Wear Flashcards
Name 4 different causes (types)of wear
- Pathological and physiological
Physiological - normal function and associated with age
Pathological - excessive wear or pulp health is compromised. - Abrasion
- Erosion
- Attrition
- Abfraction
What is erosion
Signs of erosive wear
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.
What is attrition.
What are the early and late signs.
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.
What is abrasion.
What are the signs
examples of causes
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.
What is abfraction
Loss of tooth substance through excessive occlusal forces leading to compressive/tensile forces at cervical fulcrum of tooth.
V shaped lesion at ACJ
Important aspect of the patient history
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,
Patient examination - E/O & I/O
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
Describe the Smith and Knight ‘Tooth wear index’ scores
LIke 6ppc
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.
Describe the BEWE (Like BPE)
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
Special tests to carry out in wear cases
Sensibility tests Radiographs Articulated study models Photographs Diagnostic wax up Salivary evaluation Dietary analysis
Describe possible patterns of wear
- Localised
- Generalised
- wear with reduction in OVD
- wear without reduction of OVD but enough space
- wear without reduction of OVD but with limited space.
Immediate treatment of wear patient
- PAIN = desensitising agents, fluoride, GIC, (exposed dentine)
- Pulp extirpation = compromised pulp
- smooth sharp edges
- XLA= unrestorable/non functional tooth
- TMJ =attrition
Initial treatment of wear patient
Stabilisation of dentition
- caries
- perio
- oromucosal issues
- PREVENTATIVE regime
what baseline measurements/records are required
- Photographs
- Study models
- wear indices
Abrasion treatment
- conservative
- restorative
Eliminate cause (foreign object) - bad habit
- bite nails etc
- less abrasive toothpaste and better technique
- restorative
GIC/RMGIC/composite, no tooth prep
Attrition treatment
- CBT
- Hypnosis
- splint therapy - soft/hard
How can splints help with attrition
- 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
example of a hard splint
-benefit of using it
Michigan splint
- longer lasting
- ideal postured occlusion with centric stops
- canine rise=disclusion in eccentric mandibular movements
Treatment of erosion
Identify source
- diet
- habit
- medical = GORD/eating disorder
- preventative = fluoride -toothpaste/varnish/MW
- desensitising agents = sensodyne/colgate tp
dietary habits to change in patient with erosion
- 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
Active management
-goals
Cover exposed dentine - cupped defects
- preservation of remaining tooth structure
- improve aesthetics
- restore functionality
- stable occlusion
localised anterior tooth wear
contraind to
short roots/reduced periodontal support
what does the ring of confidence mean
halo of enamel that has a positive effect on retention
lower anterior tooth wear - issue
treat
smaller bonding area,
improve aesthetics but DO NOT INCREASE OVD
who is most likely to have localised posterior tooth wear
how to treat
bulliemics, alcoholics, GORD
localised and asymp, prevention and monitor
localised posterior wear - create canine guidance, how
add composite to palatal aspect of canine to allow rise - posterior disclusion
composite build up techniques
free hand
impression - use of wax up and stent/putty ,eatrix
how to create a clear vacuum formed matrix
alginate imp/wax up/vacuum formed stent onto this/use as mould for build up
explanation to be given to patient when there anterior teeth have been built up
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
what 3 categories can generalised tooth wear be split into
- excessive wear with loss of OVD
- excessive wear without loss of OVD but enough space
- excessive wear without loss of OVD but no space available
how to treat excessive tooth wear with loss of OVD
splint used to test toleranceof new face height
half OVD increase from max/mand
how to treat excessive tooth wear without loss of OVD but limited space
can involve reorganising occlusion
splint to tolerate new face height
restoration of anterior/pposterior teeth at new facial height
how to treat generalised excessive tooth wear without loss of OVD but no space
attempt to increase OVD withsplints/dentures if lack of posterior suport
crown lengthening surgery
elective endo
ortho
crown lengthening surgery - purpose
negative
increase the amount of tooth surface available
- result in black triangles
- post op sensitivity
- unfavourable crown root ratio
- tooth loosening
immediate management of wear
PAIN - sensitivity/pulp extirpationsmooth sharp edges/XLA/TMD
initial management of wear
stabilise existing dentition
- caries
- periodontal disease
- oro-mucosal
important starting point for wear cases - baseline
baseline photos/casts/wear indices
prevention of abrasion
treatment of excessive tb
educate on OHI
try to discourage habit
RMGIC/GIC at cervical areas
attrition prevention
due to parafunction - CBT/hypnotherapy
- use of splint - habit breaker
- soft splint - diagnostic aid
- hard splint - more robust/longer term
example of splint
michigan splint - hard splint
- provides ideal occlusion with centric stops
- canine rise that discludes jaws when in excursive movements
prevention for erosion
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
what is passive management
observation/monitoring
maxillary anterior tooth wear management depends on:
pattern of anterior max tooth wear inter occlusal space space required for restorations planned quality and quantity of enamel left aesthetic demand of patient
categories of max tooth wear patterns
- tooth wear limited to palatal surfaces
- tooth wear involving palatal sufaces and incisal edges
- labial surfaces
how to make space in max wear cases
increase OVD-extracoronal restorations reoganise ICP-RCP surgical crown lengthening elective RCT/post crowns conventional ortho
what is the Dahl technique
how
who works fastest
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
contraind to Dahl technique
TMD issues active periodontal disease post ortho on bisphosphonates dental implants present existing conventional bridges
