RMTL 1 - Restorative management of tooth loss

Question 1

What are the 4 aetiologies of TSL?

Answer 1

Attrition
Abrasion
Erosion
? Abfraction ?

Question 2

What is abfraction?

Answer 2

Occlusal loading causing flexure at cervical margin and subsequent fracture

Question 3

How does erosion clinically present?

Answer 3

Cupped surfaces
Enamel translucency and thin at edges = dentine shine through
Restorations standing proud
Intrinsic sources are usually palatal and not lingual (protected by tongue)

Question 4

How does abrasion clinically present?

Answer 4

TSL matches foreign body
Can be very local
Tooth brushing - maybe unilateral

Question 5

How does attrition clinically present?

Answer 5

Wear facets 
Worn flat planes against each other
Frosty appearance 
Chipping of enamel due to undermining 
Dentoalveolar compensation

Question 6

What is dentoalveolar compensation?

Answer 6

Growing alveolar ridges = face heights the same

Causing space issue when wanting to correct worn dentition

Question 7

How can you tell patient has dentoalveolar compensation?

Answer 7

Lower third of face normal
Width of attached gingiva looks wider and irregular
Varied gingival margin heights = change corresponding with how much TSL occurs

Question 8

What is the severity classification of TSL?

Answer 8

Smith and Knight index

Question 9

How are TSL patients managed?

Answer 9

Identify cause and remove it
Stabilise everything else
Ensure TSL has stopped - study models/ photos = stain free surface likely TSL still occuring

Question 10

What is a scissor bite?

Answer 10

Alternative units of teeth missing in maxilla and mandible, causing collapse of face height

Question 11

What is the purpose of contact points?

Answer 11

Create barrier so food sheds off rather than becomes impacted between teeth