Tooth Wear 2 Flashcards
What is the overview concept for Tooth wear cases?
Diagnosis
Treatment Planning
PREVENTION
PASSIVE MANAGEMENT
Localised Anterior tooth wear
Dahl Concept
What is the correct terminology when diagnosing Pattern of tooth wear?
- Localised
- Generalised
- Wear with loss of OVD
- Wear without loss of OVD but with space available
- Wear without loss of OVD but with limited space - Dento-alveolar compensation
- Important in treatment planning
What is the immediate treatment for any pt with tooth wear?
- Deal with pain
Sensitivity
- Desensitising agents. Fluorides, bonding agents GIC coverage of exposed dentine
- Pulp extripation
- If wear has compromised pulpal health
- Smooth sharp edges
- Prevent trauma to cheeks and tongue
- Extraction
- Pain from unrestorable/non-functional tooth
- TMJ pain
- Important in attrition, acute symptoms need to be controlled
What is the Initial treatment for pt with tooth wear?
- Stabilise existing dentiion
- Deal with Caries
- Deal with Perio condition
- Oro-mucosal
What is the next stage after you have a diagnosis and have identified primary causative factor?
- Implement a preventative regime
- Txt without prevention will fail
What is the key element in prevention?
- Removal of cause
What can you identify if you are monitoring tooth wear adequately?
- Have a baseline
- Can identify if wear is progressing or if it is historic
What are some preventative measures used for Abrasion cases?
- Remove the ‘foreign object or substance’ involved in causing the abrasive wear
- Change toothpaste
- Alter tooth brushing habits
- Change habits
- Nail biting
- Wire stripping
- Piercing biting
- Pen chewing etc
What is a preventative measure for cervical tooth brush abrasion?
- RMGIC, GIC or comp restoration placed in cavity
- Pt wears through your restoration not their own tooth
- RMGIC has best survival rate
Pros and cons to composite or RMGIC for cervical toothbrush abrasion
- RMGIC has highest survival rate
- Composite has better aesthetics but may compromise retention and can give 2 caries
What is a parafunctional habit usually in response to?
- Life stressors
What is a preventaive measure for Attrition due to parafunctional habit?
- Cognitive behavioural therapy
- Hypnosis
- Splints
What are some benefits to splints to be used as a preventative measure for attrition?
- Work by being softer than teeth
- Wear away instead of tooth
- Cause no damage to opposing teeth
- May be habit breaker
- Can be used a diagnostic device (splint will wear rapidly and show wear facets as scrapes if pt grinds)
What are some advantages to Michigan splints?
- Type of hard splint
- Provides ideal occlusion with even centric stops
- Has canine rise which provide disclsuion in eccentric mandibular movements (canine guidance)
What type of tooth wear would you not use a splint for?
- Erosion
- Acid Weakens the tooth structure beneath the splint , causing more erosion
What are some preventative measures for erosion cases?
- Fluorides e.g. toothpastes and mouthwashes - pt may need to try few different ones for them until it works
- Desensitising agents like sensodyne or duraphat (helps with symptomatic relief)
What Habit changes can be discussed with the pt in cases of erosion?
- Swilling drinks around mouth
- Drinking from cans (use a straw instead)
- Rumination
- Eating too many fruits a day
- Vegan diet ?
- Sports drinks and gels
What preventative medical things can be done for erosion cases?
- Control gastric acid (GORD, Reflux, Haitus Hernia)
- Xerostomia
- Anorexia and Bulimia
What are some preventative measures for Abfraction cases?
- Assess occlusaion on teeth with lesions and consider occlusal equilibration
- Fill cavities with low modulus restorative materials like RMGIC and flowable composite
what is meant by passive management for toothwear cases?
- Prevention and monitoring is first part of any txt for dental wear
- Most pt in this for 6 months
- For many the preventative regime is enough
When do you progress to active management from passive management in tooth wear cases?
- Simple restorative intervention like covering ecposed dentine, filling cupped defects in molars and incisors
- If wear leads to further complication
- If aesthetics gone beyong pt acceptability
- If leaving intervention may cause more complex txt to be required
- Very pt specific
What is the goal of active managent?
- Preserve remaining tooth structure
- Pragmatic improvement in aesthetics
- Functioning occlusion
- Stability
What five factors determine the decision on txt and restoration for maxillary anterior tooth wear?
- The pattern of anterior maxillary tooth wear
- Inter-occlusal space
- Space required for the restorations being planned
- Quality and quantity of remaining tooth tissue, particularly enamel
- The aesthetic demands of the patient
How is Maxillary anterior tooth wear categorised?
- Tooth wear limited to the palatal surfaces only
- Tooth wear involving the palatal and incisal edges with reduced clinical crown height
- Tooth wear limited to labial surfaces
What are some examples of cases for Maxillary anterior tooth wear where there is adequate inter-incisal space? (Very rare but the easiest to treat)
- If teeth wear rapidly and there is no time for alveolar compensation
- Where there is an anterior open bite
- Where there is an increased overjet
- In these cases there can be available space for restorations with no change in OVD
What is the most common findings for Maxillary anterior tooth wear?
- No increase in freeway soace
- Compensation for loss of tooth substance by dento-alveolar bone growth
- Maintains masticatory efficiency but leaves no space for restorations
What are some txt options to make space for maxillary anterior tooth wear?
- Increase OVD
- Occlusal reorganisation from ICP to RCP
- Surgical crown lengthening
- Elective RCT and post crowns (Very destructive)
- Conventional orthodontics (lengthy txt)
What are some pros and cons to increase OVD?
- Multiple posterior extra-coronal restorations
- Reorganised approach
- It is complex, destructive and expensive
What is surgical crown lengthening?
- Exposes more of the crown for retention of final restoration
- Repositioning of gingivae apically generally with removal of bone
- Can lead to sensitivity
What is the DAHL technique?
- Method of gaining space in cases of localised tooth wear
- Faster effect and better in younger pt
- If no movement in 6 months then its not going to work
- Succes rate 90+%
When is the DAHL technique not suitable?
- Active periodontal disease
- TMJ problems
- Post Orthodontics
- Biphosphonates (poor bone turnover, rely on this )
- If dental implants present (ankylosis of implants arent going to erupt so doesnt work)
- If existing conventional bridges
Outline the DAHL technique?
- Cover the palatal surface with composite of anteriors
- Allows for occlusion on raised cingulum
- Results in posterior disclusion and incread in oVD 2-3mm
- Occlusal contacts only on incisor/canine teeth
- ** Slide 41
