5 - Wear 2

Question 1

What forms the basis of the immediate treatment planning of tooth wear cases?

Answer 1

• deal with pain and sensitivity
• can involve desensitising agents (fluoride), pulp extirpation, smoothing sharp edges, XLA or addressing TMJ pain

Question 2

What forms the basis of the initial treatment planning of tooth wear cases?

Answer 2

• stabilise existing dentition
• prevention derived from wear diagnosis is key
• deal with caries
• deal with perio
• oro-mucosal
• wear progresses slowly so deal with any other issues first

Question 3

What is involved in preventative treatment of tooth wear?

Answer 3

• baseline recordings and photos
• identify is wear is historic or progressing
• remove the cause (change toothpaste, change habits, change toothbrushing)

Question 4

How do you treat cervical toothbrush abrasion with prevention?

Answer 4

• GI or composite restorations are considered preventative as they prevent further tissue loss
• require no prep
• patient wears through restoration vs enamel

Question 5

How do you treat attrition with prevention?

Answer 5

• CBT and hypnosis for parafunction
• splints

Question 6

What different type of splint are available?

Answer 6

• soft
• hard
• Michigan

Question 7

What are the benefits of a soft splint?

Answer 7

Can be used as diagnostic device to show wear facets

Question 8

What are the benefits of a hard splint?

Answer 8

More robust and lasts longer

Question 9

How do splints treat parafunction?

Answer 9

• wear away preferentially to tooth tissue
• cause no damage to opposing teeth
• can break the habit but inhibiting the feedback loops from grinding

Question 10

What is a Michigan splint?

Answer 10

• type of hard splint
• provides ideal centric occlusion when worn
• has a canine rise which provides disclusion

Question 11

When are splints contraindicated?

Answer 11

Patients with erosion as the splint holds the acid in place

Question 12

How do you treat erosion with prevention?

Answer 12

• fluoride (toothpaste, mouthwash, tooth mousse etc)
• desensitising agents (not prevention but symptomatic relief)
• dietary management
• habit changes (rumination, using a straw, too much fruit)
• change in medication where possible

Question 13

How do you treat abfraction with prevention?

Answer 13

• consider occlusal equilibration
• fill cavities with low modulus restorative materials (RMGIC or flowable)

Question 14

What is passive management?

Answer 14

• prevention and monitoring
• first 6 months
• required before any definitive treatment, may result in no definitive treatment is prevention successful

Question 15

What is active management?

Answer 15

• intervention threshold
• simple restorative intervention so that the restoration is worn instead of tooth

Question 16

What is the threshold for intervention in wear cases?

Answer 16

• wear leading to further complications
• aesthetics are beyond patients acceptability
• not intervening may lead to more complex treatment needs (ie localised anterior can become generalised)

Question 17

What are the goals surrounding active management of wear?

Answer 17

• preservation of remaining tooth tissue
• improvement in aesthetics without compromising function
• stability (do not build up teeth beyond capability of TMJ)

Question 18

What are the factors that impact active management of wear of the maxillary anteriors?

Answer 18

• pattern of tooth wear
• inter-occlusal space
• space required for restorations
• quality and quantity of tissue, esp enamel
• aesthetic demands

Question 19

What are the patterns of maxillary anterior tooth wear?

Answer 19

• palatal only (vomit habit)
• palatal and incisal edges with reduced clinical crown height
• labial only (sucking sweets)

Question 20

Describe the active management of maxillary anterior tooth wear with adequate inter-incisal space.

Answer 20

• uncommon as usually slow process with alveolar compensation
• can be used in AOB or class II div 1
• composite buildups are usually successful and do not change OVD

Question 21

Describe the active management of maxillary anterior tooth wear without adequate inter-incisal space.

Answer 21

• surgical crown lengthening
• dahl technique

Question 22

Describe surgical crown lengthening.

Answer 22

• exposes more of the crown for retention of final restoration
• repositions gingivae apically with some removal of bone (can cause black triangles where papilla have receded)
• can cause sensitivity
• crown-root ratio decreased

Question 23

Describe the Dahl technique.

Answer 23

• removable CoCr anterior bite plane or composite placed palatally
• creates posterior open bite and encourages alveolar compensation so that posterior teeth erupt and increase the OVD to allow space for anterior restorations

Question 24

Who is the Dahl technique not suitable for?

Answer 24

• active perio
• TMJ problems
• post orthodontics
• bisphosphonates (relies on good bone turnover)
• dental implants (implants are ankylosed to bone)
• conventional bridges