Rehabilitating a severely worn dentition with removable prosthodontics.

In the next part of this series on tooth wear management, we discuss the indications and clinical stages for the provision of removable prostheses for the treatment of severely worn and depleted dentitions. The general design features of a complex prosthesis are described for reorganised occlusal schemes and maintenance guidelines are explained. In addition, the clinical stages for three different situations are described: removable-only approaches, and combined fixed and removable in the same arch and separate arches. The value of providing removable prostheses in worn dentitions allows the immediate rehabilitation of severely worn teeth taking a non-invasive and retrievable approach when the remaining dentition is of poor quality or structure and/or there are missing teeth.

Interdisciplinary management of an adult patient with significant tooth wear.

Adult patients may present with compromised dentitions which require extensive oral rehabilitation. This case report shows the fulfilment of both functional and aesthetic treatment objectives for a patient with significant tooth wear through carefully planned interdisciplinary management. © 2022 Australian Dental Association.

Bone Dimensional Change Following Immediate Implant Placement in Posterior Teeth with CBCT: A 6-Month Prospective Clinical Study.

This prospective clinical study aimed to evaluate the peri-implant hard tissue dimensional change at 6 months of immediate implant placement with bone graft materials in the posterior area using cone-beam computed tomography (CBCT). Twelve dental implants were placed concurrently following tooth extraction in the posterior area and filled with xenograft particles. The CBCT images were taken immediately after surgical procedures and then at 6 months follow-up. To evaluate the hard tissue changes, the vertical and horizontal bone thickness were analyzed and measured using ImageJ software. Paired t-test or Wilcoxon match-pair signed-rank test was done to analyze the changes of hard tissue values at the same level between immediately and 6 months following immediate implant placement. Independent t-test or Mann-Whitney U test was used to analyze the dimensional change in the vertical and horizontal direction in buccal and lingual aspects. The level of significance was set at p value = 0.05. All implants were successfully osseointegrated. At 6 months follow-up, the vertical bone change at the buccal aspect was -0.69 mm and at the lingual aspect -0.39 mm. For horizontal bone thickness, the bone dimensional changes at 0, 1, 5, and 9 mm levels from the implant platform were -0.62 mm, -0.70 mm, -0.24 mm, and -0.22 mm, respectively. A significant bone reduction was observed in all measurement levels during the 6 months after implant placement (p value < 0.05). It was noted that even with bone grafting, a decrease in bone thickness was seen following the immediate implant placement. Therefore, this technique can be an alternative method to place the implant in the posterior area.

Minimally invasive rehabilitation of the worn dentition: a case report utilising adhesive additive techniques and digital technologies.

The management of the worn dentition presents an increasing challenge that is encountered more frequently in daily dental practice. The consequences of tooth wear tend to be multifactorial and while they may initially only involve the loss of surface enamel it can progressively lead to significant destruction of the dentition. This paper discusses the management of a tooth wear case where a significant amount of tooth structure has been lost from both the anterior and posterior teeth. Protocols for assessment, treatment planning and restorative management of the tooth wear case are presented demonstrating the use of adhesive additive techniques and digital technologies to achieve functional and aesthetic rehabilitation of the dentition.

Atrición dental severa y sus factores asociados: un estudio de casos y controles / Severe dental attrition and its associated factors: a case-control study

BACKGROUND: Severe attrition is a type of dental wear caused by friction of tooth surfaces with each other. Although it is a frequent condition, it is not known what are the factors associated with its appearance. Objective: To relate factors such as: age, sex, origin, number of residual teeth, salivary pH and bruxism, with severe dental attrition. Design: cases and controls Patients: a total of 237 patients, 79 cases, with dental attrition grades 2, 3 and 4 according to the Smith and Knight index and 158 controls, with attrition grades 0 and 1. A clinical and photographic analysis was performed to determine the relationship between Dental attrition and factors such as age, sex, origin, number of residual teeth, salivary pH and bruxism. RESULTS: After a bivariate analysis, it was observed that patients older than 25 years (OR = 2.47 CI = 1.41 - 4.35 X2 = 10.21 p = 0.001), with less than 20 residual teeth in the mouth (OR = 4.95 CI = 1.47 - 16.62 X2 = 7.97 p = 0.004) and with bruxism (OR = 2.64 CI = 1.45 - 4.81 X2 = 10.49 p = 0.001), Are more likely to have severe dental attrition. After a binary logistic regression, the statistically significant relationship of these factors with severe dental attrition was confirmed. Conclusions: Severe dental attrition has a statistically significant relationship with age, number of residual teeth in the mouth and bruxism.

Antecedentes: la atrición severa es un tipo de desgaste dental causado por fricción de superficies dentarias entre sí. A pesar de ser una condición frecuente, no se conoce cuáles son los factores asociados con su aparición. Objetivo: Relacionar factores como: edad, sexo, procedencia, número de dientes residuales, pH salival y bruxismo, con la atrición dental severa. Diseño: casos y controles Pacientes: un total de 237 pacientes, 79 casos, con atrición dental grados 2, 3 y 4 según el índice de Smith y Knight y 158 controles, con atrición grados 0 y 1. Se realizó un análisis clínico y fotográfico para determinar la relación entre la atrición dental y factores como edad, sexo, procedencia, número de dientes residuales, pH salival y bruxismo. Resultados: Luego de realizar un análisis bivariado se evidenció que los pacientes con 25 años y más (OR= 2,47 IC= 1,41 ­ 4,35 X2= 10,21 p=0,001), con menos de 20 dientes residuales en boca (OR= 4,95 IC= 1,47 ­ 16,62 X2= 7,97 p=0,004) y con bruxismo (OR= 2,64 IC= 1,45 ­ 4,81 X2= 10,49 p=0,001), tienen más probabilidades de presentar atrición dental severa. Luego de una regresión logística binaria se confirmó la relación estadísticamente significativa de dichos factores con la atrición dental severa. Conclusiones: la atrición dental severa tiene una relación estadísticamente significativa con la edad, el número de dientes residuales en boca y el bruxismo.

A guide to the clinical management of attrition.

Attrition is an enigmatic condition often found in older individuals and often as a result of bruxism which can take place as a result of either day bruxism, night bruxism or both. Various studies and systemic reviews clearly shown that tooth wear is an age-related phenomena and the last Adult Dental Health Survey showed that 15% of participants showed moderate wear and 3% severe wear with 80% of patients over 50 years of age showing signs of wear. This review examines current theories around the aetiological factors contributing to attrition together with the clinical management of attrition focusing on minimal intervention where possible.

Lesiones cervicales no cariosas / Non-carious cervical lesions

El objetivo de este trabajo consiste en describir las distintas lesiones cervicales no cariosas, la abrasión, la erosión y la abfracción. Se desarrollarán en detalle su etiología, localización y características clínicas. Se mencionarán los diferentes procedimientos a realizar para su prevención y los materiales a utilizar para su restauración.

This article describes the different types of non-cariouscervical lesions, for example abrasion, erosionand abfraction. We will discuss their etiology, location and clinical features in detail. We will describe the procedures to prevent them, aswell as the materials used for their restoration.

Diagnoses and Treatment of Dental Disorders in a Research Colony of Macaca fascicularis: A Case Series.

During daily routine oral examinations in a research colony of nonhuman primates (NHPs, Macaca fascicularis), a variety of oral-dental lesions were identified. A dental care program was established based on these findings. Based on the presence of dental clinical signs and their severity, 31 animals were triaged to be examined and treated by a veterinarian. Clinical examination consisted of visual inspection using a periodontal probe/explorer and full or partial mouth dental radiographs. Treatment was performed during the same procedure. Some animals had a follow-up examination including radiographs months later. Four common dental diseases were diagnosed: periodontal disease, caries, tooth fracture, and tooth attrition. Less frequent were dental abscess, enamel hypomineralization, gingival hyperplasia, hypercementosis, tooth luxation, tooth dysplasia, root resorption, abrasion. Less severe periodontal disease was treated conservatively. If severely affected, teeth were extracted. Well-circumscribed caries without endodontic involvement were treated by composite restoration. Teeth with extensive caries and pulp involvement were extracted. Teeth with exposed pulp were treated via extraction or orthograde root canal treatment. In this case series, 27 (87%) of 31 NHPs exhibited at least 1 moderate to severe dental lesion that required treatment. The presumable improvement in welfare and weight of oral/dental lesions for the overall health status in research NHPs encourages us to continue this program prospectively.

Long-Term Provisional Bonded Composite Restorations Make Full-Mouth Rehabilitation Possible.

Full-mouth rehabilitation cases frequently require an extended period to complete. In this case involving a patient who presented with a significant amount of lost tooth structure, treatment featured laboratory-fabricated composite provisional restorations aimed at stabilizing the dentition and enabling definitive treatment to be completed in segments. The approach taken allowed occlusal and esthetic issues to be resolved through use of the provisionals while minimizing tooth preparation. The technique provided immediate improvement in esthetics, function, and comfort.

Minimizing Risk While Adapting to Treatment Complications: A Case Report.

Functional diagnoses can sometimes be ambiguous. An occlusal disorder may be paired with a parafunctional condition, as in the case presented, which features a patient who experienced anterior tooth chipping and thinning of maxillary incisal edges. The case demonstrates the principles of risk-based treatment planning and discusses challenges involved in identifying and evaluating all the evidence to maximize restorative treatment plan success. In this case, functional risk during mastication was reduced using orthodontic therapy, and a nightguard was employed to combat destructive forces during sleep. Feldspathic veneers were used to decrease the esthetic risk. The case also offers an approach for addressing unforeseen treatment complications without increasing risk for further potential problems.

Direct Placement Composite: the Treatment Modality of Choice to Restore the Worn or Eroded Dentition in Primary Dental Care.

Tooth wear is increasing in severity and prevalence, partly because of an ageing population and partly because of modern lifestyles. Management of the worn dentition with 'full mouth rehabilitation' is outmoded. This clinical paper aims to review the literature on composite restorations and give general dental practitioners the confidence to restore the worn dentition with dental composite. Composite is a versatile and widely available material that can be successfully applied within the existing occlusal vertical dimension (OVD) or at an increased OVD using a Dahl approach. Cases illustrate what is achievable, and clinical tips will help dentists optimise their results.

Treating Tooth Surface Loss: Adhesive Restoration of the Worn Anterior Dentition.

The treatment of tooth surface loss (TSL) is becoming more common in primary health care and a diverse variety of patients are presenting with this condition are often being treated by general dental practitioners. This article highlights the importance of comprehensive planning and adept execution that can enhance the patient's outcome and experience. Stages of clinical planning and treatment approaches using a selection of restorative materials utilising various established adhesive clinical techniques will be presented and discussed.

The survival of direct composite restorations in the management of severe tooth wear including attrition and erosion: A prospective 8-year study.

OBJECTIVES: Survival of directly placed composite to restore worn teeth has been reported in studies with small sample sizes, short observation periods and different materials. This study aimed to estimate survival for a hybrid composite placed by one clinician up to 8-years follow-up. METHODS: All patients were referred and recruited for a prospective observational cohort study. One composite was used: Spectrum(®) (DentsplyDeTrey). Most restorations were placed on the maxillary anterior teeth using a Dahl approach. RESULTS: A total of 1010 direct composites were placed in 164 patients. Mean follow-up time was 33.8 months (s.d. 27.7). 71 of 1010 restorations failed during follow-up. The estimated failure rate in the first year was 5.4% (95% CI 3.7-7.0%). Time to failure was significantly greater in older subjects (p=0.005) and when a lack of posterior support was present (p=0.003). Bruxism and an increase in the occlusal vertical dimension were not associated with failure. The proportion of failures was greater in patients with a Class 3 or edge-to-edge incisal relationship than in Class 1 and Class 2 cases but this was not statistically significant. More failures occurred in the lower arch (9.6%) compared to the upper arch (6%) with the largest number of composites having been placed on the maxillary incisors (n=519). CONCLUSION: The worn dentition presents a restorative challenge but composite is an appropriate restorative material. CLINICAL SIGNIFICANCE: This study shows that posterior occlusal support is necessary to optimise survival.

Comprehensive Risk-Based Diagnostically Driven Treatment Planning: Developing Sequentially Generated Treatment.

The clinical example presented in this article demonstrates a risk-based, diagnostically driven treatment planning approach by focusing on 4 key categories: periodontal, biomechanical, functional, dentofacial. In addition, our unique approach allowed the comprehensive clinical management of a patient with complex restorative needs. A full-mouth rehabilitation was completed sequentially without sacrificing the amount of dentistry necessary to restore health, comfort, function, and esthetics. The result exceeded the patient's expectation and was made financially possible by extending treatment over numerous years.

Occlusal wear and occlusal condition in a convenience sample of young adults.

OBJECTIVE: To study progression of tooth wear quantitatively in a convenient sample of young adults and to assess possible correlations with occlusal conditions. METHODS: Twenty-eight dental students participated in a three-year follow up study on tooth wear. Visible wear facets on full arch gypsum casts were assessed using a flatbed scanner and measuring software. Regression analyses were used to assess possible associations between the registered occlusal conditions 'occlusal guidance scheme', 'vertical overbite', 'horizontal overbite', 'depth of sagittal curve', 'canine Angle class relation', 'history of orthodontic treatment', and 'self-reported grinding/clenching' (independent variables) and increase of wear facets (dependent variable). RESULTS: Mean increase in facet surface areas ranged from 1.2 mm2 (premolars, incisors) to 3.4 mm2 (molars); the relative increase ranged from 15% to 23%. Backward regression analysis showed no significant relation for 'group function', 'vertical overbite', 'depth of sagittal curve', 'history of orthodontic treatment' nor 'self-reported clenching. The final multiple linear regression model showed significant associations amongst 'anterior protected articulation' and 'horizontal overbite' and increase of facet surface areas. For all teeth combined, only 'anterior protected articulation' had a significant effect. 'Self reported grinding' did not have a significant effect (p>0.07). CONCLUSIONS: In this study 'anterior protected articulation' and 'horizontal overbite', were significantly associated with the progression of tooth wear. Self reported grinding was not significantly associated with progression of tooth wear. CLINICAL SIGNIFICANCE: Occlusal conditions such as anterior protected articulation and horizontal overbite seem to have an effect on the progression of occlusal tooth wear in this convenient sample of young adults.

Full-mouth composite rehabilitation of a mixed erosion and attrition patient: a case report with v-shaped veneers and ultra-thin CAD/CAM composite overlays.

Loss of tooth substance has become a common pathology in modern society. It is of multifactorial origin, may be induced by a chemical process or by excessive attrition, and frequently has a combined etiology. Particular care should be taken when diagnosing the cause of dental tissue loss, in order to minimize its impact. Several publications have proposed the use of minimally invasive procedures to treat such patients in preference to traditional full-crown rehabilitation. The use of composite resins, in combination with improvements in dental adhesion, allows a more conservative approach. In this paper, we describe the step-by-step procedure of full-mouth composite rehabilitation with v-shaped veneers and ultra-thin computer-aided design/computer-assisted manufacture (CAD/CAM)- generated composite overlays in a young patient with a combination of erosion and attrition disorder.