Treatment of Erosion, Abrasion & Attrition Flashcards
Tooth Wear
Ñ Tooth wear is the general term used for the surface loss of
dental hard tissues from causes other than developmental ones,
dental caries, and trauma.
Ñ Lambrechts et al. in 1989 estimated the normal vertical loss of
enamel resulting from natural wear is about – μm per year
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Classification of tooth wear
(4)
Ñ Attrition
Ñ Abrasion
Ñ Abfraction
Ñ Erosion or corrosion
Attrition as defined in GPT 9 is the
mechanical wear resulting
from mastication or parafunction, limited to contacting surfaces
of the teeth
Attrition is related to the — process
aging
Attrition
Etiology is
multifactorial and is accelerated by extrinsic factors
such as coarse diet, chewing tobacco and snuff, abrasive dust,
parafunctional habits of clenching and bruxism, traumatic
occlusion in the partially edentulous dentition, anterior open
bite, and anterior teeth in edge-to-edge relationship or crossbite.
Consequences of loss of posterior support
Supraeruption was found in –% of unopposed teeth.
92
Consequences of loss of posterior support
Mean supraeruption measurement for unopposed teeth
was — mm
1.68
Consequences of loss of posterior support
Passive eruption:
After ten years of remaining
unopposed tooth, recession and root exposure occurred
without occlusal movement of the tooth as in case of
active eruption
Types of Supraeruption:
(3)
Relative wear
Periodontal growth
Active eruption
Relative wear
association with — and is
more prevalent in
increasing age
unopposed mandibular teeth
Periodontal growth
inverse association with attachment
loss. More prevalent in younger patients, in the maxilla, in
premolars, and in females
Active eruption
has an association with attachment loss.
Ó Active eruption increases, the presence of attachment
loss increases, and periodontal growth is reduced.
Ó Alters the C/R ratio, affecting the mechanical
characteristics of the tooth and its behavior under
functional loading
Abrasion as defined in GPT 9 as an
abnormal wearing away of
the tooth substance by some unusual or abnormal mechanical
process independent of mastication and occlusion.
Abrasion
Causative agent:
Foreign object or substance repeatedly
contacting the tooth surface
Abrasion
Site and pattern of the abrasive lesions:
Diagnostic as different
foreign bodies produce different patterns of abrasion
Abrasion
Example:
Overzealous horizontal tooth brushing with an
abrasive dentifrice produces a rounded or V-shaped ditch on the
facial aspects of teeth at the cemento-enamel junction
Clinical presentation of
Abrasion
Most commonly affected teeth:
Canines and premolar
Clinical presentation of
Abrasion
Causative agents:
(5)
1) Improper use of dental floss,
2) chewing tobacco;
3) Biting on hard objects such as
pens, pencils or pipe stems;
opening hair pins with teeth; and
biting fingernails.
4) Abrasion also can be produced
by the clasps of partial dentures.
5) Occupational abrasion:
5) Occupational abrasion:
(3)
a) Tailors – sever thread with their
teeth,
b) Shoemakers and upholsterers -
hold nails between their teeth,
c) Glassblowers and musicians-play
wind instruments
Abfraction is defined in GPT 9 as the
the pathologic loss of hard tooth
substance caused by biomechanical
loading forces; which is the result of
flexure and chemical fatigue
degradation of enamel and/or dentin
at some location distant from the
actual point of loading
Abfraction
Causative agent:
Stress
Abfraction
Stresses that lead to abfractions are transmitted by occlusal loading forces
such as (3)
occlusal interferences,
premature contacts, habits of bruxism
and clenching
Erosion as defined in GPT 9 as the
progressive loss of tooth substance
by chemical processes that do not involve bacterial action, producing
defects that are wedge-shaped depressions often in occlusal, facial
and cervical areas
Erosion
Causative agent:
Acids from external and internal sources
Erosion
Extrinsic factor:
(4)
1) Acidic foods such as citrus fruit, pickle, vinegar (acetic acid),
sucking lemons, fruit juice and carbonated drinks, yogurt, herbal
tea, spicy food.
2) Medicines such as effervescent and chewable vitamin C
preparations46 and hydrochloric acid for achlorhydria,
3) Occupational exposure to acid fumes (sulfuric, hydrochloric, nitric,
and tartaric acids),
4) Swimming in acidic gas-chlorinated pools.
Erosion
Surface involved:
Labial surface of maxillary teeth affected
Erosion
Appearance:
Scooped-out depressions
Erosion
Intrinsic factor:
(3)
1) Anorexia and bulimia nervosa or regurgitation of gastric contents
because of abnormalities in the gastrointestinal tract, pregnancy
morning sickness, and chronic alcoholism.
2) Certain drugs may cause nausea or vomiting such as estrogens,
opiates, tetracycline, levodopa, aminophylline, digitalis, and
disulfiram,
3) Other factors such as reduced salivary secretion and calcium and
phosphorus levels
Erosion
Surface involved:
Palatal surface of the maxillary teeth affected
Erosion
Appearance:
Concave depression involving the entire surface.
Clinical presentation of Erosion
Palatal surface and occlusal surface of
posterior teeth involved due to —
Labial surface involved due to
—
GERD
consumption of acidic food
Attrition- Abfraction:
Is the
joint action of stress and
friction when teeth are in
tooth-to-tooth contact, as in
bruxism or repetitive
clenching.
Abrasion- Abfraction:
Is the
loss of tooth substance caused
by friction from an external
material on an area in which
stress concentration due to
loading forces may cause
tooth substance to break away
— is an Occlusal Parafunctional Habit
Bruxism
Bruxism is an Occlusal Parafunctional Habit
Ñ May be:
Sleep bruxism or Awake bruxism
bruxism
It is defined as the
grinding of teeth during non functional movements
of the masticatory system: it is a mandibular parafunction
Mechanical wear resulting from bruxism often results in
progressively
greater wear towards the anterior teeth (with open bite as exception)
Bruxism
Two etiological factors are:
Ø Structural:
(2)
Ø Functional:
(2)
a. Occlusal interferences
b. Altered maxillo mandibular relationships
a. Stress
b. Children Brux
Clinical presentations of Bruxism
Intraoral findings:
(8)
Ñ Grooving of lateral borders of tongue
Ñ Cheek biting
Ñ Fractured porcelain restorations
Ñ Cupping or cratering of occlusal
surface
Ñ Teeth grinding or clenching
Ñ Teeth are worn down, flattened or
chipped
Ñ Increased tooth sensitivity
Clinical presentations of Bruxism
Extraoral findings:
(4)
Ñ Jaw pain or tightness in jaw muscles
Ñ Earache
Ñ Dull morning headache
Ñ Chronic facial pain
Prevention rather treatment of
Bruxism
(3)
Ñ There is no specific treatment available at this time to stop
bruxism, so that the focus has been to reduce the adverse effects
of the habit.
Ñ The use of inter occlusal appliances is the most common and
accepted way to prevent wear of teeth and prosthodontic
restorations
Ñ When prosthetic intervention is indicated in a patient with
bruxism, efforts should be made to reduce the effects of heavy
occlusal loading on all the components that contribute to
prosthetic structural integrity
Amelogenesis imperfecta:
Hereditary
defect of dental enamel
Amelogenesis imperfecta:
Characterized by
early loss of enamel
with concomitant and more rapid
attrition of tooth structure.
AI
Classified into three basic types:
1) Hypoplastic:
2) Hypomaturation:
3) Hypocalcified:
1) Hypoplastic:
The enamel has only
one eighth to one fourth of the
normal thickness.
2) Hypomaturation:
The enamel has
normal thickness and is softer than
normal and tends to fracture from
the dentin.
3) Hypocalcified:
The enamel normal
thickness but is extremely friable
and frequently lost soon after tooth
eruption
Dentinogenesis imperfecta or hereditary opalescent dentin:
Is a
dominant autosomal trait with a high degree of penetrance and
the enamel tends to chip away from underlying dentin at an early
stage and the teeth show gross attrition associated with
obliterated pulp chambers and short roots.
DI
This anomaly may or may not be associated with the
generalized
skeletal disease osteogenesis imperfecta
DI
Characterized by
an amber-colored translucency of the dentition
DI
Ñ Type 1:
(6)
- No Family History
- Obliterated pulps frequent
- Periapical radiolucency’s less frequent
- Defect not pitted
- Mild or non existent anterior open bite
- Always associated with osteogenesis imperfecta
DI
Ñ Type 2:
(1)
- All symptoms similar as type I only difference is that its is not associated
with osteogenesis imperfecta
DI
Ñ Type 3:
(6)
- Positive family history
- Pulps are large
- Periapical radiolucency’s frequent
- Defect is pitted
- Significant open bite
- Not associated with osteogenesis imperfecta
How to diagnose and treat these
cases?
(7)
Ñ History taking
Ñ Clinical examination
Ñ Radiographs
Ñ Diagnostic casts mounted in MIP and CR
Ñ Clinical intraoral photographs
Ñ TMJ examination
Ñ Salivary gland examination
Management of Localized active
tooth wear:
5 important factors to be considered are:
1) Pattern of tooth wear and the surfaces involved
2) Available inter occlusal space
3) Available restorative space for dental restorations
proposed
4) The quantity and quality of available hard tissue
and enamel respectively
5) Esthetic demands of the patient
Consequences of Wear
(3)
1) Loss of VDO
2) Compromised Esthetics
3) Occlusal discrepancies
Management of Generalized
tooth wear:
The restorative management of patients presenting
with generalized tooth wear (TW) will be considered
according to the three categories described by Turner
and Missirilian;
* Category 1 –
* Category 2 –
* Category 3 –
Excessive wear with loss of vertical
dimension of occlusion
Excessive wear without loss of vertical
dimension, but with space available
Excessive wear without loss of vertical
dimension, but with limited space.
Ñ Wear of the antagonist enamel surface was as follows:
Stained
and glazed Zirconia > Stained Zirconia> Polished Zirconia
Ñ Wear of the antagonist enamel was even more with
layered
feldspathic porcelain. Glazed or unglazed causes similar
amount of wear
Ñ Care has to be taken to polish the porcelain surface well after
chairside adjustments to minimize the
roughness in turn
minimize wear of the opposing tooth.
Ñ The depth of enamel wear caused by monolithic zirconia and
composite resin was significantly — than that caused by
glass ceramic and enamel
lower
Ñ Composite resin restorations caused — wear of the antagonist
enamel as compared to ceramics
less
Ñ Wear depth of — is the closest to that of the enamel.
gold
Ñ The milled and not glazed Zirconia reinforced lithium disilicate
shows — wear depth compared
with type III gold and human enamel.
small but significantly increased
Ñ Wear depth and volumetric loss for the — did not statistically differ in
comparison with the human enamel.
glaze-fired Zirconia
reinforced lithium disilicate and for the other ceramics like heat
pressed, CAD/CAM Feldspathic
Ñ The wear properties of the new zirconia-reinforced lithium
silicate ceramic is improved by a
glaze firing cycle
