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Bds4 Restorative > Toothwear > Flashcards

Toothwear Flashcards

1
Q

What are the causes of non various tooth surface loss?

A

Trauma
Developmental problems
Tooth wear

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2
Q

What is the difference between normal and pathological tooth wear?

A

Normal- wear associated with normal function (20-38 um per annum)
Pathological- when remaining tooth structure or pulpal health is compromised/ excessive rate/ masticatory or aesthetic deficit

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3
Q

What are the 4 causes of toothwear?

A

Attrition - result of tooth to tooth contact
Abrasion - through an abnormal mechanical process independent of occlusion (foreign object)
Erosion - by a chemical process that does not involve bacterial action
Abfraction - loss of hard tissue from eccentric occlusal forces leading to stresses at cervical fulcrum areas

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4
Q

What is the most common cause of attrition?

A

Parafunctional habit

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5
Q

What is the clinical presentation of attrition?

A

Polished facet on cusps/ flattening incisal edges
Progression to reduction in cusp height/ shortening of clinical crown

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6
Q

Where is abrasion most common?

A

Labial/ buccal, cervical on canine and premolar teeth (V shaped lesions)

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7
Q

What is the most common cause of abrasion?

A

Toothbrushing

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8
Q

How does erosion present clinically?

A

Loss of surface detail
Bilateral, concave lesions (without chalky appearance of bacterial decalcification)
Progression - dentine becomes affected, preferential wear of dentine leads to cupping of occlusal surfaces and incisal edges. Increased translucency of incisal edges, restorations sit proud, no tooth staining present

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9
Q

What causes abfraction?

A

combination of occlusal stress (loading forces), abrasion and erosion leading to loss of substance at the cervical margin.

Loading forces result in flexure and failing of enamel and dentine at a location away from the loading- causing cracks in the tooth which chip out

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10
Q

How prevelant is toothwear in adults?

A

77% have wear in their anteriors involving dentine

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11
Q

How prevelant is toothwear in children?

A

> 50% of 5 year olds exhibit tooth wear on their primary incisors

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12
Q

Why is masticatory deficiency uncommon in toothwear?

A

Toothwear generally happens slowly- time for passive eruption to maintain occlusion

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13
Q

What would be relevant MH to tooth wear?

A

Medication with low pH/ which cause dry mouth
Eating disorder
Alcoholism
Heartburn/GORD
Hiatus hernia
Rumination
Pregnancy

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14
Q

When examining the patient, what should you look for - extra oral

A

TMJ (restriction, clicking, crepitus?)
Musculature (hypertrophy)
Mouth opening restriction? (<4cm) and deviation on movement
Parotid hypertrophy
Overclosure
Lip line, smile line

IO:
FWS and OVDS
Stable contacts in centric relation? Tooth contacts in excursion movements?

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15
Q

Describe BEWE classification

A

0- no erosive wear
1- initial loss of surface
2- distinct defect, <50% hard tissue loss
3- hard tissue loss>50%

Count up scores for each sextant

<2 - no risk
3-8 - low risk
9-13 - med risk
>14 - high risk

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16
Q

Which special tests are appropriate for tooth wear treatment planning?

A

Sensibility (pulpal damage rare due to deposition of 3ry dentine over a period of time)
Radiographs- AP related to toothwear if lost 1/3 -1/2 tooth
Articulated study models
Intra oral photographs
Diagnostic wax up
Dietary analysis

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17
Q

How is toothwear diagnosed?

A

Pattern:
- localised
- generalised: wear with loss OVD, wear without loss OVD but space, wear without loss OVD with no space

Dento-alveolar compensation- important for tx planning

18
Q

Immediate treatment of toothwear?

A

Address pain:
- sensitivity (desens, fluoride, GIC over exposed dentine)
- pulp extripation (if required)
- smooth sharp edges (prevent trauma)
- extraction (unrestorable/ non-functional teeth)
- TMJ pain (needs to be controlled before restorations)

19
Q

Initial treatment of toothwear

A

Stabilise existing dentition
Deal with caries, perio etc (treat other problems as well as toothwear as wear is a slow progress)
Diagnosis and identify causative factor - institute preventative regime (prevention)

20
Q

Preventative treatment of tooth wear

A

Baseline wear recording (BEWE/ pictures/ models)
Monitor (restoration required if active)
Remove cause

21
Q

Prevention for abrasion

A

Remove foreign object/ habit
RMGIC restoration at cervical margin- pt will wear through this rather than tooth (better bond to dentine than composite, YM similar to tooth)

22
Q

Prevention for attrition

A

Address parafunctional habit- CBT, hypnosis
Splints- wear away in preference to tooth, can be used as a habit breaker (can also be sued as diagnostic device), Michigan splint has canine rise to provide disclusion in eccentric mandibular movements.

23
Q

Prevention for erosion

A

Establish if intrinsic or extrinsic?

Fluoride- sensory energy, tooth mousse, duraphat
Desensitising agents- more symptomatic relief
Dietary management- fruit juice, fizzy juice, acidic foods
Gastric acid control- GORD, reflux, hiatus hernia (refer to GP)

24
Q

Prevention of abfraction

A

Fill cavities with RMGIC/ flowable composite

25
Q

What is passive management of tooth wear

A

Prevention and monitoring (6 months)

26
Q

What is active management?

A

Simple restorative intervention- cover exposed dentine
Composite restorations (aesthetic)- should be >2mm to prevent de bond

27
Q

What are the 5 considerations when treatment planning for active management of maxillary anterior toothwear

A

Pattern of tooth wear
Inter occlusal space
Space required
Quality and quantities of remaining enamel
Aesthetic demands of patient

28
Q

What are the 3 main patterns of anterior maxillary tooth wear

A

Limited to palatal surfaces (vomiting etc)
Involving palatial and incisal edges with reduced crown height
Limited to labial surfaces (holding juice in mouth, uncommon)

29
Q

What are the tx options for anterior maxillary wear?

A

Increase OVD- reorganised approach (complex)
Reorganisation from ICP to RCP
Surgical crown lengthening
Elective RCT and post crowns
Conventional ortho
Dahl technique

30
Q

What is the Dahl technique

A

Method of gaining space in localised tooth wear
Composite covering palatal surfaces and allowing occlusion on a raised cingulum - resulting in posterior disclusion and increase in OVD (2-3mm)
Over 3-6 months gain space between incisors (passive eruption)

Definitive treatment
90% success rate (if no movement in 6 months, not going to work)

31
Q

Contraindications for Dahl technique

A

Active perio
TMD
Post ortho
Bisphosphonates (poor bone turnover)
Implants- ankylosis to bone so wont continue to erupt
Existing conventional bridges- not likely to continue to erupt

32
Q

Contraindications for composite build ups

A

Short roots (will be increasing tooth length with already decreased support)
Reduced periodontal support due to perio disease

Lack of enamel - not contraindication but reduces success rate

33
Q

What is the ring of confidence?

A

Thickness of remaining enamel- has a positive relationship on retention

34
Q

Reasons why mandibular anterior builds are less successful than maxillary?

A

Less enamel, smaller bonding area
Harder to achieve moisture control

35
Q

Management of localised posterior tooth wear?

A

Unusual on its own

Fill directly with composite with no change in OVD
Composite added to palatal of canines to disclude posteriors- often canine wear resulted in the posterior wear (saves from further damage)

36
Q

Methods of composite build ups?

A

Direct build up- alginate imps, wax up, putty matrix
Clear vacuum formed matrix- alginate imps, wax up, impression of wax up poured in stone, clear plastic matrix formed and cut to size

37
Q

What is the first treatment option for toothwear?

A

Composite resin restoration (minimally invasive)

38
Q

Information for patients getting composite build ups

A
  • tooth coloured fillings on front teeth to prevent wearing more (no LA, minimal drilling- no tooth substance is removed)
  • bite will feel strange for a couple of days, will resolve (only front teeth will come together, back teeth will come together within 3-6 months)
  • may cause lisp for a few days
  • front teeth may feel tender for a few days
  • may accidentally bit tongue/ lips over next few days
  • crowns/ bridges/ dentures at back of mouth will need replaced
  • longevity should be good although small chance de bonds- will require maintenance (including cost)
39
Q

3 categories of generalised tooth wear

A

Excessive wear with loss of OVD
Excessive wear without loss OVD but with space
Excessive wear without loss OVD and no space

40
Q

Management of generalised toothwear - excessive loss with loss of OVD

A

Easiest to treat but least common

Splint to assess pt tolerance to new face height
Half OVD increase maxillary and half mandibular

Alveolar compensation

41
Q

Management of generalised toothwear - without loss of OVD with limited space

A

Re-organisation of occlusion

Splint
Then restoration of anterior and posterior teeth at new face height (minimal prep adhesive restorations)

42
Q

Management of generalised toothwear - loss of OVD and no space

A

Refer to specialist

Attempt to increase OVD by use of splints/ dentures if lack of posterior support (as there is often in these cases)
Crown lengthening- increases amount of coronal tooth substance (black triangles where ID papilla is further down) - unfavourable crown to root ratio
Over-dentures (although can be bulky for pt to wear)

Bds4 Restorative (6 decks)

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