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BDS4 Operative Dentistry > Tooth Wear (Patterson) > Flashcards

Tooth Wear (Patterson) Flashcards

1
Q

Why is lack of posterior support a problem in tooth wear cases?

A

-increases the severity of wear
-increases rate of progression
-can lead to occlusal collapse
-functional and aesthetci problems

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2
Q

Why do pts end up with lack of posterior support?

A

-denture intolerance (pt doesn’t see they have a problem)
-denture refusal
-supervised neglect (XLA posterior teeth and just let pt get on with it)

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3
Q

Why do we try to avoid complete dentures in tooth wear patients?

A

Bruxism does not stop once you lose teeth:
-fractured dentures, ridge resorption, pain and ulceration under complete denture

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4
Q

What are the removable prosthetic options in tooth wear?

A

-overdentures
-transitional dentures
-metal based dentures
-simplify small saddles

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5
Q

Advantages of overdentures?

A

-correction of occlusion and aesthetics
-support
-tooth wear management
-preservation of ridge form (future implants)
-proprioception
-denture retention (better undercuts and can put in precision attachments)
-MRONJ and radiotherapy pts - avoids XLA
-psychological benefits
-useful in elderly (polypharmacy - keeps tx simplier)
-eases transition to edentulism

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6
Q

Disadvanatages of overdentures?

A

-need for good OH
-increased caries/perio problems
-care homes (harder for OH maintenance)
-denture #
-discomfort/infection (around roots when it goes wrong)
-medical hx (fails and have worrying MG, now have infection plus need XLA)
-potenitally more traumatic extractions (removing carious roots harder)

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7
Q

What care is required with overdentures?

A

-good OH
-Fl- toothpaste application to roots
-regular examination and radiographs
-denture hygiene

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8
Q

When can an overdenture be used in toothwear?

A

-after XLA of hopeless teeth
-overdenture over roots and increase OVD

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9
Q

What do transitional dentures do?

A

-they can increase OVD in cases where there is poor posterior support to create restorations (aka no posterior support so no point providing anterior restorations as will just fail)
-so do a transitional denture to see if the pt can cope with both a denture and an increased OVD
-if they can then can move to definitive restorations and denture

acrylic overlaying natural teeth to have stable occlusion in this increased OVD
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10
Q

When would you consider a metal based denture in toothwear cases?

A

Bruxism

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11
Q

Why does a metal based denture help with bruxism?

A

Becuase acrylic prone to fracture due to high occlusal forces, teeth fall off etc

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12
Q

Why does a metal based denture help with bruxism?

A

Becuase acrylic prone to fracture due to high occlusal forces, teeth fall off etc

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13
Q

In a bruxist with lack of posterior support (due to wearing of posterior teeth), what denture option is there? How does it work?

A

-Metal based overlay denture (splint)
-pt has a posterior open bite so this overlays the teeth to protect remaining teeth (anterior teeth) and bring posterior teeth back into occlusion

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14
Q

Why is it a good idea to simplify small saddles in dentures for tooth wear patients?

A

Because bruxists will continually break off the small saddle so easier if you can get rid of the saddle from the denture

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15
Q

What is an option to simplify small saddles for dentures?

A

Use of bridgework (just need to be careful with adhesive bridges and debonding in bruxists etc)

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15
Q

What is an option to simplify small saddles for dentures?

A

Use of bridgework (just need to be careful with adhesive bridges and debonding in bruxists etc)

16
Q

What things do you need to do to plan/prepare to treat a toothwear case? (regardless if you are conforming or changing/rehab OVD)

A

-impressions and facebows
-mounted articulated casts on semi-adjustable articulator +/- surverying
-high quality interocclusal record
-diagnostic wax up
-stents for mock-ups
-temporary (transitional dentures)
-clinical photographs
-radiographs if required

17
Q

What things do you need to do to plan/prepare to treat a toothwear case? (regardless if you are conforming or changing/rehab OVD)

A

-impressions and facebows
-mounted articulated casts on semi-adjustable articulator +/- surverying
-high quality interocclusal record
-diagnostic wax up
-stents for mock-ups
-temporary (transitional dentures)
-clinical photographs
-radiographs if required

18
Q

When would you consider indirect restorations in tooth wear?

A

After considering/trying adhesive minimally-invasive dentistry first

19
Q

Fixed restorations are usually possible if what % of tooth structure is remaining?

A

if 50% of tooth structure remaining above the gingival margin

20
Q

Why is tooth prep difficult in tooth wear for indirect restorations?

A

-lack of occluso-ginigval height
-lack of occlusal space
-severly compromised tooth

basically there will be little resistance and retention form

21
Q

In what ways can you modify preparations for indirect restoration in tooth wear to create retention and resistance in small teeth?

A

-materials
-grooves
-inlays
-ferrule
-parallel preps
-margins and occluding surfaces
-cores
-electrosurgery
-surgical crown lengthening

22
Q

How might you want to change your material for crown in tooth wear cases?

A

-put metal on biting surfaces
-metal is more forgiving than porcelain and stronger in thin surfaces

-might consider porcelain in smile line and rest in metal like the pic

23
Q

How do inlays and grooves within crown prep increase retention and resistace?

A

enhance resistance form by reduction in radius of rotation, place inlays and grooves in long axis of tooth

24
Q

What is a ferrule and why is it important to consider it?

A

ferrule is a band of dentine/enamel that will be left after crown prep

assesses the restoratbility of a tooth - no ferrule = unrestorable

25
Q

Why would you use electrosurgery?

A

To create a ferrule

26
Q

How do you provide a reinforced composite?

A

with Nayyar core (amalgam packed into top part of root oriface and acts as a core)

27
Q

What material do you tend to want at the margins of crowns in tooth wear and why?

A

Metal margins as need to remove less tooth tissue (then further away from pulp so less likely for RCT to fail)

28
Q

Attrition modifying factors?

A

-lack of posterior teeth
-occlusion (deep OB or edge to edge - some teeth might take bigger occlusal load and increase wear progession for these teeth)
-restorations (porcelain)
-erosion and abrasion
-stress nd anxiety (can worsen clenching and grinding)

29
Q

Common features of the bruxist.

A

-Significatn wear throughout dentition
-repeated restoration failure (crowns shatter)
-root fractures (particularly concerning in virgin teeth)
-often onset in early adulthood
-progressive (can be rapid)

30
Q

Carbonated drink intake common features

A

-incisal erosion on upper centrals (holding can or bottle to these teeth)
-cupping on lower molars
-palatal erosion on upper incisors
-sensitivity
-interproximal caries and buccal white spot/browm spot lesions

31
Q

Eating disorder common features.

A

-palatal erosion on upper teeth
-polished restorations
-erosion around restorations
-sensitivity
-caries
-sometimes altered taste
-halitosis sometimes
-soft tissue changes (bulimia - rare)

31
Q

Eating disorder common features.

A

-palatal erosion on upper teeth
-polished restorations
-erosion around restorations
-sensitivity
-caries
-sometimes altered taste
-halitosis sometimes
-soft tissue changes (bulimia - rare)

32
Q

Examples of abrasive behaviours?

A

-toothbrush abrasion (including interdental brushes)
-oral self-harm
-tongue studs
-occupational
-unusual habits (pipe smoker etc)

33
Q

Often have combination of wear. What are common causes of erosion (intrinsic and extrinsic) with attrition and abrasion?

A

-alcohol and drug abuse
-eating disorder

34
Q

Often have combination of wear. What are common causes of erosion (intrinsic and extrinsic) with attrition and abrasion?

A

-alcohol and drug abuse
-eating disorder

35
Q

When might you see extrinsic erosion and attrition in combo?

A

-bruxist with poor diet

36
Q

When might you see erosion (intrinsic and extrinsic) with attrition?

A

Bruxist with poor diet and GORD

37
Q

When you don’t know the aetiology, how should you approach treatment?

A

-plan warily as no idea if and how restorations will work/last
-communicate a guarded prognosis

BDS4 Operative Dentistry (10 decks)

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