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BDS4 Restorative > Wear 2 > Flashcards

Wear 2 Flashcards

1
Q

How is a wear diagnosis determined?

A

As almost all wear is multifactorial- decide on the primary causative factor (best fit)

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2
Q

What are the different patterns of tooth wear?

A

Localised

Generalised
-> Wear with loss of OVD
-> Wear without loss of OVD but with space available (C2div1)
-> Wear without loss of OVD but with limited space

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3
Q

What is done in the immediate phase of treatment when treating patients with wear?

A

Deal with pain:
Sensitivity- Desensitising agents, Fluorides, bonding agents GIC coverage of exposed dentine

Pulp extripation- if wear has compromised pulpal health

Smooth sharp edges- prevent trauma to cheeks and tongue

Extraction- pain from unrestorable/non-functional tooth

TMJ pain- important in attrition, acute symptoms need to be controlled

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4
Q

What can be done to treat TMJ pain?

A

Splint, ultrasound, jaw exercises, relaxation techniques

-> treated before wear

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5
Q

What is done in the initial phase of plan when treating patients with wear?

A

Stabilise the existing dentition

Deal with caries

Deal with perio condition

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6
Q

What is done when you identify a primary causative factor for tooth wear?

A

Institute a preventive regime (cannot treat an ongoing problem or it will fail)

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7
Q

How can wear be monitored?

A

Wear indices

Models

Photos

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8
Q

Why is it important to monitor wear?

A

Helps decide if it is active (requiring treatment/prevention) or historic (may not require treatment if not problems)

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9
Q

What is the key element in prevention?

A

Removal of the cause

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10
Q

How is abrasion prevention achieved?

A

Remove the ‘foreign object or substance’ involved in causing the abrasive wear

Change toothpaste (less abrasive)

Alter tooth brushing habits

Change parafunctional/functional habits

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11
Q

What can be done to treat abrasion?

A

Put in simple restorations (may not require preparation)- so patient wears them out rather than their own tooth tissue

->replace as required

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12
Q

Why may flowable composite be less useful in restoring abrasive wear?

A

Flowable composite may not be the best as it is more translucent- dentine underneath shines through

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13
Q

Why is RMGIC preferred to composite to restore abrasive lesions?

A

RMGIC- lower modulus, more flexible than composite in this situation

-> Higher modulus of composite compromises retention

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14
Q

How is attrition prevented?

A

Treat parafunction- CBT, hypnosis, relaxation, splinting

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15
Q

What are the ADV of using splints to treat attritive wear?

A

Softer than teeth- Wear away in preference to tooth

Cause no damage to the opposing teeth

May work as habit breaker

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16
Q

What types of splints can be used?

A

Soft- good as diagnostic device to determine whether patient is grinding

Hard- better long term (more robust)

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17
Q

What are the features of a Michigan splint (hard)?

A

Made of acrylic

Provides an ‘ideal occlusion’ with even centric stops

Has canine rise which provide disclusion in eccentric mandibular movements (canine guidance)

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18
Q

What is it important to establish or fix before prescribing a patient a splint?

A

That the patient does not suffer from erosion (esp intrinsic)

-> would accelerate tooth wear

19
Q

What patient habits contributing to erosive wear may need to be changed when treating patients?

A

Swilling drinks around in mouth

Drinking from cans/bottles- Use a straw

Rumination

Educating patient about hidden sugars and acids

Vegan diet

Use of sports drinks/gels in athletes

20
Q

Which medical conditions can cause erosion from intrinsic acid production?

A

GORD
Reflux
Hiatus Hernia
Xerostomia
Anorexia and Bulimia

21
Q

What can be used to prevent erosion?

A

Fluoride supplements (help remineralisation)

Desensitising agents (trial and error)

Dietary modifications (extrinsic acids)

Habit changes

Medicines- PPI, h2 blockers (ranitidine), antacids

22
Q

What is the issue with PPI?

A

Patient can suffer rebound when they stop using them

23
Q

Which specialists may you refer patients on to if you notice a problem with intrinsic acid?

A

Gastroenterologist- GORD

Psychiatrist/psychologist- Anorexia/Bulemia

24
Q

What is done to treat abfraction?

(if it exists)

A

Restore cavities with low modulus materials

-> RMGIC

-> Flowable Composite

25
Q

What should the first form of treatment for dental wear be?

A

Passive management- prevention and monitoring

-> most patients will be in this stage for around 6 months (this may be all that is required)

26
Q

What is the issue when choosing the right time to begin active management approach to treat tooth wear?

A

There is no intervention threshold (lack of evidence)

-> manage with simple interventions for as long as possible (covering exposed dentine etc)

27
Q

What situations would prompt you to consider starting active management of wear?

A

Wear leading to further complications

Aesthetics have gone beyond patient acceptability

Leaving intervention may cause more complex treatments to be required

28
Q

What are the goals in active management of tooth wear?

A

Preserve remaining tissue

Pragmatic aesthetics

Functioning occlusion

Stability

29
Q

What is the decision on whether to treat maxillary anterior tooth wear based on?

A

The pattern of anterior maxillary tooth wear

Inter-occlusal space

Space required for the restorations being planned

Quality and quantity of remaining tooth tissue, particularly enamel (important for bonding)

Aesthetic demands of the patient

30
Q

What are the categories of maxillary anterior tooth wear?

A

Tooth wear limited to the palatal surfaces only (assoc. with reflux and vomiting)

Tooth wear involving the palatal and incisal edges with reduced clinical crown height

Tooth wear limited to labial surfaces (assoc. with drink holding/over-brushing)

31
Q

What material is used to treat maxillary anterior tooth wear?

A

Composites

32
Q

What are examples of instances when inter-incisal space is adequate in maxillary anterior tooth wear? (easiest to treat)

A

If teeth wear rapidly and there is no time for alveolar compensation

Anterior open bite

Increased overjet

-> Space available with no need for change in OVD

33
Q

What is the issue with dental-alveolar compensation?

A

FWS remains the same and OVD will need to change when placing restorations (complex)

  • is good for maintaining masticatory efficiency
34
Q

What makes it difficult to create space in maxillary anterior tooth wear?

A

Little tooth tissue to begin with

Poor retention due to short axial walls

Good chance of pulpal damage due to short clinical crowns

35
Q

What can be done to make space when teeth are already shortened?

A

Increase OVD via multiple posterior extra-coronal restorations (reorganised approach)- Complex, Destructive, Expensive

Occlusal reorganisation from ICP to RCP-complicated, can be destructive

Surgical Crown lengthening- doesn’t really create more space

Elective RCT and post crowns- very destructive

Conventional Orthodontics- lengthy treatment

36
Q

What is surgical crown lengthening?

A

Repositioning of gingivae apically generally with removal of bone to expose more crown for retention of restoration

-> can result in sensitivity (exposes root)
-> occlusal reduction still required
-> better if high smile line

37
Q

What is the Dahl technique?

A

Propping occlusions open anteriorly with a bite plane/composite build up creating posterior disocclusion to allow over-eruption

*Anteriors should intrude slightly

-> can increase OVD by 2-3mm

38
Q

When is the Dahl Technique used?

A

To create space in localised areas of tooth wear

39
Q

Why is composite now used instead of CoCr bite plane?

A

Better aesthetic

Better compliance

Easier to adjust

Quicker- teeth look better automatically

40
Q

Why is the Dahl technique more successful in younger patients?

A

More eruptive potential

41
Q

What is the success rate with the Dahl technique?

A

90+%

42
Q

What is a sign the Dahl technique is not working?

A

If there is no movement after 6 months

43
Q

What are the contraindications for the Dahl technique?

A

Active periodontal disease- don’t want to overload anteriors

TMJ problems

Post Orthodontics

Biphosphonates- slows turnover of bone

If dental implants present

If existing conventional bridges

BDS4 Restorative (12 decks)

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