Restoration of the Worn Dentition Flashcards
when does pathologic wear occurs
when the process of physiologic wear is accelerated by exogenous or endogenous factors and frequently it is multifactorial and a variable problem
the excessive wear of just one tooth of extensive restorations or of the full dentition has been associated to:
- supraeruption of the opposing teeth
- inclination of the teeth to a contact that has been eroded
- reduction of the vertical dimension
- some authors also believe that it can be a contributing factor in temporomandibular disorders
what are the etiologies of wear
- congenital anomalies
- attrition
- loss of posterior vertical support
- abrasion
- erosion
- abfraction
what should be evaluated in the intitial interview to determine type of wear presetn
a detailed review of the medical history, diet, and an evaluation of the presence of environmental factors and patient habits should be done
what are the etiologies of mechanical wear
- loss of posterior support
- premature occlusal contacts
- bruxism
- inadequate brushing technique
- parafunctional habits
what are the characteristics of mechanical wear
- presence of wear facets with a well defined loss that coincides on the articulated models
- the pattern of the wear facets should be analized because they tend to occur in predictable places
what are the causes of greater wear on anterior teeth compared to posterior teeth
- posterior suport inadequate or unstable
- loss of posterior teeth
- premature occlusal contacts
what is the cause of progressive wear greater on anterior teeth
can be result of bruxism
what is the cause of wear on the buccal surfaces of premolars and canines
can be the result of excessive brushing or an inadequate brushing technique
what is the cause of wear on the incisal or occlusal surfaces
usually due to parafunctional habits
what are the etiologies of chemical wear
- chronic vomit
- sucking of citrus fruits
- consumption of acidic drinks and foods
- medicines with an acid pH
- abuse of certain drugs
- environmental factors
what are the characteristics of chemical wear
- presence of amalgam islands
- presence of grooves and fossae
- there can be hypersensitivity
- in most cases there are no stains or changes in color
- the wear facets dont have a defined periphery
what are the causes of greater loss of dental structure on anterior surfaces than on posterior surfaces
- the more common cause is chronic vomit
- sucking on citrus fruits
what are the causes of greater loss on posterior surfaces than on anterior surfaces
- consumption of acidic foods or drinks
- rinse with or retain acidic drinks in the mouth
- chew the pulp of certain fruits
what are the variable location and miscellanesou causes of chemical wear
- medicines with an acid pH that have frequent contact with dental surfaces
- abuse of amphetamine extasis
- application of cocaine to the oral mucosa
- patients that are exposed to acidic vapors and aerosols
it is assumed that extensive wear of the dentition results in a:
reduced vertical dimension of occlusion
what are the 3 situations in which it is possible that wear is present
- fast wear in which compensation is not achieved and there is a reduction of the vertical dimension
- slow wear in which the vertical dimension is maintained
- wear is not present or very slow
what is evaluated in the vertical dimension
- posterior support
- history of the wear present
- phonetic evaluation
- interocclusal distance
- facial appearance
- perception of the patient
what is category 1 of patients with occlusal wear
- excessive wear and reduction of the vertical dimension
- the pt will present:
- few posterior teeth missing
- excessive occlusal wear present on anterior teeth
- unstable occlusion on posterior teeth
- closest speaking space close to 3mm
- interocclusal space of 6mm
what should be fabricated to evaluate if the pt tolerates the increase in vertical dimension
an interocclusal splint or a temporary RPD
the provisional restorations will provide the opportunity to:
objectively evaluate the comfort, esthetics and hygiene
what is category II of occlusal wear
excessive wear without reduction of the vertical dimension with space for restorative materials
- the pt will present:
- extensive history of occlusal wear
- interocclusal space of 3mm
- patients closest speaking space of 1mm
- sufficient space for materials
in category II patients, the constant eruption has:
maintained the vertical dimension
the preparation of the teeth to establish adequate ___________ forms is complex in these patients
retentive and resistant
what is a category III patient
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 1mm
- interocclusal space of 3mm
the space for restorative materials can be obtained by:
orthodontics, restorative repositioning, orthognathic surgery or programmed modification of the vertical dimension
the increase of the vertical dimension should be:
as minimal as possible
what are the determinants in the treatment of patients with excessive occlusal wear
- 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 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
what are the treatment options
- no active intervention
- prevention of loss of additional dental structure
- restoration to revert the effects of the loss of dental structure
what are the restorative methods
- extraction and replacement with complete dentures, overdentures or RPDs
- restoration using amalgam, composite resins, onlays
- restoration using fixed prostheses, removable prostheses, implants or a combination
changes in vertical dimension should be evaluated with:
an occlusal splint before starting any treatment
what are the symptoms of intolerance to an increase in vertical dimension
- clenching
- muscular fatigue
- pain in the teeth
- muscles or articulations
- headaches
- intrusion of teeth
- fracture of restorations and occlusal instability
when can the provisional restorations be made
after the patient accepts the occlusal guard and feels comfortable wearing it
when are function and esthetics evaluated
after making provisionals
the final restorations of this type of patient should present elements like:
shallow cusps and a reduced occlusal surface in the buccolingual aspect
why are final restorations made this way
they help reduce the destructive forces directed to the restored teeth
after final restorations have been made what is done after that
- an occlusal guard( rigid) should be made to prevent nocturnal parafunctional habits wear or fracture of the restorations
when should neutral sodium fluoride be used once a day in trays
in patients with an extensive restorations with an inadequate oral hygiene and high indices of plaque
what is the recall interval for these patients
every 3 months the first year and then every 6 months after that in combination with periodic periodontal treatment
