This document discusses tooth wear, including types, etiology, management, prevention, and restorative treatment. It defines tooth wear and describes the main types as attrition, erosion, abrasion, and abfraction. Factors that can increase tooth wear like amelogenesis imperfecta are also outlined. The document discusses consequences of tooth wear, classifications by Turner, and approaches to management including monitoring, preventative measures, restorations, and referrals. Treatment planning considerations and options for localized anterior tooth wear are also summarized.
Post endodontic restoration /certified fixed orthodontic courses by Indian de...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
PIT AND FISSURE SEALANTS- PUBLIC HEALTH DENTISTRYANKUSHA ARORA
Introduction
Definition
Morphology of Pits and fissures
Types of Pit and fissure sealants
Materials used as sealants
Requirements of sealants
Diagnosis of Pit and Fissure caries
Procedure of application of sealants
Indications
Contra-indications
Factors affecting sealant retention in mouth
Summary
Due to the complex morphology of the root canal system in primary teeth, the clinician must rely primarily on chemical cleansing and sterilization and secondarily on mechanical instrumentation during pulpectomy procedure.
And in order to increase the chance of success of the endodontic treatment, substances with antimicrobial properties are frequently used as root canal filling materials in deciduous teeth
Geriatric Dentistry with Nutrition in Geriatrics...Prosthodontics and Geriatrics...Management of Geriatric Patients in Prosthodontics...Full prepared seminar.. Have a look :)
Post endodontic restoration /certified fixed orthodontic courses by Indian de...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
PIT AND FISSURE SEALANTS- PUBLIC HEALTH DENTISTRYANKUSHA ARORA
Introduction
Definition
Morphology of Pits and fissures
Types of Pit and fissure sealants
Materials used as sealants
Requirements of sealants
Diagnosis of Pit and Fissure caries
Procedure of application of sealants
Indications
Contra-indications
Factors affecting sealant retention in mouth
Summary
Due to the complex morphology of the root canal system in primary teeth, the clinician must rely primarily on chemical cleansing and sterilization and secondarily on mechanical instrumentation during pulpectomy procedure.
And in order to increase the chance of success of the endodontic treatment, substances with antimicrobial properties are frequently used as root canal filling materials in deciduous teeth
Geriatric Dentistry with Nutrition in Geriatrics...Prosthodontics and Geriatrics...Management of Geriatric Patients in Prosthodontics...Full prepared seminar.. Have a look :)
Orthodontic Correction of Midline Diastema in Aggressive Periodontitis: A Cli...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
the aims of orthodontics is to treat protruded teeth to prevent trauma . crowded teeth help initiation of caries so their treatment is indicated by orthodontics
Teeth in The Line of Mandibular FracturesAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Approximately 60% of fractures of the mandible occur in the teeth bearing area. Incisors and third molars are the most commonly involved teeth on the fracture lines. The damaged to the tooth involved at the fracture site may include exposure of the root surface subluxation, avulsion or root fracture. This may lead to the vitalization, consequent infection and complicated healing of the fraction. Wether to remove or preserve the tooth in line of fraction is discussed. Certain guidelines have been suggested.
Benefits and limiting factors
of orthodontic treatment
Prepared by:
Dr. Mohammed Alruby
Benefits of orthodontic treatment
1- Resistance to caries and periodontal disease:
Straight teeth make it easier to keep mouth clean. Patient with orthodontic treatment demonstrate lower plaque scores.
Orthodontic treatment helps to prevent periodontal breakdown as:
- Correction of anterior cross bite associated with recession of lower incisors
- Correction of deep and traumatic over bite
2- Improved masticatory efficiency:
Reduced occlusal contact appear to effect the efficiency of chewing
Posterior cross bite in child is associated with a symmetrical muscle activity during chewing
correction of class II and III malocclusion following orthognathic surgery, improved masticatory performance in the long term
3- Temporomandibular joint dysfunction:
There is no evidence to suggest orthodontic treatment is a risk factor for development of TMD either with or without extraction
There is also lack of evidence to support the concept that orthodontic intervention can reduce the signs and symptoms of TMD
Occlusal features associated with TMD: anterior open bite, deep over bite, class II and III malocclusion, and posterior cross bite.
4- Improved speech:
Speech pattern are established very early in life, before eruption of permanent dentition
Some speech problem may relate to anterior open bite and lips but treating malocclusion will not guarantee resolution of problem
5- Prevention of trauma:
An increased overjet is a risk factor for trauma to the upper incisors
High percentage of class II div 1 incisors relationship present with damaged upper incisors
Correction of these cases reduce the amount of damage due to trauma
6- Psychological benefits:
Health means: state of complete physical, social, and mental well being
Sever malocclusion associated with facial disfigurement such as cleft lip and palate
Patient with increased over jet ----- more susceptible to teasing and social problem
Malocclusion and need for treatment is associated with poor health related quality of life and orthodontic treatment can result in an improvement
Limiting factors to orthodontic treatment
a- Factors related to the patients:
1- Medical health: certain medical condition will preclude complex appliance therapy
2- Dental health: excellent oral hygiene and absence of active dental disease is very important requirement for fixed appliances
3- Age of patient: growth is important to correct skeletal discrepancy, deep over bite can be corrected by using bite plate which allow extrusion of teeth, but it is not stable when occur in adult
4- Patient compliance: the success of treatment depends on good pt compliance but it is difficult measure as using removable appliance and using extra-oral force traction
b- Factors related to malocclusion:
1- The more severe skeletal discrepancy, it is harder to correct the underlying malocclusion with orthodontic tooth movem
Excess of space in the dental arch is diagnosed as a
generalised spacing or a local divergence, often
observed in the maxillary anterior region, as a median
diastema, traumatic loss of central incisors, or
congenital absence of lateral incisors. Furthermore,
spacing is observed in aging individuals, due to
pathological migration of teeth caused by
periodontitis. Finally, adult individuals with partial
edentulous jaws demand pre-prosthetic orthodontic
treatment from functional aspects. Thus, indication for
orthodontic treatment in subjects with spacing of teeth
exists for aesthetic reasons, but also for facilitating
prosthetic restorations with optimal occlusalstability.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
2. Outline:
■ Introduction
■ Types and Etiology
■ Management and Prevention
■ Restorative and ProstheticTreatment
Mohammed Aldosari, DMD
3. Tooth Wear
■ “ Defined as the surface loss of dental hard tissues from causes other than
dental caries, trauma or as a result of developmental disorders. “ 1
■ Tooth wear is normal physiological proses related to aging 2, but it can be
accelerated by unusual endogenous or exogenous factors.
1. Hattab F,Yassin O. Etiology and diagnosis of tooth wear: a literature review and presentation of selected cases. IntJ Prosthodont
2000; 13: 101–107.
2. Lambrechts P, Braem M,Vuylsteke-Wauters M, et al: Quantitative in vivo wear of human enamel. J Dent Res 1989;68:1752-1754
Mohammed Aldosari, DMD
4. Types ofTooth Wear
■ Attrition:
– Tooth to tooth contact
■ Erosion:
– loss of tooth surface by a chemical process that does
not involve bacterial action
■ Abrasion
■ Abfraction
Verrett RG. Analyzing the etiology of an extremely worn dentition. Journal of Prosthodontics. 2001 Dec 1;10(4):224-33.
Mohammed Aldosari, DMD
5. Types ofTooth Wear
■ Abrasion:
– The wear of tooth structure through some unusual
or abnormal mechanical process other than tooth-
to- tooth contact (1)
■ Abfraction:
– The loss of hard tissue from eccentric occlusal
loads leading to compressive and tensile stresses
at the cervical fulcrum area of the tooth. 2
1. Glossary of ProsthodonticTerms, ed 7. J Prosthet Dent 1999;81:48
2. Braem M, Lambrechts P,Vanherle G. Stress induced cervical lesions. J Prosthet Dent 1992; 67: 718–722.
Mohammed Aldosari, DMD
6. Tooth Wear
Other conditions that may increase incident and severity:
■ Amelogenesis Imperfecta:
– is a hereditary defect of dental enamel that occurs in a ratio of 1/14000 persons .1
■ Hypoplasia, Hypomaturation, Hypocalcified
■ Dentinogenesis Imperfecta:
– It is a genetic disorder of tooth development.
1-Turner KA, Missirlian DM. Restoration of the extremely worn dentition.The Journal of prosthetic dentistry. 1984 Oct 1;52(4):467-74.
2- Hattab F,Yassin O. Etiology and diagnosis of tooth wear: a literature review and presentation of selected cases. IntJ Prosthodont 2000; 13:
101–107.
3- Illustrated Dental Embryology, Histology, andAnatomy, Bath-Balogh and Fehrenbach, Elsevier, 2011, page 64
Mohammed Aldosari, DMD
7. Consequences of loss of (VDO)
• Appearance • Neuromuscular system • dental occlusion
• masticatory efficiency •TMJ
■ Functional surfaces of teeth: flatter and wider,
disrupting the occlusal plane
■ Over closure and deep bite
■ Over contraction of muscles
■ Thinning of the lips
■ Forward position of mandible causing chin prominence
Mohammed Aldosari, DMD
8. Turner’s classification
■ The loss of tooth structure may or may not result in an increase in the Freeway space.
Following an evaluation of the existing vertical dimension of occlusion (OVD) patients
presenting with generalized wear may be assigned to three categories according to
Turner classification:
■ Category 1 – excessive wear with loss of vertical dimension of occlusion
■ Category 2 – excessive wear without loss of vertical dimension of occlusion, but with
space available
■ Category 3 – excessive wear without loss of vertical dimension, but with limited space.
Mohammed Aldosari, DMD
9. Category 1: Excessive wear with loss ofVDO
■ Closest speaking space is more than 1mm
■ Interocclusal space is more than 4 mm
■ Loss of facial contour
■ Drooping the corners of the mouth
Mehta, S. B., Banerji, S., Millar, B. J., & Suarez-Feito, J. M. (2012). Current concepts on the management of tooth wear: part
1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear. British dental
journal, 212(1), 17-27.
Mohammed Aldosari, DMD
10. Category 2: excessive wear without loss ofVDO
But with space available
History of gradual wear:
■ Bruxism
■ Moderate oral habits
■ Environmental factors
OVD maintained by continuous eruption
• Tooth prep to establish retention & resistance(critical)
• Gingivoplasty ( gain clinical crown length)
• Enameloplasty of the opposing posterior teeth
Mohammed Aldosari, DMD
11. Category 3: Excessive wear without loss ofVDO
But with limited space
Excessive wear of anterior teeth
Minimal wear of posterior teeth
CR = CO
Closest speaking space = 1mm
Interocclusal distance = 2-3 mm
Vertical space obtained by
• Orthodontic movement
• Restorative repositioning
• Surgical repositioning segment
Mohammed Aldosari, DMD
13. TREATMENT PLANNING FOR CASES OF
TSL
■ Treatment planning for casesTSL follows the same basic as for the planning for the
regular restorative dental care for any other case.
■ The first management of acute conditions.
■ Simple adjustment of a sharp cusp or incisal edge to the application of a desensitising
agent or glass ionomer cement over an area of exposed dentine.
■ Pulpal extirpation, or in severe cases a dental extraction, may need to be considered.
■ In some cases where aesthetics may have been compromised a composite resin can be
provisionally applied.
Mohammed Aldosari, DMD
14. ■ The next stage is prevention.
■ Next phase would be the definitive dental
restorations.
■ The final stage involves monitoring and maintenance.
Mohammed Aldosari, DMD
15. ■ Several researchers appear to support that once tooth wear has been diagnosed wear
progression appears to occur relatively slow rate particularly in cases where
preventative advice has been successfully implemented.
■ The benefits of fluoride in reducing the efficacy of soft drinks in promoting erosive
tooth wear has been reported by a multitude of in vitro studies
Hemmings K, Truman A, Shah S, Chauhan R. Tooth wear guidelines for the bsrd part 3: removable management of tooth wear. Dental Update. 2018 Sep 2;45(8):687-96.
Sorvari R, Kiviranta I, Luonia H. Erosive effects of a sport drink mixture with and without the addition of fluoride and magnesium on the molar teeth of rats. Scand J Dent Res 1988; 96: 336–231.
Mohammed Aldosari, DMD
16. ■ Desensitising therapy –
■ Potassium containing toothpastes also considered to be appropriate for the
management of sensitive dentine.
■ Dietary counselling
Shafer W, Hine M, Levy B. A textbook of oral pathology. pp 318–323. Philadelphia: WB Saunders, 1983.
Mohammed Aldosari, DMD
17. ■ Splint therapy –
■ a full coverage hard acrylic occlusal
splint should be constructed An
example is a Michigan splint or a
Tanner appliance, as shown.
■ The splint should be fabricated to
provide an ideal occlusion
incorporating the presence of even
centric.
Canine guidance to provide posterior tooth
separation during lateral excursive and
protrusive mandibular movements.
Mohammed Aldosari, DMD
18. ■ 6. Sealant restorations –
■ The application of dentine bonding agents and fissure sealant to eroded areas
may be helpful in providing some level of protection and reduce dentinal
hypersensitivity.
■ Whilst the results of a study by Sundaram et al.38 showed the longevity of
sealants in the form of dentine bonding agents applied to teeth displaying
severe wear to be relatively short lived, they may help to reduce the rate of
wear on applied surfaces up to a period of nine months following application
Similarly, glass ionomer cements can be readily applied to worn surfaces for
the same purposes.
Bartlett D, Sundaram G, Moazzez R. Trial of protective effect of fissure sealants, in vivo, on the palatal surfaces of anterior teeth, in patients suffering from erosion. Journal of
dentistry. 2011 Jan 1;39(1):26-9.
Mehta SB, Banerji S, Millar BJ, Suarez-Feito JM. Current concepts on the management of tooth wear: part 4.An overview of the restorative techniques and dental materials
commonly applied for the management of tooth wear. British dental journal. 2012 Feb;212(4):169-77.
Mohammed Aldosari, DMD
19. 7. Referral to a medical practitioner –
■ This is considered appropriate when the dental operator suspects a case of bulimia or
reflux disease.
■ Medication can be used to reduce gastric reflux and acid production such as
omeprazole and ranitidine.
Mohammed Aldosari, DMD
20. MONITORING STRATEGIES
■ The primary goal for the management of any patient presenting with tooth wear is to
prevent further pathological wear
■ It is desirable to avoid restorative intervention where possible because undoubtedly it
will commit the patient to costly long term maintenance care.
■ Monitoring the progression of tooth wear is can be undertaken by high quality
sequential clinical photographs and by the periodic study casts at approximately 6-12
monthly intervention.
■ Both of the two methods of monitoring are not very sensitive but can provide a gross
subjective estimate of the rate of tooth wear.
Hanif A, Rashid H, Nasim M.Tooth surface loss revisited:Classification, etiology, and management. Journal of Restorative Dentistry. 2015 May 1;3(2):37.
Mohammed Aldosari, DMD
22. THE NEED FOR ACTIVE RESTORATIVE
INTERVENTION
■ There maybe esthetic concern
■ Symptoms of pain or discomfort
■ Functional difficulties
■ Unstable occlusion
■ The rate of teeth wear is extreme concern of the patient or the dentist
■ a preventative program and a period of monitoring of 6-12 months before embarking
upon what usually involves complex, technically demanding restorative dentistry.
Mohammed Aldosari, DMD
23. LOCALISED MAXILLARYANTERIOR
TOOTHWEAR
■ Maxillary anterior teeth are most commonly involved in localized tooth wear,
especially where erosion is a major factor.
■ The decision on how to optimally restore these teeth will depend on five factors:
– 1.The pattern of anterior, maxillary tooth surface loss
– 2. Inter-occlusal space availability
– 3. Space requirements of the dental restorations being proposed
– 4.The quantity and quality of available dental hard tissue and enamel respectively
– 5.The aesthetic demands of the patient.
Mehta SB, Banerji S, Millar BJ, Suarez-Feito JM. Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive
management of tooth wear. British dental journal. 2012 Jan;212(1):17-27.
Mohammed Aldosari, DMD
24. Inter-occlusal space availability
■ In the majority of patients, tooth wear is accompanied by dentoalveolar
compensation.The physiological compensatory mechanism allows occlusal contacts
to be maintained, in order to attempt to preserve the efficacy of the masticatory
system.
■ In some cases, particularly where the rate of tooth wear may be very rapid, or
compensatory mechanisms evolve at a relatively slower rate, or in the case of a
patient with an anterior open bite, deep overbite or increased overjet adequate space
may be available between the upper and lower dentition in centric occlusion(CO)
Mohammed Aldosari, DMD
26. ■ Adhesive restorations may simply be bonded into the available space in order to
restore form, aesthetics and function, while conventional restorations may require
minimal reduction of the affected surfaces.
■ One option would be to follow traditional prosthodontic protocols and to create space
to accommodate restorations/restorative materials through the process of tooth
reduction and to conform to the existing occlusion.
■ The aggressive loss of dental hard tissue through tooth preparation, particularly
among severely worn teeth, may also lead to a significantly reduced axial height
Mohammed Aldosari, DMD
27. ■ In some cases, the required inter-occlusal clearance may be present in centric relation
(CR).This is often best confirmed by the means of accurate study casts mounted in
centric relation on a semi-adjustable articulator, with the aid of diagnostic wax mock-
ups.
■ the space created by such a reorganized approach may be sufficient to permit the use
of more rigid materials such as metallic alloys which require less bulk thickness to
ensure longevity, but not enough for the use of more elastic materials such as resin
composite.
■ resin composite restorations to display longevity, in areas of occlusal loading, they
should be placed at a minimal thickness of 1.5 to 2.0 mm
Mohammed Aldosari, DMD
28. The Dahl concept
■ This concept is frequently referred to in dental literature as a means of gaining space
in cases of localized tooth wear, where there is insufficient space available in either CO
or CR.
■ described the use of a removable anterior bite platform, fabricated from cobalt
chromium, retained by clasps in the canine and premolar regions to create inter-
occlusal space in a patient with tooth wear localized to the anterior maxillary segment.
The appliance was designed to cover the cingulum areas of the affected teeth and
increase the occlusal vertical dimension in the region of 2-3 mm.
Mohammed Aldosari, DMD
29. ■ occlusal contacts were only present between the mandibular anterior teeth and the
bite platform.
■ The actual Dahl concept refers to the relative axial tooth movement that is observed
to occur when a localized appliance or localized restoration(s) are placed in supra-
occlusion and the occlusion re-establishes full arch contacts over a period of time.
■ It was reported by Dahl and Krungstad that the inter-occlusal space created occurs
through a process of combined intrusion(40%) and extrusion (60%).
Mohammed Aldosari, DMD
30. ■ success rate of between 94-100% has been reported. Furthermore, the level of space
creation was consistently found to be irrespective of age and sex.
■ failures also occur in patients with gross class III malocclusions and in cases with
mandibular facial asymmetry that had a lack of stable occlusal contacts in either CO or
CR.
■ Patients who may present with bony ankyloses, dental implants, conventional fixed
bridgework and those with anterior open bites, will all have limited eruptive potential.
Mohammed Aldosari, DMD
31. ■ great caution with patients who may have active/a past history of periodontal disease,
temporomandibular joint pain dysfunction syndrome, where endodontically teeth
may be involved, in cases post-orthodontic treatment and among patients who may
be taking oral or IV bisphosphonate drugs.
Mohammed Aldosari, DMD
33. ■ The use of metal posts has been well documented to be associated with the risks of
root fracture, which may be exaggerated in cases where due to parafunctional habits,
excessive occlusal loading has been applied.The more recent advent of fiber-resin
posts has been suggested to overcome this concern.
■ Common area of fracture at post-core interface.
Mohammed Aldosari, DMD
34. LOCALISEDANTERIOR MANDIBULAR
TOOTHWEAR
■ If both upper and lower teeth are affected, then space should be gained through the
process of the Dahl concept and the lower dentition restored before the upper.
■ Localized anterior mandibular wear is often seen among patients who have been
provided with maxillary metal-ceramic crowns, particularly with porcelain occluding
surfaces which have been adjusted to accommodate the occlusion and left
unpolished.
Mehta SB, Banerji S, Millar BJ, Suarez-Feito JM. Current concepts on the management of tooth wear: part 2. Active restorative care 1: the management of localised tooth wear. British dental
journal. 2012 Jan;212(2):73.
Mohammed Aldosari, DMD
35. ■ restoring a localized worn lower dentition follows the same basic tenets as the
restoration of worn maxillary anterior teeth.
■ The application of less invasive, dentine bonded crowns may have a promising role in
the management of worn lower anterior teeth.
■ However, the risks of fracture among patients who display parafunctional tooth
grinding habits remain a concern.
Mohammed Aldosari, DMD
36. LOCALISED POSTERIORWEAR
■ The aim of restorative care being to provide posterior disocclusion and canine
guidance, and to prevent the affected tooth from further wear.
■ The placement of restorations in supra-occlusion should be avoided among
periodontally involved or endodontically treated teeth, as well as among cases which
display signs of limited eruptive potential orTMJ dysfunction.
■ The use of resin composite onlays has been shown by Bartlett et al. to be
associated with a high level of failure, with a failure rate of 28% for direct
composite onlays and 21% for indirectly fabricated composite onlays after an
observation period of three years
Mohammed Aldosari, DMD
37. Generalized tooth wear
■ The indications for active restorative intervention for a patient presenting with
pathological tooth wear!!
■ the restorative management of patients presenting with generalized tooth wear will
be considered according to the three categories described byTurner and Missirilian:
– Category 1 – excessive wear with loss of vertical dimension of occlusion
– Category 2 – excessive wear without loss of vertical dimension, but with space
available
– Category 3 – excessive wear without loss of vertical dimension, but with limited
space.
Mehta SB, Banerji S, Millar BJ, Suarez-Feito JM. Current concepts on the management of tooth wear: part 3. Active restorative care 2: the management of
generalised tooth wear. British dental journal. 2012 Feb;212(3):121-7.
Mehta SB, Banerji S, Millar BJ, Suarez-Feito JM. Current concepts on the management of tooth wear: part 4.An overview of the restorative techniques and
dental materials commonly applied for the management of tooth wear. British dental journal. 2012 Feb;212(4):169-77.
Mohammed Aldosari, DMD
38. ■ The desired increase in OVD will primarily be determined by what is necessary to
produce functionally stable, aesthetic dental restorations and an adequate freeway
space.
■ Clinically this can be estimated by measurement of the existing OVD of the worn
dentition and the face height with the mandible at rest with an adequate lip seal; the
difference between the two measurements needs to accommodate the desired
increase in the OVD and the freeway space.
■ The planned increase may be programmed into the articulator (by raising the pin on
the articulator), and a diagnostic wax up fabricated accordingly(preferably on
duplicate casts).
Mohammed Aldosari, DMD
39. ■ The diagnostic wax up should take account of basic aesthetic principles (such as tooth
shape, length, inclination and relationship of the incisal edge to the lip line)
■ final occlusal scheme should provide:
– Simultaneous stable bilateral tooth contacts
– Centric relation (CR) coincident with centric occlusion (CO)
– Disclusion of the posterior teeth, upon lateral and protrusive mandibular
movements
– Anterior teeth disclusion, when posterior teeth are in maximum intercuspation
– Shared/even anterior guidance
– Canine guided occlusion, with planned group function
Mohammed Aldosari, DMD
40. RESTORATIVETECHNIQUES - ADHESIVE
VS CONVENTIONAL
■ Conventional restorative techniques (those which depend on mechanical tooth
preparation features to provide retention and resistance form) have traditionally been
the mainstay for the management of tooth surface loss.
■ In recent times, with improvements in adhesive technology and the availability of
superior resin composites, adhesive retained restorations have become ever
increasingly popular.
Mohammed Aldosari, DMD
41. Conventional VS Adhesive restorations
■ Conventional restorations will require the copious removal of sound dental hard tissue
(from tooth structure which will have already been compromised by the process of
TW).Adhesive preparations in contrast are minimally invasive
■ Conventional, full coverage restorations have been associated with high risks of loss of
pulp tissue vitality.
■ Conventional tooth preparations are irreversible
■ Conventional restorations require careful tooth preparation to provide adequate
resistance and retention form.
■ The success of adhesive restorations is dependent to a large extent on the presence of
a copious quantity of high quality tooth enamel.
Mohammed Aldosari, DMD
42. Cont.
■ Adhesive techniques are highly operative sensitive and require meticulous moisture
control
■ Conventional techniques are dependent on the need for provisional restorations,
which is not required when using adhesive restorations
■ Conventional restorations are associated with higher initial financial costs
■ Conventional restorations may offer superior levels of longevity when compared to
adhesive restorations, however failures in the longer term tend to be catastrophic and
often unamenable to repair. In opposite to adhesive restorations
Mohammed Aldosari, DMD
43. ■ Adhesive restorations may very effectively serve as medium term restorations, where
eventually they may be replaced with conventional techniques, having established the
patient’s tolerance and adaptability to their new occlusal scheme
Mohammed Aldosari, DMD
44. CATEGORY 1 PATIENTS:
‘EXCESSIVETOOTH WEAR,TOGETHER
WITH A LOSS INTHE OVD’
■ Such cases may be considered the most straight forward of all three categories to
manage.
■ A full coverage, hard acrylic stabilization splint, such as a Michigan splint, can be used
to evaluate the patient’s tolerance/ adaptability to the planned occlusal changes
Mohammed Aldosari, DMD
45. ■ Ideally, half the increase in OVD should be incorporated into each arch, but this
depends on the pattern of wear, and the desired aesthetic outcome.Where the
increase in OVD is shared equally between the dental arches, it will not only allow for a
better distribution of the increase in crown to root ratio, but also make the increase in
OVD less abrupt, there by improving the chances of successful adaptation.
■ (usually the arch with the greatest discrepancy will be prepared first)
Mohammed Aldosari, DMD
47. CATEGORY 2: ‘EXCESSIVEWEARWITHOUT
LOSS OF OVD, BUT WITHLIMITED SPACE
AVAILABLE’
■ In such cases, a discrepancy will usually exist between centric occlusion (CO)and
centric relation (CR).CR may provide space to accommodate restorative materials;
however, it might not always be fully adequate and there may be a need to plan an
increase in the OVD. For such cases, the patient should be provided with a full
coverage, hard acrylic occlusal splint, which will provide an increase in the OVD to the
required range, while the mandible is manipulated into its retrieve arch of closure.
Mohammed Aldosari, DMD
48. ■ The occlusal prescription of the splint should aim to provide a removable mutually
protective scheme.The patient should be instructed to wear the splint continually for
a period of one month (at all times other than when eating) to evaluate the tolerance
of the increase in OVD.
Mohammed Aldosari, DMD
49. ■ resin based restorations may be applied ‘directly’ to reduce costs, this approach is very
time and skill demanding and indeed, it may be impossible to attain the desired
dynamic occlusal scheme particularly for complex posterior restorations, which will
need to be placed in a supraocclual position (at the desired new vertical dimension).
Mohammed Aldosari, DMD
50. CATEGORY 3: ‘NO LOSS OF OVD,WITH
INSUFFICIENT SPACE FOR RESTORATIVE
MATERIALS’
■ such cases, every effort should be made to obtain space by means other than an
increase in the OVD. Only if such methods fail to provide enough space, would an
increase in the OVD
■ Other methods which may be used to create space include:
– Surgical crown lengthening, with osseous recontouring. ‘black triangles’
– Elective endodontics may be considered to permit the application of a post and core
system. Parafunctional habits
– Orthodontic tooth movements
Mehta, S.B., Banerji, S., Millar, B.J. and Suarez-Feito, J.M., 2012. Current concepts on the management of tooth wear: part 4. An overview of the restorative techniques and dental materials
commonly applied for the management of tooth wear. British dental journal, 212(4), pp.169-177.
Mohammed Aldosari, DMD
51. RESTORATIVE MATERIALS/ RESTORATIONS
COMMONLY USED INTHE MANAGEMENT OF
TOOTH WEAR
■ Advances in adhesive dentistry a number of other options have become available,
including:
– Direct composite resin restorations
– Indirect composite resin restorations
– Cast adhesive alloys (metal palatal veneers and metal adhesive onlays) Adhesive
ceramic restorations.
Mohammed Aldosari, DMD