Tooth Wear (Patterson) Flashcards
Why is lack of posterior support a problem in tooth wear cases?
-increases the severity of wear
-increases rate of progression
-can lead to occlusal collapse
-functional and aesthetci problems
Why do pts end up with lack of posterior support?
-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)
Why do we try to avoid complete dentures in tooth wear patients?
Bruxism does not stop once you lose teeth:
-fractured dentures, ridge resorption, pain and ulceration under complete denture
What are the removable prosthetic options in tooth wear?
-overdentures
-transitional dentures
-metal based dentures
-simplify small saddles
Advantages of overdentures?
-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
Disadvanatages of overdentures?
-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)
What care is required with overdentures?
-good OH
-Fl- toothpaste application to roots
-regular examination and radiographs
-denture hygiene
When can an overdenture be used in toothwear?
-after XLA of hopeless teeth
-overdenture over roots and increase OVD
What do transitional dentures do?
-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
When would you consider a metal based denture in toothwear cases?
Bruxism
Why does a metal based denture help with bruxism?
Becuase acrylic prone to fracture due to high occlusal forces, teeth fall off etc
Why does a metal based denture help with bruxism?
Becuase acrylic prone to fracture due to high occlusal forces, teeth fall off etc
In a bruxist with lack of posterior support (due to wearing of posterior teeth), what denture option is there? How does it work?
-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
Why is it a good idea to simplify small saddles in dentures for tooth wear patients?
Because bruxists will continually break off the small saddle so easier if you can get rid of the saddle from the denture
What is an option to simplify small saddles for dentures?
Use of bridgework (just need to be careful with adhesive bridges and debonding in bruxists etc)
What is an option to simplify small saddles for dentures?
Use of bridgework (just need to be careful with adhesive bridges and debonding in bruxists etc)
What things do you need to do to plan/prepare to treat a toothwear case? (regardless if you are conforming or changing/rehab OVD)
-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
What things do you need to do to plan/prepare to treat a toothwear case? (regardless if you are conforming or changing/rehab OVD)
-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
When would you consider indirect restorations in tooth wear?
After considering/trying adhesive minimally-invasive dentistry first
Fixed restorations are usually possible if what % of tooth structure is remaining?
if 50% of tooth structure remaining above the gingival margin
Why is tooth prep difficult in tooth wear for indirect restorations?
-lack of occluso-ginigval height
-lack of occlusal space
-severly compromised tooth
basically there will be little resistance and retention form
In what ways can you modify preparations for indirect restoration in tooth wear to create retention and resistance in small teeth?
-materials
-grooves
-inlays
-ferrule
-parallel preps
-margins and occluding surfaces
-cores
-electrosurgery
-surgical crown lengthening
How might you want to change your material for crown in tooth wear cases?
-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
How do inlays and grooves within crown prep increase retention and resistace?
enhance resistance form by reduction in radius of rotation, place inlays and grooves in long axis of tooth
What is a ferrule and why is it important to consider it?
ferrule is a band of dentine/enamel that will be left after crown prep
assesses the restoratbility of a tooth - no ferrule = unrestorable
Why would you use electrosurgery?
To create a ferrule
How do you provide a reinforced composite?
with Nayyar core (amalgam packed into top part of root oriface and acts as a core)
What material do you tend to want at the margins of crowns in tooth wear and why?
Metal margins as need to remove less tooth tissue (then further away from pulp so less likely for RCT to fail)
Attrition modifying factors?
-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)
Common features of the bruxist.
-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)
Carbonated drink intake common features
-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
Eating disorder common features.
-palatal erosion on upper teeth
-polished restorations
-erosion around restorations
-sensitivity
-caries
-sometimes altered taste
-halitosis sometimes
-soft tissue changes (bulimia - rare)
Eating disorder common features.
-palatal erosion on upper teeth
-polished restorations
-erosion around restorations
-sensitivity
-caries
-sometimes altered taste
-halitosis sometimes
-soft tissue changes (bulimia - rare)
Examples of abrasive behaviours?
-toothbrush abrasion (including interdental brushes)
-oral self-harm
-tongue studs
-occupational
-unusual habits (pipe smoker etc)
Often have combination of wear. What are common causes of erosion (intrinsic and extrinsic) with attrition and abrasion?
-alcohol and drug abuse
-eating disorder
Often have combination of wear. What are common causes of erosion (intrinsic and extrinsic) with attrition and abrasion?
-alcohol and drug abuse
-eating disorder
When might you see extrinsic erosion and attrition in combo?
-bruxist with poor diet
When might you see erosion (intrinsic and extrinsic) with attrition?
Bruxist with poor diet and GORD
When you don’t know the aetiology, how should you approach treatment?
-plan warily as no idea if and how restorations will work/last
-communicate a guarded prognosis
