Toothwear 3

Question 1

why are lower anteriors harder to fix with build-ups than upper anteriors?

Answer 1

less enamel, smaller bonding

Question 2

when doing composite buildups on anterior teeth, what do you not want to increase for a patient?

Answer 2

Their OVD, you will affect their function

Question 3

if you notice worn canines with posterior wear. How can you save posteriors from further wear?

Answer 3

restoring canine to original length will result in canine guidance preventing further wear to the posterior teeth

Can buildup freehand OR diagnostic waxup + stent template

Question 4

what are the steps for creating a vacuum formed matrix for buildups?

Answer 4

• alginate impression
• diagnostic wax up
• impression poured into stone
• vacuum formed matrix created based on the stone model

Question 5

why do maxillary buildups/restorations last better than mandibular?

Answer 5

• increased bonding area
• maxillary wear more common (tongue protects lowers too)

Question 6

what is the downside to build ups for a tooth wear patient?

Answer 6

• requires repair and maintenance. Wont be a 1 visit job.

Question 7

what should you tell a patient when they ask about composite buildups?

Answer 7

• No LA needed, minimal drilling
• You should see improvement
• bite may feel strange for a few days
• front teeth will receive tooth coloured fillings to restore shape of tooth

Question 8

if a patient regards about longevity of composite buildups, what do you tell them?

Answer 8

• longevity should be good, but small chance they can chip/debond off. They can be reattached with no damage
• these will require maintenance, may have chipping or need polishing

Question 9

generalised tooth wear can be divided into 3 categories, what are they?

Answer 9

• excessive wear with loss of OVD
• excessive wear without loss of OVD but with available space
• excessive wear without loss of OVD and with no space available

Question 10

In generalised tooth wear, if a pt has wear with loss of OVD, how would you treat them?

Answer 10

• use a splint first to assess if patient can tolerate increase of OVD
• if only doing comp bonding, go straight to buildups, half of OVD increase should come from each arch. (50% upper, 50% lower)
• dentures may be required to provide posterior support at the new OVD

Question 11

In generalised tooth wear, if a pt has wear without loss of OVD, but limited space available, how would you treat them?

Answer 11

• much more complex
• check try to get pt to increase OVD slightly with splint and adjust to it over time
• restore anterior and posterior teeth to the new OVD
• if possible use minimal prep adhesive restorations only

Question 12

In generalised tooth wear, if a pt has wear without loss of OVD, but NO space available, how would you treat them?

Answer 12

• VERY DIFFICULT
• SPECIALIST OPINION
• Attempt to increase OVD with splints +/- dentures if no posterior support
• crown lengthening surgery??
  (comes with risks such as poor crown:root ratio, sensitivity)

OVERDENTURES can be a good option in this case. Ensure good OH under the denture for the pt