RESTORATION OF THE WORN DENTITION Flashcards
PATHOLOGIC WEAR OCCURS WHEN THE PROCESS
OF PHYSIOLOGICWEAR IS ACCELERATED BY
— FACTORS AND
FREQUENTLY IT IS
— AND A VARIABLE
PHENOMENON.
EXOGENOUS OR ENDOGENOUS
MULTIFACTORIAL
THE EXCESSIVE WEAR OF JUST ONE TOOTH, OF
EXTENSIVE RESTORATIONS OR OF THE FULL
DENTITION HAS BEEN ASSOCIATED TO:
- — OATHE OPPOSING TEETH
- INCLINATION OF THE TEETH TO A CONTACT THAT HAS BEEN —
- REDUCTION OF THE — DIMENSION
- SOME AUTHORS ALSO BELIEVE THAT IT CAN BE A CONTRIBUTING FACTOR IN — DISORDERS.
SUPRAERUPTION
ERODED
VERTICAL
TEMPOROMANDIBULAR
ETIOLOGY OF WEAR
(6)
congenital anomalies
attrition
loss of posterior vertical support
abrasion
erosion
abfraction
DETERMINING THE TYPE OF
WEAR PRESENT
in the initial interview
a detailed review of the medical history, diet and an evaluation of the presence of environmental factors and patient habits should be done
ETIOLOGIES OF MECHANICAL
WEAR
(5)
loss of posterior support
premature occlusal contacts
bruxism
inadequate brushing technique
parafunctional habits
CHARACTERISTICS OF MECHANIC WEAR
(2)
presenceof wear facts with a well defined loss, that coincides on the articulated models
the pattern of the wear facets should be analyzed because they tend to occur in predictable places
GREATEST WEAR ON ANTERIOR TEETH
COMPARED TO POSTERIOR TEETH:
(3)
posterior support is inadequate or unstable
loss of posterior teeth
premature occlusal contacts
PROGRESSIVE WEAR GREATER ON ANTERIOR
TEETH:
(VERRET 2001)
(1)
it can be the result of bruxism
WEAR ON THE BUCCAL SURFACES OF
PREMOLARS AND CANINES:
(1)
is can be the result of excessive brushing or an inadequate brushing technique
WEAR ON THE INCISAL OR OCLUSAL
SURFACES:
(1)
usually due to parafunctional habits
ETIOLOGY OF CHEMICAL WEAR
(6)
chronic vomit
sucking of citric fruits
consumption of acidic drinks and foods
medicines with an acid pH
abuse of certain drugs
environmental factors
CHARACTERISTICS OF
CHEMICAL WEAR
presence of —
presence of —
there can be —
in most cases there are no — or changes in —
the wear facets done have a defined —
amalgam islands
grooves and fossae
hypersensitivity
stains,color
periphery
CHEMICAL ETIOLOGY
GREATER LOSS OF DENTAL STRUCTURE
ON ANTERIOR SURFACES THAN ON
POSTERIOR SURFACES:
(2)
the more common cause is chronic vomit
sucking on citric fruits
GREATER LOSS ON POSTERIOR SURFACES
THAN ON ANTERIOR SURFACES:
(3)
consumption of acidic foods or drinks
rinse with or retain acidic drinks in the mouth
chew the pulp of certain fruits
VARIABLE LOCATION AND MISCELANEOUS CAUSES:
medicines with an acid pH that have frequent contact with dental surfaces
abuse of the —
application of — to the oral mucosa
patients that are exposed to acidic —
ampetamine extasis
cocaine
vapors and aerosols
WEAR AND THE VERTICAL DIMENSION
(3)
it is assumed that extensive wear of the dentition results in a reducded OVD
there is no evidence that proves that this concept is correct
some authors coincide that cases in which there is extensive wear of the dentition, the wear is compensated by overeruption
BERRY AND POOLE (1974, 1976) AND RUSSEL (1987)
DESCRIBED THREE SITUATIONS IN WHICH IT IS POSSIBLE THAT WEAR IS PRESENT:
I FAST WEAR IN WHICH
II. SLOW WEAR IN WHICH
III. WEAR IS NOT PRESENT OR VERY SLOW
COMPENSATION IS NOT
ACHIEVED AND THERE IS A REDUCTION OF THE VERTICAL DIMENSION.
THE VERTICAL DIMENSION
IS MAINTAINED.
EVALUATION OF THE VERTICAL
DIMENSION
(6)
posterior support
history of the wear present
phonestic eval
interocclusal distance
facial apperance
perception of the patient
CATEGORY I:
* EXCESSIVE WEAR AND REDUCTION OF THE VERTICAL DIMENSION
* THE PATIENT WILL PRESENT:
-FEW POSTERIOR TEETH MISSING
-EXCESSIVE OCCLUSAL WEAR PRESENT ON
ANTERIOR TEETH
-UNSTABLE OCCLUSION ON POSTERIOR
TEETH
-CLOSEST SPEAKING SPACE CLOSE TO
– MM
- INTEROCLUSAL SPACE OF – MM
+3
+6
CATEGORY I:
Treatment (2)
AN INTEROCCLUSAL SPLINT OR A TEMPORARY.
RPD THAT RESTORES THE PATIENT?S VERTICAL DIMENSION SHOULD BE FABRICATED. TO EVALUATE IF THE PATIENT TOLERATES THE INCREASE: IN VERTICAL DIMENSION.
* THE PROVISIONAL RESTORATIONS WILL
PROVIDE THE OPPORTUNITY TO OBJECTIVELY EVALUATE THE COMFORT, ESTHETICS AND HYGIENE.
CATEGORY II:
* EXCESSIVE WEAR WITHOUT REDUCTION OF THE VERTICAL DIMENSION WITH SPACE FOR RESTORATIVE MATERIALS:
* THE PATIENT WILL PRESENT:
-EXTENSIVE HISTORY OF OCCLUSAL
WEAR
-INTEROCCLUSAL SPACE OF — MM
-PATIENTS CLOSEST SPEAKING SPACE
OF —MM
-SUFFICIENT SPACE FOR MATERIALS
+ 3
+ 1
CATEGORY II:
* IN THESE PATIENTS, THE CONSTANT ERUPTION HAS MAINTAINED THE — DIMENSION
* THE PREPARATION OF THE TEETH TO ESTABLISH ADEQUATE RETENTIVE AND RESISTANT FORMS IS COMPLEX IN THESE PATIENTS:
* PERIODONTAL SURGERY, LIKE —, IS FREQUENTLY NECESSARY.
VERTICAL
CROWN LENGTHENING
CATEGORY III:
EXCESSIVE OCCLUSAL WEAR WITHOUT A REDUCTION. IN THE VERTICAL DIMENSION AND LIMITED SPACE: FOR THE RESTORATIVE MATERIALS:
* THE PATIENT WILL PRESENT:
-MINIMAL WEAR ON POSTERIOR TEETH
-EXCESSIVE WEAR OF ANTERIOR TEETH
-CENTRIC RELATION AND MAXIMUM INTERCUSPATION ARE COINCIDENT
-CLOSEST SPEAKING SPACE OF –MM
-INTEROCLUSAL SPACE OF # – MM
1
3
CATEGORY III:
Treatment (2)
*THE SPACE FOR THE RESTORATIVE MATERIALS CAN BE OBTAINED BY ORTHODONTICS, RESTORATIVE REPOSITIONING, ORTHOGNATIC SURGERY OR PROGRAMMED MODIFICATION OF THE VERTICAL DIMENSION
* THE INCREASE OF THE VERTICAL DIMENSION SHOULD BE AS MINIMAL AS POSSIBLE, TO CREATE ONLY THE SPACE NEEDED FOR THE RESTORATIVE MATERIALS.
IMPORTANT DETERMINANTS IN THE
TREATMENT OF PATIENTS WITH
EXCESSIVE OCCLUSAL WEAR
(10)
- ETIOLOGY OF THE OCCLUSAL WEAR
- MOTIVATION OF THE PATIENT TO PRESERVE HIS TEETH
- CAPABILITY OF THE PATIENT TO MAKE A FINANCIAL AND TIME COMMITMENT FOR THE THE PROPOSED TREATMENT
- ABILITY TO MAINTAIN AND TAKE CARE OF THE FINAL RESTORATIONS
- PERIODONTAL HEALTH
- SEVERITY OF THE WEAR PRESENT
- NUMBER AND POSITION OF THE REMAINING
TEETH - PATIENTS EXPECTATIONS
- THE PATIENTS COMPROMISE TO WEAR AN OCCLUSAL GUARD AND ALSO TO WORK TO CONTROL THE PARAFUNCTIONAL
ACTIVITIES DURING THE DAY. - ANALYSIS OF THE DIAGNOSTIC TOOLS
TREATMENT OPTIONS
(3)
no active intervention
prevention of loss of additional dental structure
restoration to revert the effects of the loss of dental structure
RESTORATIVE METHODS
(3)
extraciton and replacement with complete dentures, overdentures, or RPD
restoration using amalgam, composite resin, onlays, etc
restoration used FPD, removable presthesis, implants or combo
- GOOD CLINICAL CRITERIA SHOULD BE USED WHEN A NEW — DIMENSION IS
ESTABLISHED - THE CHANGES IN VERTICAL DIMENSION SHOULD BE EVALUATED WITH AN — PRIOR TO STARTING ANY IRREVERSIBLE TREATMENT.
- SOME SYMPTOMS OF INTOLERANCE TO AN INCREASE IN VERTICAL DIMENSION ARE:
(8)
VERTICAL
OCCLUSAL SPLINT
CLENCHING, MUSCULAR FATIGUE, PAIN IN THE TEETH, MUSCLES OR ARTICULATIONS, HEADACHES, INTRUSION OF TEETH, FRACTURE OF RESTORATIONS AND OCLUSAL INSTABILITY
AFTER THE PATIENT ACCEPTS THE OCCLUSAL GUARD AND FEELS COMFORTABLE WEARING IT, THE PROVISIONAL RESTORATIONS CAN BE MADE: THIS IS THE MOMENT WHEN …
* THE FINAL RESTORATIONS OF THIS TYPE OF PATIENT SHOULD PRESENT ELEMENTS LIKE SHALLOW CUSPS AND A REDUCED OCCLUSAL SURFACE IN THE BUCCO-LINGUAL ASPECT.
THESE ELEMENTS HELP REDUCE THE …
FUNCTION AND ESTHETICS CAN BE EVALUATED, AS WELL AS THE PATIENT’S ORAL HYGIENE.
DESTRUCTIVE FORCES DIRECTED TO THE RESTORED TEETH.
CONCLUSIONS
* AN OCCLUSAL GUARD (PREFERABLE RIGID) SHOULD BE MADE TO PREVENT …
* IN PATIENTS WITH EXTENSIVE FIXED RESTORATIONS, WITH AN INADEQUATE ORAL HYGIENE AND HIGH INDICES OF PLAQUE, … SHOULD BE USED ONCE A DAY, APPLIED WITH A TRAY.
NOCTURNAL PARAFUNCTIONAL HABITS WEAR OR FRACTURE OF THE RESTORATIONS.
NEUTRAL SODIUM FLUORIDE
