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Management of toothwear/ dental education in india
The document discusses the management of tooth wear, outlining monitoring, prevention, and treatment strategies for both anterior and posterior tooth wear, including the use of splints, dietary analysis, and restorative options. It highlights the importance of adequate interocclusal space and treatment planning to address issues like dentine sensitivity and tooth substance loss. The document emphasizes a multidisciplinary approach to correcting malocclusion and improving overall dental health.
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Management of toothwear/ dental education in india
- 1. Management of toothwear INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
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- 4. Localized anterior toothwear Monitoring •Studycasts •Photographs Prevention •Stabilization splint •Vinyl mouthguard •Dietary analysis •Flouride varnish Monitoring •Study casts •Photographs Prevention •Stabilization splint •Vinyl mouthguard •Dietary analysis •Flouride varnish Pathological signs, Eg. Pulpal exposure Patient wants or needs, Eg. Aesthetics / appearance Treatment (with adequate Posterior support) Treatment (with adequate Posterior support) Adequate anterior interocclusal clearance Adequate anterior interocclusal clearance Created space by •Dahl appliance ( fixed or removable) •Occlusal adjustment ( RCP : ICP) •Straight wire appliance •Segmental osteotomy Created space by •Dahl appliance ( fixed or removable) •Occlusal adjustment ( RCP : ICP) •Straight wire appliance •Segmental osteotomy Involvement of incisal/labial surfaces ? Involvement of incisal/labial surfaces ? Obtained interocclusal clearance Adequate crown length Adequate crown length Palatal backing made of •Gold •Non precious metal •Resin composite •Porcelain Palatal backing made of •Gold •Non precious metal •Resin composite •Porcelain Full crowns or double veneersFull crowns or double veneers Surgical crown lengtheningSurgical crown lengthening No Yes YesNo Yes www.indiandentalacademy.com
- 5. • Mild painand sensitivity in upper front teeth. • Patient consumed large amount of citrus fruits • Dentine exposure on the palatal side of upper teeth • Little discrepancy b/w RCP and ICP • Overjet and overbite was minimal. Patient had canine guidance in left and right excurtions www.indiandentalacademy.com
- 6. Treatment sequence • Softvinyl occlusal splint made to protect the teeth and reduce dentine hypersentivity by home use flouride gel application • After dietary advise and 6 month monitoring, incisal edges were repaired with composite resin and palatal surface restored with Nickel – chromium veneers at and increased OVD ( 0.5mm speration) • Posterior teeth seperated • Occlusal contacts reestablished in 4 weeks www.indiandentalacademy.com
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- 8. • Dentine sensitivity withworn upper anteriors. • Lateral incisor congenitally missing. • Class II division 2 insical relationship and little horizontal discrepancy between RCP and ICP • No interocclusal space www.indiandentalacademy.com
- 9. Treatment plan • Hardacrylic occlusal splint prescribed to prevent further toothwear and to asses the patients ability to tolerate an increase in OVD • Interocclusal space created in anterior by a fixed dahls appliance cemented. • All posterios gained contact after 4 months • Crown lenghtening done to increase crown height www.indiandentalacademy.com
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- 12. Localized posterior toothwear www.indiandentalacademy.com
- 13. Localized posterior toothwearLocalizedposterior toothwear Adequate interocclusal space ?Adequate interocclusal space ? Need to have cast restoration for cuspal protection(endodontically treated or bridge abutment) Need to have cast restoration for cuspal protection(endodontically treated or bridge abutment) YesYes Create space by: •Reduction of oppsoing worn tooth(+elective endodontics) •Posterior supraoccluding restorations to intrude over erupted teeth •Fixed ortho appliance •Increased OVD Create space by: •Reduction of oppsoing worn tooth(+elective endodontics) •Posterior supraoccluding restorations to intrude over erupted teeth •Fixed ortho appliance •Increased OVD No Intracoronal restorationIntracoronal restoration Enough tooth substance left for Retention of extracoronal restoration ? Enough tooth substance left for Retention of extracoronal restoration ? Partial veneer crowns Full veneer crowns Nickel chromium onlays Adhesive onlays using plastic materials Partial veneer crowns Full veneer crowns Nickel chromium onlays Adhesive onlays using plastic materials Core build up: •Adhesive restoration •Pins •Periodontal surgery to increase crown length Core build up: •Adhesive restoration •Pins •Periodontal surgery to increase crown length No No YesYes YesYes www.indiandentalacademy.com
- 14. • Localized tootwear posteriorly. • Marked tooth substance loss and exposure of secondary dentine of 45 and 47. • 14 to 17 had all over erupted • Mild toothwear in anterior region • Has class III malocclusion incisal relationship www.indiandentalacademy.com
- 15. complications • Mandible cannotbe repositioned to a more retruded position even if patient wore a splint • Edge to edge contact might further increase the tooth wear in anterior region since there was inadeqaute anterior guidance. • Missing 36 and 46 encourages the patient to posture the mandible more anteriorly leading to more anterior toothwear www.indiandentalacademy.com
- 16. Treatment plan • Intrusionof posterior teeth • Proclination of anterior teeth • Multidisciplinary approach – Bilateral posterior bite plane – Correcting anterior edge to edge relation using maxillary fixed orthodontic appliance www.indiandentalacademy.com
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- 19. Thank you For moredetails please visit www.indiandentalacademy.com www.indiandentalacademy.com