Toothwear 3 Flashcards
how do you decide whether anterior wear cases are suitable for composite build ups
- Deciding which cases are suitable for build up with composite is not a precise science = there are no absolute rules
- If destruction is relatively minimal and limited to the palatal surfaces the teeth can be restored definitively with a high degree of confidence
- There is no evidence to guide decisions where a substantial amount of tooth is lost
- However, it is non-invasive and should be considered first choice treatment in the majority of cases of anterior tooth wear
how is composite build-ups non-invasive
Sticking composite onto teeth is ‘reversible’
Doesn’t do any harm
Composite might chip / completely break off but it just leaves you where you started so you are no worse off
Not destructive like crown preps
what are contraindications to the Dahl technique
○ Short roots
○ Reduced periodontal support due to periodontal disease
○ Not a contraindication but lack of remaining enamel reduces the success rate significantly
§ More difficult to bond well to little enamel
§ Difficult to create a long term bond
§ Need to be realistic
what is the ring of confidence
Remaining enamel “ring of confidence”
Has a very positive influence on retention
If there is enamel the full way around the erodedd dentine then you can expect to get a decent bond to these teeth
Thicker edge of enamel is better
is upper or lower anterior wear more difficult to fix
lower anterior wear is more difficult to fix because there is less enamel so there is a smaller bonding area
does lower tooth wear occur on its own
Generally in conjunction with maxillary wear
Quite rare on its own
should you build up upper or lower tooth wear first
If you have to build up lowers then do this first before the uppers
○ Probably because they are more likely to break off so whenever they return to get their uppers down you can fix the lower at the same time
No science behind it
when can localised posterior tooth wear occur
Unusual on its own
Sometimes erosive in ruminating patients
Erosive in bulimic and alcoholic patients
what is appropriate treatment when posterior tooth wear is localised and asymptomatic
If localised and asymptomatic, prevention and monitoring are appropriate
how can occlusal erosive wear be treated
Occlusal erosive wear can be filled directly with composite with no change in occlusion
Once you change the occlusion it becomes more complicated
Fill in the ‘cupping’ from erosion = no problem
how can treating canines help with restorative care in posterior tooth wear
Restorative care can be aimed at providing sufficient canine guidance to ensure posterior disclusion
Composite resin can be added to the palatal of the upper canines to increase the canine rise and disclude the posteriors during lateral and protrusive excursions
Often there is canine wear which has removed guidance and lead to posterior wear
Correct the canine wear and the posterior will be saved from further damage
what are the methods of composite build-up
- Alginate impression
- Wax up
- Putty matrix
how do you use a clear vacuum formed matrix to build up teeth
Alginate impression
Diagnostic wax
Impression of this poured in stone
Vacuum formed clear plastic matrix formed on this
Cut to size and used as mould for build up
what is the success of composite resin build ups like
- Generally good patient satisfaction
- Posterior occlusion is normally re-achieved
- Seldom TMJ problems
- No detrimental effect on pulpal health
- No worsening of periodontal condition
Composite resin restorations placed at an increased OVD may be a viable and minimally invasive treatment option for the treatment of localised anterior tooth wear
how are composite build ups in terms of longevity
- Viable medium term option
- Requires repair and maintenance
- Maxillary restorations last better than mandibular
○ Probably due to increased bonding area
○ Maxillary wear more common
§ Tongue and saliva protect lowers - No definitive figures perhaps around 70% over 10 years
- But if these fail they can be replaced or repaired and no tooth destruction occurred during their placement
Relatively easy to do the same treatment again
what are the aesthetic problems associated with composite build ups
- Aesthetic results are good but not the highest achievable
○ Much better than it was before hand- No further damage to already worn teeth
- Biologically based management
○ Not removing tooth tissue - Unrealistic expectations of patients
- ‘daughter test’
○ Ie would you do this treatment to your daughter / another family member
○ If you wouldn’t do it for them, then why would you do it for this patient
what information would you give your patients about composite build ups
- Your front teeth will receive tooth coloured fillings to cover the exposed and worn tooth surface, This will prevent the teeth from wearing more because the fillings will now wear instead of the tooth tissue
- This procedure will be carried out without LA as there will be no or minimal drilling to your teeth
○ The only drilling that is really necessary is polishing of the restorations afterwards - An improvement in the appearance of your teeth should be possible
- Your ‘bite will feel strange for a few days and you may have difficulty chewing as only your front teeth will touch together
○ Your back teeth will gradually come back together but this will take 3-6 moths - Over a week or so you will become accustomed to your new ‘bite’ and will be able to eat more normally
- The change in the shape of your front teeth may cause lisping for a few days
- You front teeth may feel a little tender to bite on for a few days
○ Similar to braces getting tightened
○ Anterior teeth are being intruded slightly whenever the posterior eruption is occurring so this can cause the pain - You may bite your lips and tongue initially Because the occlusion has been changed slightly
- If you have crowns / bridges or partial dentures or implants at the back of your mouth it is likely that these will need to be replaced
○ These won’t move in the way we would like them to move so it is probable these restorations will have to be changed
○ Prepare patient so they don’t become concerned
what should you tell the patient about the longevity of these restorations
○ The longevity of these restorations should be good but there is a small potential for restorations to debond and fall off
§ They can be replaced with no damage to your remaining tooth
§ What has been placed is as strong as we can make it but it won’t be as strong as the original tooth
○ These restorations will require maintenance
§ The margins will require occasional polishing
§ Occasional chipping of restorations may occur
Need to pay for this treatment - patients responsibility
