RESTORATION OF THE WORN DENTITION

Question 1

PATHOLOGIC WEAR OCCURS WHEN THE PROCESS
OF PHYSIOLOGICWEAR IS ACCELERATED BY
— FACTORS AND
FREQUENTLY IT IS
— AND A VARIABLE
PHENOMENON.

Answer 1

EXOGENOUS OR ENDOGENOUS
MULTIFACTORIAL

Question 2

THE EXCESSIVE WEAR OF JUST ONE TOOTH, OF
EXTENSIVE RESTORATIONS OR OF THE FULL
DENTITION HAS BEEN ASSOCIATED TO:
- — OATHE OPPOSING TEETH
- INCLINATION OF THE TEETH TO A CONTACT THAT HAS BEEN —
- REDUCTION OF THE — DIMENSION
- SOME AUTHORS ALSO BELIEVE THAT IT CAN BE A CONTRIBUTING FACTOR IN — DISORDERS.

Answer 2

SUPRAERUPTION
ERODED
VERTICAL
TEMPOROMANDIBULAR

Question 3

ETIOLOGY OF WEAR
(6)

Answer 3

congenital anomalies
attrition
loss of posterior vertical support
abrasion
erosion
abfraction

Question 4

DETERMINING THE TYPE OF
WEAR PRESENT
in the initial interview

Answer 4

a detailed review of the medical history, diet and an evaluation of the presence of environmental factors and patient habits should be done

Question 5

ETIOLOGIES OF MECHANICAL
WEAR
(5)

Answer 5

loss of posterior support
premature occlusal contacts
bruxism
inadequate brushing technique
parafunctional habits

Question 6

CHARACTERISTICS OF MECHANIC WEAR
(2)

Answer 6

presenceof wear facts with a well defined loss, that coincides on the articulated models
the pattern of the wear facets should be analyzed because they tend to occur in predictable places

Question 7

GREATEST WEAR ON ANTERIOR TEETH
COMPARED TO POSTERIOR TEETH:
(3)

Answer 7

posterior support is inadequate or unstable
loss of posterior teeth
premature occlusal contacts

Question 8

PROGRESSIVE WEAR GREATER ON ANTERIOR
TEETH:
(VERRET 2001)
(1)

Answer 8

it can be the result of bruxism

Question 9

WEAR ON THE BUCCAL SURFACES OF
PREMOLARS AND CANINES:
(1)

Answer 9

is can be the result of excessive brushing or an inadequate brushing technique

Question 10

WEAR ON THE INCISAL OR OCLUSAL
SURFACES:
(1)

Answer 10

usually due to parafunctional habits

Question 11

ETIOLOGY OF CHEMICAL WEAR
(6)

Answer 11

chronic vomit
sucking of citric fruits
consumption of acidic drinks and foods
medicines with an acid pH
abuse of certain drugs
environmental factors

Question 12

CHARACTERISTICS OF
CHEMICAL WEAR
presence of —
presence of —
there can be —
in most cases there are no — or changes in —
the wear facets done have a defined —

Answer 12

amalgam islands
grooves and fossae
hypersensitivity
stains,color
periphery

Question 13

CHEMICAL ETIOLOGY
GREATER LOSS OF DENTAL STRUCTURE
ON ANTERIOR SURFACES THAN ON
POSTERIOR SURFACES:
(2)

Answer 13

the more common cause is chronic vomit
sucking on citric fruits

Question 14

GREATER LOSS ON POSTERIOR SURFACES
THAN ON ANTERIOR SURFACES:
(3)

Answer 14

consumption of acidic foods or drinks
rinse with or retain acidic drinks in the mouth
chew the pulp of certain fruits

Question 15

VARIABLE LOCATION AND MISCELANEOUS CAUSES:
medicines with an acid pH that have frequent contact with dental surfaces
abuse of the —
application of — to the oral mucosa
patients that are exposed to acidic —

Answer 15

ampetamine extasis
cocaine
vapors and aerosols

Question 16

WEAR AND THE VERTICAL DIMENSION
(3)

Answer 16

it is assumed that extensive wear of the dentition results in a reducded OVD
there is no evidence that proves that this concept is correct
some authors coincide that cases in which there is extensive wear of the dentition, the wear is compensated by overeruption

Question 17

BERRY AND POOLE (1974, 1976) AND RUSSEL (1987)
DESCRIBED THREE SITUATIONS IN WHICH IT IS POSSIBLE THAT WEAR IS PRESENT:
I FAST WEAR IN WHICH
II. SLOW WEAR IN WHICH
III. WEAR IS NOT PRESENT OR VERY SLOW

Answer 17

COMPENSATION IS NOT
ACHIEVED AND THERE IS A REDUCTION OF THE VERTICAL DIMENSION.

THE VERTICAL DIMENSION
IS MAINTAINED.

Question 18

EVALUATION OF THE VERTICAL
DIMENSION
(6)

Answer 18

posterior support
history of the wear present
phonestic eval
interocclusal distance
facial apperance
perception of the patient

Question 19

CATEGORY I:
* EXCESSIVE WEAR AND REDUCTION OF THE VERTICAL DIMENSION
* THE PATIENT WILL PRESENT:
-FEW POSTERIOR TEETH MISSING
-EXCESSIVE OCCLUSAL WEAR PRESENT ON
ANTERIOR TEETH
-UNSTABLE OCCLUSION ON POSTERIOR
TEETH
-CLOSEST SPEAKING SPACE CLOSE TO
– MM
- INTEROCLUSAL SPACE OF – MM

Answer 19

+3
+6

Question 20

CATEGORY I:
Treatment (2)

Answer 20

AN INTEROCCLUSAL SPLINT OR A TEMPORARY.
RPD THAT RESTORES THE PATIENT?S VERTICAL DIMENSION SHOULD BE FABRICATED. TO EVALUATE IF THE PATIENT TOLERATES THE INCREASE: IN VERTICAL DIMENSION.
* THE PROVISIONAL RESTORATIONS WILL
PROVIDE THE OPPORTUNITY TO OBJECTIVELY EVALUATE THE COMFORT, ESTHETICS AND HYGIENE.

Question 21

CATEGORY II:
* EXCESSIVE WEAR WITHOUT REDUCTION OF THE VERTICAL DIMENSION WITH SPACE FOR RESTORATIVE MATERIALS:
* THE PATIENT WILL PRESENT:
-EXTENSIVE HISTORY OF OCCLUSAL
WEAR
-INTEROCCLUSAL SPACE OF — MM
-PATIENTS CLOSEST SPEAKING SPACE
OF —MM
-SUFFICIENT SPACE FOR MATERIALS

Answer 21

+ 3
+ 1

Question 22

CATEGORY II:
* IN THESE PATIENTS, THE CONSTANT ERUPTION HAS MAINTAINED THE — DIMENSION
* THE PREPARATION OF THE TEETH TO ESTABLISH ADEQUATE RETENTIVE AND RESISTANT FORMS IS COMPLEX IN THESE PATIENTS:
* PERIODONTAL SURGERY, LIKE —, IS FREQUENTLY NECESSARY.

Answer 22

VERTICAL
CROWN LENGTHENING

Question 23

CATEGORY III:
EXCESSIVE OCCLUSAL WEAR WITHOUT A REDUCTION. IN THE VERTICAL DIMENSION AND LIMITED SPACE: FOR THE RESTORATIVE MATERIALS:
* THE PATIENT WILL PRESENT:
-MINIMAL WEAR ON POSTERIOR TEETH
-EXCESSIVE WEAR OF ANTERIOR TEETH
-CENTRIC RELATION AND MAXIMUM INTERCUSPATION ARE COINCIDENT
-CLOSEST SPEAKING SPACE OF –MM
-INTEROCLUSAL SPACE OF # – MM

Answer 23

1
3

Question 24

CATEGORY III:
Treatment (2)

Answer 24

*THE SPACE FOR THE RESTORATIVE MATERIALS CAN BE OBTAINED BY ORTHODONTICS, RESTORATIVE REPOSITIONING, ORTHOGNATIC SURGERY OR PROGRAMMED MODIFICATION OF THE VERTICAL DIMENSION
* THE INCREASE OF THE VERTICAL DIMENSION SHOULD BE AS MINIMAL AS POSSIBLE, TO CREATE ONLY THE SPACE NEEDED FOR THE RESTORATIVE MATERIALS.

Question 25

IMPORTANT DETERMINANTS IN THE
TREATMENT OF PATIENTS WITH
EXCESSIVE OCCLUSAL WEAR
(10)

Answer 25

• ETIOLOGY OF THE OCCLUSAL WEAR
• MOTIVATION OF THE PATIENT TO PRESERVE HIS TEETH
• CAPABILITY OF THE PATIENT TO MAKE A FINANCIAL AND TIME COMMITMENT FOR THE THE PROPOSED TREATMENT
• ABILITY TO MAINTAIN AND TAKE CARE OF THE FINAL RESTORATIONS
• PERIODONTAL HEALTH
• SEVERITY OF THE WEAR PRESENT
• NUMBER AND POSITION OF THE REMAINING
  TEETH
• PATIENTS EXPECTATIONS
• THE PATIENTS COMPROMISE TO WEAR AN OCCLUSAL GUARD AND ALSO TO WORK TO CONTROL THE PARAFUNCTIONAL
  ACTIVITIES DURING THE DAY.
• ANALYSIS OF THE DIAGNOSTIC TOOLS

Question 26

TREATMENT OPTIONS
(3)

Answer 26

no active intervention
prevention of loss of additional dental structure
restoration to revert the effects of the loss of dental structure

Question 27

RESTORATIVE METHODS
(3)

Answer 27

extraciton and replacement with complete dentures, overdentures, or RPD
restoration using amalgam, composite resin, onlays, etc
restoration used FPD, removable presthesis, implants or combo

Question 28

• GOOD CLINICAL CRITERIA SHOULD BE USED WHEN A NEW — DIMENSION IS
  ESTABLISHED
• THE CHANGES IN VERTICAL DIMENSION SHOULD BE EVALUATED WITH AN — PRIOR TO STARTING ANY IRREVERSIBLE TREATMENT.
• SOME SYMPTOMS OF INTOLERANCE TO AN INCREASE IN VERTICAL DIMENSION ARE:
  (8)

Answer 28

VERTICAL
OCCLUSAL SPLINT

CLENCHING, MUSCULAR FATIGUE, PAIN IN THE TEETH, MUSCLES OR ARTICULATIONS, HEADACHES, INTRUSION OF TEETH, FRACTURE OF RESTORATIONS AND OCLUSAL INSTABILITY

Question 29

AFTER THE PATIENT ACCEPTS THE OCCLUSAL GUARD AND FEELS COMFORTABLE WEARING IT, THE PROVISIONAL RESTORATIONS CAN BE MADE: THIS IS THE MOMENT WHEN …
* THE FINAL RESTORATIONS OF THIS TYPE OF PATIENT SHOULD PRESENT ELEMENTS LIKE SHALLOW CUSPS AND A REDUCED OCCLUSAL SURFACE IN THE BUCCO-LINGUAL ASPECT.
THESE ELEMENTS HELP REDUCE THE …

Answer 29

FUNCTION AND ESTHETICS CAN BE EVALUATED, AS WELL AS THE PATIENT’S ORAL HYGIENE.

DESTRUCTIVE FORCES DIRECTED TO THE RESTORED TEETH.

Question 30

CONCLUSIONS
* AN OCCLUSAL GUARD (PREFERABLE RIGID) SHOULD BE MADE TO PREVENT …
* IN PATIENTS WITH EXTENSIVE FIXED RESTORATIONS, WITH AN INADEQUATE ORAL HYGIENE AND HIGH INDICES OF PLAQUE, … SHOULD BE USED ONCE A DAY, APPLIED WITH A TRAY.

Answer 30

NOCTURNAL PARAFUNCTIONAL HABITS WEAR OR FRACTURE OF THE RESTORATIONS.

NEUTRAL SODIUM FLUORIDE