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FRP - Crowns/Bridges/Wear/TMD/SDA/IMPLANTS > Wear > Flashcards

Wear Flashcards

1
Q

Name 4 different causes (types)of wear

A
  • Pathological and physiological
    Physiological - normal function and associated with age
    Pathological - excessive wear or pulp health is compromised.
  • Abrasion
  • Erosion
  • Attrition
  • Abfraction
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2
Q

What is erosion

Signs of erosive wear

A

Loss of tooth substance due to a chemical process not involving bacterial action. Chronic exposure of hard tissues to chemical agent
-Signs - loss of enamel surface detail, smoothing and flattening of surface.
Bilateral concave lesions.
-Later - dentine exposed and patient experiences sensitivity. Restorations stand proud of teeth.

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3
Q

What is attrition.

What are the early and late signs.

A

It is the wear of tooth substance through repeated tooth to tooth contact.
Parafunction.
- Early = flattening of cusp, polished facet of incisal edge
Progresses to loss of cusp height and flattening of occlusal inclined planes - shortening of clinical crowns.
E/O - TMD - painful muscles,
I/O - bilateral linea alba, scalloped tongue, wear facets.

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4
Q

What is abrasion.
What are the signs
examples of causes

A

The physical wear of tooth substance through repeated abnormal mechanical process involving a foreign object

  • v shaped/rounded lesions
  • sharp enamel edges
  • excessive toothbrushing, use of vape pen, bad habit.
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5
Q

What is abfraction

A

Loss of tooth substance through excessive occlusal forces leading to compressive/tensile forces at cervical fulcrum of tooth.

V shaped lesion at ACJ

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6
Q

Important aspect of the patient history

A

Complaint = Pain/sensitivity/aesthetic/functional issues/

PMH - GORD, alcoholism, hiatus hernia, pregnant, eating disorder.
-Drugs - cause xerostomia or low pH

PDH - reg attender, OH regime, treatment experience,

SH - lifestylr, occupation, diet, habits, alcohol, smoke,

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7
Q

Patient examination - E/O & I/O

A

E/O -TMJ - function, movement, opening, click, crepitus, pain, locking
-Muscles - hypetrophy - masseter

I/O - Lip and smile line
-Occlusion - FWS, dentoalveolar compensation, centric relation with stable contacts.
Perio, OHI, caries risk, charting

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8
Q

Describe the Smith and Knight ‘Tooth wear index’ scores

LIke 6ppc

A

Grade 0 - No loss of enamel characteristics

Grade 1 - loss of surface emanel characteristics

Grade 2 - buccal, lingual and occlusal loss of enamel and exposed dentine for < one third of surface

Grade 3 -buccal, lingual and occlusal loss of enamel and exposed dentine for > one third of surface. Incisal loss of enamel. Substantial dentine exposure

Grade 4 - buccal, lingual and occlusal loss of enamel with pulpal exposure and exposure of secondary dentine.

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9
Q

Describe the BEWE (Like BPE)

A 
Score: 
0 - no erosive wear
1 - initial loss of surface texture
2 - distinct defect, hard tissue loss <50% surface
3 -Hard tissue loss >50% of surface
Cumulative sextant score
No treatment - =2
Low - 3-8
Medium -9-23
High - >14
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10
Q

Special tests to carry out in wear cases

A 
Sensibility tests
Radiographs
Articulated study models 
Photographs
Diagnostic wax up
Salivary evaluation
Dietary analysis
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11
Q

Describe possible patterns of wear

A
  1. Localised
  2. Generalised
    - wear with reduction in OVD
    - wear without reduction of OVD but enough space
    - wear without reduction of OVD but with limited space.
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12
Q

Immediate treatment of wear patient

A
  • PAIN = desensitising agents, fluoride, GIC, (exposed dentine)
  • Pulp extirpation = compromised pulp
  • smooth sharp edges
  • XLA= unrestorable/non functional tooth
  • TMJ =attrition
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13
Q

Initial treatment of wear patient

A

Stabilisation of dentition

  • caries
  • perio
  • oromucosal issues
  • PREVENTATIVE regime
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14
Q

what baseline measurements/records are required

A
  • Photographs
  • Study models
  • wear indices
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15
Q

Abrasion treatment

  • conservative
  • restorative
A

Eliminate cause (foreign object) - bad habit

  • bite nails etc
  • less abrasive toothpaste and better technique
  • restorative
    GIC/RMGIC/composite, no tooth prep
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16
Q

Attrition treatment

A
  • CBT
  • Hypnosis
  • splint therapy - soft/hard
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17
Q

How can splints help with attrition

A
  • bite splint instead of teeth and wear that away
  • habit breaker
  • soft splint - diagnostic device to see wear worst worn areas are
  • hard splint - more robust and so longer lasting
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18
Q

example of a hard splint

-benefit of using it

A

Michigan splint

  • longer lasting
  • ideal postured occlusion with centric stops
  • canine rise=disclusion in eccentric mandibular movements
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19
Q

Treatment of erosion

A

Identify source

  • diet
  • habit
  • medical = GORD/eating disorder
  • preventative = fluoride -toothpaste/varnish/MW
  • desensitising agents = sensodyne/colgate tp
20
Q

dietary habits to change in patient with erosion

A
  • reduce sugar/acid consumption
  • use a straw
  • habit change (swirl drink around mouth)
  • sports drinks
  • MH - GORD = GMP involved - rennies/gaviscon use
  • eating disorder - psychologist/psychiatrist help
21
Q

Active management

-goals

A

Cover exposed dentine - cupped defects

  • preservation of remaining tooth structure
  • improve aesthetics
  • restore functionality
  • stable occlusion
22
Q

localised anterior tooth wear

contraind to

A

short roots/reduced periodontal support

23
Q

what does the ring of confidence mean

A

halo of enamel that has a positive effect on retention

24
Q

lower anterior tooth wear - issue

treat

A

smaller bonding area,

improve aesthetics but DO NOT INCREASE OVD

25
Q

who is most likely to have localised posterior tooth wear

how to treat

A

bulliemics, alcoholics, GORD

localised and asymp, prevention and monitor

26
Q

localised posterior wear - create canine guidance, how

A

add composite to palatal aspect of canine to allow rise - posterior disclusion

27
Q

composite build up techniques

A

free hand

impression - use of wax up and stent/putty ,eatrix

28
Q

how to create a clear vacuum formed matrix

A

alginate imp/wax up/vacuum formed stent onto this/use as mould for build up

29
Q

explanation to be given to patient when there anterior teeth have been built up

A

teeth buid up using white filling, bite will feel strange for a while, only front teeth will touch initially but the posterior teeth will follow after 3-6mth

30
Q

what 3 categories can generalised tooth wear be split into

A
  1. excessive wear with loss of OVD
  2. excessive wear without loss of OVD but enough space
  3. excessive wear without loss of OVD but no space available
31
Q

how to treat excessive tooth wear with loss of OVD

A

splint used to test toleranceof new face height

half OVD increase from max/mand

32
Q

how to treat excessive tooth wear without loss of OVD but limited space

A

can involve reorganising occlusion
splint to tolerate new face height
restoration of anterior/pposterior teeth at new facial height

33
Q

how to treat generalised excessive tooth wear without loss of OVD but no space

A

attempt to increase OVD withsplints/dentures if lack of posterior suport
crown lengthening surgery
elective endo
ortho

34
Q

crown lengthening surgery - purpose

negative

A

increase the amount of tooth surface available

  • result in black triangles
  • post op sensitivity
  • unfavourable crown root ratio
  • tooth loosening
35
Q

immediate management of wear

A

PAIN - sensitivity/pulp extirpationsmooth sharp edges/XLA/TMD

36
Q

initial management of wear

A

stabilise existing dentition

  • caries
  • periodontal disease
  • oro-mucosal
37
Q

important starting point for wear cases - baseline

A

baseline photos/casts/wear indices

38
Q

prevention of abrasion

treatment of excessive tb

A

educate on OHI
try to discourage habit
RMGIC/GIC at cervical areas

39
Q

attrition prevention

A

due to parafunction - CBT/hypnotherapy

  • use of splint - habit breaker
  • soft splint - diagnostic aid
  • hard splint - more robust/longer term
40
Q

example of splint

A

michigan splint - hard splint

  • provides ideal occlusion with centric stops
  • canine rise that discludes jaws when in excursive movements
41
Q

prevention for erosion

A

find source of issue
Fluorides/desensitising agents
diet - discourage acidic drink/food
eating disorder - refer for specialist help
-GORD - referral to GMP
xerostomia - management with salivary replacements/advice

42
Q

what is passive management

A

observation/monitoring

43
Q

maxillary anterior tooth wear management depends on:

A 
pattern of anterior max tooth wear
inter occlusal space
space required for restorations planned
quality and quantity of enamel left
aesthetic demand of patient
44
Q

categories of max tooth wear patterns

A
  1. tooth wear limited to palatal surfaces
  2. tooth wear involving palatal sufaces and incisal edges
  3. labial surfaces
45
Q

how to make space in max wear cases

A 
increase OVD-extracoronal restorations
reoganise ICP-RCP
surgical crown lengthening
elective RCT/post crowns
conventional ortho
46
Q

what is the Dahl technique
how
who works fastest

A

a method of gaining interocclusal space over a period of 3-6mth - anterior intrude, posteriors erupt

  • Composite-good compliance/aesthetics
  • faster in younger patients, monitor
  • if no movement after 6mth - not work
47
Q

contraind to Dahl technique

A 
TMD issues
active periodontal disease
post ortho
on bisphosphonates
dental implants present
existing conventional bridges

FRP - Crowns/Bridges/Wear/TMD/SDA/IMPLANTS (8 decks)

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