This document discusses various causes of non-carious tooth destruction and disfigurement including attrition, abrasion, abfraction, erosion, enamel hypoplasia, hypocalcification, dentin hypoplasia, hypocalcification, discoloration, malformation, amelogenesis imperfecta, dentinogenesis imperfecta, and trauma. For each cause, signs and symptoms and treatment modalities are described. Endodontic therapy and restorative treatments like composite resin, glass ionomer cement, and metallic restorations are commonly used to address the defects and restore form and function.

3. Non carious destruction and
disfigurement of teeth

4. Non carious destruction
 Attrition
 Abrasion
 Abfraction
 Erosion
 Localized non-hereditary enamel hypoplasia
 Localized non-hereditary enamel hypocalcification
 Localized non-hereditary dentinal hypoplasia
 Localized non-hereditary dentin hypocalcification
 Discoloration
 Malformation
 Amelogenesis imperfecta
 Dentinogenesis imperfecta
 Trauma

5. Attrition
 It can be defined as surface tooth structure loss
resulting from direct frictional forces between
contacting teeth
 Continuous ,age dependent process usually physiologic
 Affects occluding surfaces and results in flattening of
their inclined planes and in facet formation
 ‘Reverse cusp’ is seen in severe cases
 Accelerated by parafunctionaL mandibular movement
noticebly brusixm

6. Can precipitate any of following:
A. Physiologic surface attrition (proximal surface
faceting)
• Results from surface tooth structure loss and
flattening wideni ng of the proximal contact areas.
• Therefore area proximally is increased in dimension
and is susceptible to decay.

7. Mesiodistal dimension of teeth are decreased
↓
Overall reduction of arch length
↓
Interproximal space will be decreased in dimension
↓
Thereby interfering physiology of interdental papillae
↓
More plaque accumulation
↓
Periodontitis

8. B. Occluding surface attrition
 Loss ,flattening, faceting and/or reverse cusping of occluding elements
→ loss of vertical dimension of tooth
 If wear is severe ,generalized and accomplished in relatively shorter
time →vertical loss on face as well as loss of vertical dimension
 If wear is over a long period of time alveolar bone can grow occlusally
→vertical dimension loss is seen but not imparted to face.
 Deficient masticatory capabilities ,blunting of cusps may compel patient
to apply more force on teeth.
 Cheek biting is sequelae of occlusal surface attrition
 Decay at occluding area leads to more exposed dentin
 Tooth sensitivity

9. Severe generalized attrition from
tooth grinding with abrasion of
exposed dentin
The diestone cast shows flat
enamel facet with well defined
margins resulting from attrition
Severe attrition

10. Treatment modalities
1. Extraction of pulpally involved teeth
2. Parafunctional activities ,bruxism should be controlled
3. Myofunctional,TMJ,or any stomatognathic system disorders
should be diagnosed and resolved
4. Occlusal equilibrium should be performed
5. Protect sensitive dentinal areas and actual caries should be
obliterated
6. Restorative modalities should be done.

11. An acrylic resin maxillary
occlusal splint for correction
of bruxism

12. Abrasion
 Defined as surface loss of tooth structure resulting from
direct friction forces between the teeth and external objects or
from frictional forces between contacting teeth components in
the presence of an abrasive medicine
 Pathologic process
 Sometimes abrasion rate is faster than the dentin deposition
rate →direct or indirect pulpal involvement

13. Cervical abrasion in unopposed
premolar tooth resulting from
incorrect tooth brushing and
dentifrices
Abrasion results in a more rounded and
less well defined occlusal appearance

14.  Toothbrush abrasion most predominant
 Occur cervically,usually to the most facially prominent teeth
in the arch
 Its surface extent, depth and rate of formation is dictated by:
a. The direction of brushing strokes.
b. The size of the abrasive.
c. The percentage of abrasives in the dentrifice
d. Type of abrasive
e. Diameter of brush bristles
f. Type of bristle
g. Forces used in brushing
h. Type of tooth tissues being abraded

15. Signs and symptoms of toothbrush abrasion:
1. The lesion may be linear in outline, following the path of
brush bristles.
2. The peripheries of the lesion are very angularly demarcated
from the adjacent tooth surface.
3. The surface of the lesion is extremely smooth and polished,
and it seldom has any plaque accumulation or carious activity
in it.
4. The surrounding walls of abrasive lesion tend to make a v-
shape ,by meeting at an acute angle axially.
5. Probing or stimulating (hot, cold or sweets) the lesion can
elicit pain.

16.  Other oral habits which create abrasion:
a.Chewing tobacco
b.Toothpick
c.Cutting sewing thread with incisor teeth
d.Holding and pulling nails with front teeth
 Iatrogenic
1. Dentures with porcelain teeth opposing natural teeth
2. Use of cast alloy with higher abrasive resistance than tooth
enamel in a restoration opposing natural teeth

17. Treatment modalities
1. Diagnose the cause of the presented abrasion.
2. Correct or replace the iatrogenic dental work,habit
3. Restorative treatment if habits are not broken.
4. Abrasive lesions at non occluding tooth surfaces should be
critically evaluated
5. If teeth are sensitive ,desensitize exposed dentin before
starting restorative treatment is started
6. Restorative treatment

19. Abfraction
 Syn.idiopathic erosion
 Cervical wedge shaped defects or abfractures caused by strong
eccentric occlusal forces
 Caused due to excessive occlusal stresses and
 Only a single tooth may b affected leaving the neighbouring
teeth uninvolved
 More number of teeth are affected in bruxists and in older
patients
 These lesions can progress around existing cervical
restorations and extend subgingivally
 The lingual surfaces of mandibular teeth are rarely affected.

20. treatment modalites

21. Erosion
 Defined as the loss of tooth structure resulting from chemico-
mechanical acts in the absence of specific microorganism.
 Popular theories of causes and pathogenesis:
1. Ingested acid
2. Salivary citrates
3. Secreted acids’
4. Mechanical abrasion
5. Chelating microbial metabolic products
6. Acid fumes
7. Excessive tensile stresses at the tooth clinical cervix
8. Refused acids’
9. Salivary flow

22. Progressive erosion results in
occlusal scooping or cupping of the
exposed softer dentin in posterior
teeth and grooving in anterior
teeth
Extensive erosion in teeth of
wine tester
Teeth showing acid erosion

23. Treatment modalities
1. Eliminate the causes
2. Preoperative study models or photographs
3. Give restorative modalities in extremely
symptomatic of disfiguring lesions
4. Metallic restoration should be the material of choice
if restorations are indicated

24. Localized non hereditary enamel
hypoplasia
 During enamel formation if ameloblasts are irritated ,their
metabolic product,i.e the enamel matrix,will not be properly
formed ,causing certain interruptions and defects.
 When the teeth erupt ,these defect are seen in crown portion
of tooth and is known as localized non hereditary enamel
hypoplasia
 Lesion range from isolated pits to widespread linear defects
,depressions ,or loss of a segment in the enamel
 Discoloration increases with age

25. Factors that can injure or destroy the ameloblast includes
i. Systemic disorders
ii. Localized disorders
iii. fluorides

26. Treatment modalities
 If defects are of minimum size : Selective odontotomy
 If defect is at occluding or contacting area go for
metallic or cast restorations
 If lesions are discolured and veneering procedures are
not planned,vital bleaching can be attempted

27. Localized non hereditary enamel
hypocalcification
 Destruction of ameloblasts can interfere with the enamel
matrix formation,it can also interfere with the mineralization
of this matrix ,even it is formed this leads to Localized non
hereditary enamel hypocalcification
 Signs and symptoms same as enamel hypoplasia
 Affective areas appear chalky and soft to identation and will
be very stainable
 Enamel can be chipped if lesion involves entire surface of a
tooth

28. Treatment modalities
1. If diagnosis is made early, Mineralization of tooth enamel
is done using periodic fluoride application, fluoride
ionophoresis and strict prevention of plaque accumulation
in these areas
2. Vital bleaching ,laminated veneering ,composite veneering
and porcelain fused to metal and cast ceramic crowns
Vital bleaching ,using H2O2 of the maxillary anterior teeth discolored by
chromogenic bacteria staining and fluorosis mottling

29. Localized non-hereditary
dentin hypocalcification
 Same causes as hypoplasia
 Dentin will be present in substance ,it will be softer,
more penetrable and less resilent.eg:interglobular
dentin
Treatment: intermediary basing

30. Discoloration
 Classified from etiologic aspect as
1. Extrinsic : due to surface staining , calculus or any
other surface deposits
2. Intrinsic : created from changes in one or more of
the tooth tissues
 Discoloring changes in enamel include hypoplasia
and hypocalcification

31.  Discoloring changes in dentin may result from non –
vitality resulting in disintegration of the dentinal
tubules contents or from pigmentation and staining
which is due to external sources e.g. corrosion products
of metallic restorations,medications,microbial
metabolites,etc
 Tetracycline coloration
 Discoloring changes in the pulp root canal system can
result from pulpal necrosis

32. Treatment modalities
 By scaling and polishing with abrasives
 Intrinsic discoloration in enamel and dentin can be
treated by Vital bleaching ,laminated veneering
,composite veneering and porcelain fused to metal
and cast ceramic crowns as in localized non
hereditary enamel hypoplasia and hypocalcification.

33.  In intrinsic discoloration due to discoloring changes in
pulp-root canal system first endodontic therapy
should be instituted and then proceed with following
treatment sequence
a. non-vital bleaching
b. If no pleasant result are there it may be necessary to
to resort laminated veneer or porcelain fused to metal
or cast ceramic veneering restorations

34. Malformation
 Can be either in micro- or macroforms and usually of
hereditary origin.
 One or two teeth (usually upper lateral) that are
noticebly smaller in size than surrounding ones ,with
pointed incisal edges(peg teeth)- most common
malformation

35. Treatment modalities
1. If the affected tooth is properly aligned in the arch and has
intact enamel and is not subjected to extensive occluding
forces,then conditioning of the enamel & building the tooth
up with a direct tooth-colored resinous material is done.
2. If the affected tooth is malaligned ,repositioning should be
performed before restoration
3. If excessive occluding forces are present select porcelain
fused to metal or cast ceramic veneering restorations.

36. Amelogenesis imperfecta
 Results from genetically determined abnormalities in the
formative stage of enamel unassociated with evidence of
biochemical or systemic diseases.
 Can be autosomal dominant
traits(hypocalcification,hereditary generalized and localized
hypoplasia) or they can be X-linked trait (hypomaturation) or
a recessive trait (pigmented hypomaturation)
 The abnormality could be in the matrix formation leading to
hypoplasia or it could be in the mineralization leading to
hypomineralization.
 Affects one type of dentition,and only enamel

37. Classes of hypoplasia show following features
1. Thin enamel
2. Open contact
3. Small teeth ,with short roots ,very limited pulp chambers and root canal dimensions
4. Delay in eruption
5. Sometimes the enamel is glassy(prismless)
6. There may be some discoloration ,usually yellow
7. The enamel could look wrinkled
8. All signs of severe occlusal wear

38. Class of hypomineralization imperfectas shows:
1. Enamel is usually stained (yellow or black).it may be chalky at early stages of life.
2. The enamel chips easily
3. enamel can be very soft in consistency (cheesy)
4. Teeth are normally erupted but have dull surfaces readily stainable by age
5. Enamel is worn away very easily in life with all signs and symptoms of severe attrition
.

39. Treatment modalities
 Selective odontotomy
 Full veneering includes procedures with metallic ,
metallic based or cast ceramic restorations.

40. Dentinogenesis imperfecta
 Genetically dictated classes of diseases affecting the
formation and/or maturation of the dentin matrix in
the absence of any obvious systemic or biochemical
changes.
 Clinical features
1. Color may be from grey,brown ,yellow brown to violet
2. Most of them exhibit a translucent hue.
3. The enamel ,although intact ,is easily chipped because
of defective dentino -enamel junction

41. 4. The crowns are overcontoured.
5. The roots are short and slender
6. There are signs and symptoms of extensive attrition
7. The dentin is devoid of tubules
8. The dentin contains a lot of interglobular dentin.
9. The decay process ,if initiated ,will spread laterally.
10. Root canal and pulp chamber space is obliterated.
11. Dentin hardness and resilience is almost half that of
normal dentin

42. Treatment modalities
1. Selective odontotomy
2. Permanent full veneering

43. Trauma
 Separation and/or loss of tooth structure as a result of trauma
frequently occurs necessitating dental treatment
 According to Ellis classification ,injury to natural teeth can be
classified into:
Class I : simple fracture of tooth crown involving little or no dentin
 Treatment
Smoothing of edges and peripheries
esthetic reshaping
If relatively large surface areas are involved ,in anterior GIC restoration
and in posterior metallic restoration

44. Class II :Extensive fracture of tooth crown involving considerable dentin but no pulp.
 Treatment
 In anterior, provisional restoration can be Class IV and in posterior amalgam
restoration
Class III : extensive fracture of crown , involving considerable dentin and exposing the
pulp
 Treatment
 Pulp and root canal treatment

45. Class IV :
A traumatized tooth which becomes non vital with/without
loss of crown structure
 Treatment
 If tooth crown is intact - Endodontic therapy
a. If tooth crown is fracture-pulp or root canal therapy
b. If tooth crown is discolored – non vital bleaching or
laminated veneering
c. If toth is discolored beyond any bleaching then should be
veneered with cast alloy based or cast ceramic restoration

46. Class V :
Tooth lost as a result of trauma
 Treatment
 Accidental tooth loss or fracture beyond any restorative capability
should be replaced with a prosthesis like
o Provisional fixed bridge
o Pontic
o Electrochemically etched ,non noble alloy based bridge

47. Class VI :
Fracture of tooth root with or without loss of tooth structure
Root fracture can be
a. Cervically horizontal :
Treatment –endodontic therapy
b. midradicularally horizontal :
Treatment –endodontic treatment and/or splinting
c. Apically horizontal:
Treatment-
vital tooth –should be left without interference
non vital tooth-endodontic therapy and splint, when surgery is not feasible
d. Vertical root fracture
Treatment-unfavorable prognosis
Single rooted teeh-extraction
Multirooted teeth -hemisectioning

48. Class VII :
Displacement (dislocation) of tooth(teeth) without fracture of crown or root
 Treatment
After proper reduction of tooth and/or replacing in its socket should be splinted
Class VIII : fracture of crown en masse with broken crown pieces
Treatment
Endodontic treatment pulpchamber shold be filled with resin and two pieces should be
brought together and kept under pressure until primer and composite resin sets

49. Amelogenesis imperfecta

50. Class IX :
Incomplete fracture of tooth cracked tooth
Treatment:
Relieve tooth from eccentric occluding contacts.
Orthodontic band
If any sign of pulpitis-endodontic therapy

51. Conclusion
 Firstly, endodontic therapies should be considered to treat the
deformities like
Attrition-Composite resin
Abrasion-glass ionomer cement
Erosion –metallic restorations
Abfraction-composite resins
Enamel hypoplasia and calcifications-vital bleaching,selective
odontomy,flouride application
Dentin hypoplasia and calcificatons-intermediary basing
Amelogenesis and dentinogenesis imperfecta-Odontomy and full veneer
Discolouration –abrasives
Trauma-splinting