without
creating space first
• Allowing posterior teeth to
re-establish
• No/little tooth preparation
• Good aesthetic results
• Conservative approach
• Prevents further loss
FABRICATION - Direct or indirect
DIRECT
• No lab fee
• Cheaper
• Time consuming
• Can be difficult to place
and finish at chair side
• Not as durable, but easy
to replace/repair
INDIRECT
• Lab fee
• More expensive
• Easier to obtain accurate
morphology
• Difficult to locate, no tooth
prep
COMBINATION
Lab wax up and chairside composite
COMBINATION
Lab wax up and chairside composite
• Lab wax up on study models
• Accurate occlusal contours and contacts
• Direct intra oral placement using lab constructed stent
• Aesthetic and conservative approach
COMBINATION
Lab wax up and chairside composite
COMBINATION
Lab wax up and chairside composite
• Lab wax up on study models
• Accurate occlusal contours and contacts
• Direct intra oral placement using lab constructed stent
• Aesthetic and conservative approach
ADVANTAGE OF PALATAL MATRIX
ADVANTAGE OF PALATAL MATRIX
• Gives palatal contour and incisal length
• Helps when using layering technique
• Minimum adjustments and wastage
Conclusion
CONCLUSION
Adhesive materials to restore worn dentition well reported
in the literature
BUT
Limited acceptance and application by dental profession
Concerns re durability and long term clinical performance
•Remember the “restorative cycle”, “lifetime of the tooth”
