what is a popular type of splint used for treating attrition
michigan hard splint
has canine rises which discludes other teeth during lateral movements
how long should passive management of dental wear be done for
at least 6 months
involves prevention and monitoring
what 5 factors does active management of toothwear depend on
- pattern of toothwear
- inter occlusal space
- space required for restorations being planned
- quality and quantity of remaining tooth tissue (particularly enamel)
- aesthetic demands of patient
what are the 3 categories of maxillary incisor toothwear
toothwear limited to the palatal surfaces only
toothwear involving the palatal and incisal edges with reduced clinical crown height
toothwear limited to labial surfaces (rare)
what is the favoured method in gaining space in cases of localised anterior tooth wear
dahl technique
describe the dahl technique
either a bite platform or composites should be used to create inter occlusal space anteriorly
Results in posterior disclusion and an increase in OVD of around 2-3mm
Over period of 3-6 months space is gained between incisor teeth and the posteriors erupt
what thickness of composite must be used to prevent early failure
at least 2mm
contraindications to composite build ups for anterior toothwear
short roots
reduced periodontal support
lack of enamel - reduced success rate
‘ring of confidence’
enamel around entirety of area placing composite
much better success if this is present
why is lower anterior toothwear more difficult to fix
less enamel therefore smaller bonding area
moisture control is much harder
localised posterior toothwear is rare, what patients may it be seen in
ruminating patients
name the 2 methods of composite build ups (using ‘templates’)
- putty matrix - alginate impression, wax up, putty matrix
- vaccum splint - alginate impression, wax up, stone cast, clear vaccum matrix
if doing build ups for a patient what post op ‘instructions’ should they be given about their new bite
- may feel strange for a few days but should become accustomed to it within about a week
- may have difficulty chewing initially until bite settles
- may notice a lisp for the first few days
- may find yourself biting lip and tongue initially
- longevity should be good but there is risk of debonding and lifelong maintenane is required
who proposed the shortened dental arch concept
Kayser 1981
what is the shortened dental arch concept
a dentition where most posterior teeth are missing
Patient has satisfactory oral function without use of RPD
in regards to the shortened dental arch concept , how may occlusal unit must a patient have to have sufficient adaptive capacity
3-5 occlusal units
occluding pre molars = 1 unit
occluding molars = 2 units
indications for shortened dental arch
missing posterior teeth with 3-5 occlusal units remaining
favourable prognosis for remaining anterior and pre molar teeth
patient not otivated to pursue a complicated treatment plan
limited financial resources for dental care
contraindications for shortened dental arch
poor prognosis for remaining dentition
untreated or advanced periodontal disease
pre existing TMJ dysfunction
signs of pathological toothwear
significant malocclusion (wont have anything to bite together)
why is SDA not appropriate for patients with severe or untreated periodontal disease
- periodontally compromised teeth may drift under occlusal load
- distal tooth migration, which occurs in SDA, is exacerbated by inadequate periodontal support
- loss of alveolar bone leading to compromised denture bearing area should it be required in the future
why is pathological toothwear a contraindication of SDA
compromises long term survival of teeth
will see gradual loss of occlusal contacts and occlusal stability
what is occlusal stability
the stability of tooth positioning relative to its spatial relationship in the occluding dental arches
