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
