tooth wear 3

Question 1

When are composite build ups on anterior teeth ideal?

Answer 1

If minimal wear and limited to palatal surfaces
First choice of treatment in majority of cases

Question 2

What are the contraindications to composite build ups for anterior wear?

Answer 2

Short roots
Reduced periodontal support due to periodontal disease
Lack of remaining enamel reduces the success rate significantly

Question 3

What is the ring of confidence?

Answer 3

The remaining enamel on anterior teeth with tooth wear
Has a very positive influence on retention

Question 4

When is localised posterior toothwear seen and how is it treated?

Answer 4

Unusual on its own
Sometimes erosive in ruminating, bulimic and alcoholic patients
If localised and asymptomatic - prevention and monitor
Occlusal erosive wear can be filled directly with composite with no change in occlusion

Question 5

How is maxillary canine wear alongside posterior wear treated?

Answer 5

Restored to provide sufficient canine guidance to ensure posterior disclusion
Composite added to palatal surfaces to increase canine rise and disculpe the posteriors during lateral and protrusive excursions
Correct canine wear and posteriors will be saved from further damage

Question 6

What are the steps in creating a clear vacuum formed matrix

Answer 6

1. Take an alginate impression
2. Make a diagnostic wax up
3. Impression of this is poured in stone
4. Vacuum formed clear plastic matrix formed on this
5. Cut to size and used as mould for build up

Question 7

Describe the success of composite build ups

Answer 7

Generally good
Posterior occlusion is normally reachieved
Does not cause TMJ problems
No detrimental effect on pulpal health
No worsening of periodontal condition

Question 8

How long do composite build ups last?

Answer 8

No definitive figure - roughly 70% success over 10 years
If they fail can be replaced or repaired with no tooth destruction

Question 9

Name 6 pieces of information to give to patients before providing composite build ups

Answer 9

Any from:
- from teeth will receive tooth coloured fillings preventing more wear
- procedure with no LA and no/minimal drilling
- will add, not remove to teeth
- aesthetically improvement should be possible
- bite will feel strange for a few days and may have difficulty chewing, only your front teeth will touch but your back teeth will gradually come back together in 3-6 months
- over a week bite will become normal and you’ll be able to eat normally
- change may cause lisping for a few days
- you may bite your tongue and lips initially
- any crowns/bridges or partial dentures at the back of your mouth will likely need replaced

Question 10

What information should be given to patients about longevity of composite build ups?

Answer 10

Small potential for restorations to deboned and fall off - these can be replaced with no damage to your remaining tooth
Restorations will require maintenance - the margins will require occasional polishing, occasional chipping of restorations may occur

Question 11

How is excessive tooth wear with loss of OVD treated?

Answer 11

Splint can be used to assess the patients tolerance of the new face height
Ideally half the OVD increase should be maxillary and half mandibular
Often a mix of adhesive and conventional restorations required
Dentures may be required to provide posterior support at the new OVD

Question 12

How is excessive tooth wear without loss of OVD but with limited space available treated?

Answer 12

Can involve reorganisation of the occlusion
Splint should be considered as an increase in occlusal hace height is required
Restoration of anterior and posterior teeth carried out at new occlusal faces height
Should involve minimal preparation adhesive restorations

Question 13

How is excessive tooth wear without loss of OVD with no space available treated?

Answer 13

Specialist opinion prior to commencing treatment
Attempt to increase OVD by use of splints and possible dentures if lack of posterior support
Crown lengthening surgery
Elective orthodontics - post and cores don’t work well with attrition
Orthodontics
Patient will likely need dentures as treatment is often not possible

Question 14

Why is crown lengthening used in tooth wear?

Answer 14

To increase the amount of coronal tooth substance available

Question 15

What are the risks of crown lengthening for tooth wear?

Answer 15

May result in black triangles between the teeth where the interdental papilla is further down
Can lead to an unfavourable crown to root ratio - increased chance of mobility
Often has post-op sensitivity
Any subsequent crown prep will be further down the root - greater chance of pulpal damage

Question 16

What are overdentures used for in tooth wear and what are the drawbacks of them?

Answer 16

Preserves tooth substance and bone for support of denture when teeth are so worn down that restorations aren’t possible
Can be bulky for patient to wear
Difficulties with keeping teeth and gingiva healthy beneath the prosthesis

Question 17

Name 4 ways of managing risks in toothwear treatment?

Answer 17

Any from:
- notice it is happening and inform the patient
- if wear is progressing, you must let the patient know
- advice must be recorded in patient notes
- if patient is non-compliant this must be recorded
- any surface treatments such as topical fluoride must be recorded on each occasion
- consent - patient must understand what you’re doing and why
- provisional treatment - important to make a definitive diagnosis that is explained and understood by the patient
- definitive treatment - minimum intervention treatments should be tried first, if in doubt, get a second opinion from a restorative specialist