Toothwear (Management 2 and 3) Flashcards
list the 4 treatment approaches for toothwear?
- Preventive Advice/Strategies (for pts with minimal TW)
- Minimal intervention (to make pts comfortable by managing the symptoms without re-building teeth to their original size)
- Simple Reconstruction
- Complex Reconstruction (Teeth re-building to restore aesthetics)
what is the Preventive Advice/Strategies (for pts with minimal TW)
- Monitor and Advice:
1) Fluoride (esp Stannous Fluoride)
2) Tooth mousse (contains calcium and phosphate to help the teeth to remineralise/repair)
3) Lifestyle changes:
a) Toothbrushing advice + Don’t brush straight after eating or vomiting (as acids soften enamel so brushing immediately promote further TW)
b) No eating at late night (as it increases acid reflux at night) + Drink more water
c) Lose weight
d) Sleep with head well-supported
what is the Minimal intervention for TW-patients?
- Smooth sharp edges
- Treat Sensitivity by other things (FV and Bonding agents)
- Place small amounts of composite over exposed dentine “not re-building the tooth” to reduce Sensitivity and Protect dentine from further TW
- Provide a Splint (Soft or Hard) to Bruxism pts to prevent TW
What types of Splints available for Pt with TW?
a) Soft rubbery Splint (Night guard) to protect teeth during parafunction night grinding (Bruxism) but it doesn’t treat Bruxism
b) Hard acrylic “Stabilisation” Splint for more severe grinding patients (Bruxism)
Types of Hard splints: Michigan Splint & Tanner Appliance
What does the Simple Reconstruction approach involve?
Simple changes to the occlusion that can be done freehand.
How can we do Simple changes to the occlusion that can be done freehand (Simple Reconstruction approach)?
by Composite Canine Risers:
Rebuilding the canines which worn down a little bit to put canine guidance back in (restore canine guidance), so the strain will be on the canines to protect other teeth from further TW. Although the Composite that we place will wear down, so need to be replaced over time but it is much more favourable to have composite is wearing away and needing to be fixed rather than tooth tissue wearing away and never come back
in Complex Reconstruction we need to change the occlusion. what articulator should we use?
Semi-adjustable articulator
what does Complex Reconstruction involve?
Reorganise the Occlusion (Reorganisation)
What interventions we should do prior to teeth re-building up
- Pre-op assessment of teeth that need building-up:
- Sensitivity (Vitality) tests
- PA’s (to assess bone level “needed for re-building teeth” and PA pathology)
- Assessment of Periodontal support
- Study Models (to see teeth from different angles)
when deciding how much to build teeth up, we should follow some guidance. what is it?
a) Tooth proportion (eg: average upper central incisors should be 11.5mm tall and 9mm wide)
b) Height to Width
which is better to build up teeth with (composite or crowns) and explain the reason
Composite because:
► Crowns:
a) More destructive as it needs more tooth prep so compromising the pulp and longevity of tooth
b) More challenging to create the new bite
c) Needs lab intervention each time of adjustment
d) Crowned teeth become non-vital in some stage and need RCT
► Composite:
a) Less destructive and Adapt the pt to changes
b) Easier to create the new bite
c) Easy to add or remove from it if needed until reaching the desired bite
d) Less problems with loss of vitality
explain the steps on How to build up teeth with Composite?
a) Create Memosil splint from build ups (a putty index of the wax ups in the palatal side - see pic) to help us building up teeth, so we can see how long and wide each tooth should be and to create the palatal shape which is difficult for us to do directly in the mouth
b) Use this splint to build up the lower incisors first (make sure to build the incisal edge thick and chunky to be strong and durable)
c) Put patient into retruded position (RCP) (as pt with significant amount of tooth wear is often in postural class 3)
d) Build up upper canines into canine guidance at the desired OVD
e) Build up upper incisors using Memosil splint to achieve aesthetics
After building up Anterior teeth, sometimes it might leave gaps between Posterior teeth (No contact between Posteriors). what should you do here?
Manage Posterior occlusion:
If they suffer from TW: Build them up
If they don’t suffer from TW: Wait for them to erupt into occlusion (Dahl effect which takes 18 months for the back teeth to come together to some degree)
