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FRP - Crowns/Bridges/Wear/TMD/SDA/IMPLANTS > Wear > Flashcards

Flashcards in Wear Deck (47)
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1

Name 4 different causes (types)of wear

- Pathological and physiological
Physiological - normal function and associated with age
Pathological - excessive wear or pulp health is compromised.

- Abrasion
-Erosion
-Attrition
-Abfraction

2

What is erosion
Signs of erosive wear

Loss of tooth substance due to a chemical process not involving bacterial action. Chronic exposure of hard tissues to chemical agent
-Signs - loss of enamel surface detail, smoothing and flattening of surface.
Bilateral concave lesions.
-Later - dentine exposed and patient experiences sensitivity. Restorations stand proud of teeth.

3

What is attrition.
What are the early and late signs.

It is the wear of tooth substance through repeated tooth to tooth contact.
Parafunction.
- Early = flattening of cusp, polished facet of incisal edge
Progresses to loss of cusp height and flattening of occlusal inclined planes - shortening of clinical crowns.
E/O - TMD - painful muscles,
I/O - bilateral linea alba, scalloped tongue, wear facets.

4

What is abrasion.
What are the signs
examples of causes

The physical wear of tooth substance through repeated abnormal mechanical process involving a foreign object
- v shaped/rounded lesions
-sharp enamel edges
-excessive toothbrushing, use of vape pen, bad habit.

5

What is abfraction

Loss of tooth substance through excessive occlusal forces leading to compressive/tensile forces at cervical fulcrum of tooth.

V shaped lesion at ACJ

6

Important aspect of the patient history

Complaint = Pain/sensitivity/aesthetic/functional issues/

PMH - GORD, alcoholism, hiatus hernia, pregnant, eating disorder.
-Drugs - cause xerostomia or low pH

PDH - reg attender, OH regime, treatment experience,

SH - lifestylr, occupation, diet, habits, alcohol, smoke,

7

Patient examination - E/O & I/O

E/O -TMJ - function, movement, opening, click, crepitus, pain, locking
-Muscles - hypetrophy - masseter

I/O - Lip and smile line
-Occlusion - FWS, dentoalveolar compensation, centric relation with stable contacts.
Perio, OHI, caries risk, charting

8

Describe the Smith and Knight 'Tooth wear index' scores
(LIke 6ppc)

Grade 0 - No loss of enamel characteristics

Grade 1 - loss of surface emanel characteristics

Grade 2 - buccal, lingual and occlusal loss of enamel and exposed dentine for < one third of surface

Grade 3 -buccal, lingual and occlusal loss of enamel and exposed dentine for > one third of surface. Incisal loss of enamel. Substantial dentine exposure

Grade 4 - buccal, lingual and occlusal loss of enamel with pulpal exposure and exposure of secondary dentine.

9

Describe the BEWE (Like BPE)

Score:
0 - no erosive wear
1 - initial loss of surface texture
2 - distinct defect, hard tissue loss <50% surface
3 -Hard tissue loss >50% of surface

Cumulative sextant score
No treatment - =2
Low - 3-8
Medium -9-23
High - >14

10

Special tests to carry out in wear cases

Sensibility tests
Radiographs
Articulated study models
Photographs
Diagnostic wax up
Salivary evaluation
Dietary analysis

11

Describe possible patterns of wear

1. Localised
2. Generalised
-wear with reduction in OVD
-wear without reduction of OVD but enough space
-wear without reduction of OVD but with limited space.

12

Immediate treatment of wear patient

-PAIN = desensitising agents, fluoride, GIC, (exposed dentine)
-Pulp extirpation = compromised pulp
-smooth sharp edges
-XLA= unrestorable/non functional tooth
-TMJ =attrition

13

Initial treatment of wear patient

Stabilisation of dentition
-caries
-perio
-oromucosal issues

- PREVENTATIVE regime

14

what baseline measurements/records are required

-Photographs
-Study models
-wear indices

15

Abrasion treatment
- conservative
-restorative

Eliminate cause (foreign object) - bad habit
- bite nails etc
- less abrasive toothpaste and better technique

- restorative
GIC/RMGIC/composite, no tooth prep

16

Attrition treatment

-CBT
-Hypnosis
- splint therapy - soft/hard

17

How can splints help with attrition

- bite splint instead of teeth and wear that away
- habit breaker

-soft splint - diagnostic device to see wear worst worn areas are
-hard splint - more robust and so longer lasting

18

example of a hard splint
-benefit of using it

Michigan splint
-longer lasting
-ideal postured occlusion with centric stops
-canine rise=disclusion in eccentric mandibular movements

19

Treatment of erosion

Identify source
-diet
-habit
-medical = GORD/eating disorder

- preventative = fluoride -toothpaste/varnish/MW
-desensitising agents = sensodyne/colgate tp

20

dietary habits to change in patient with erosion

-reduce sugar/acid consumption
-use a straw
-habit change (swirl drink around mouth)
-sports drinks

-MH - GORD = GMP involved - rennies/gaviscon use
- eating disorder - psychologist/psychiatrist help

21

Active management
-goals

Cover exposed dentine - cupped defects
-preservation of remaining tooth structure
-improve aesthetics
-restore functionality
-stable occlusion

22

localised anterior tooth wear
contraind to

short roots/reduced periodontal support

23

what does the ring of confidence mean

halo of enamel that has a positive effect on retention

24

lower anterior tooth wear - issue
treat

smaller bonding area,
improve aesthetics but DO NOT INCREASE OVD

25

who is most likely to have localised posterior tooth wear
how to treat

bulliemics, alcoholics, GORD
localised and asymp, prevention and monitor

26

localised posterior wear - create canine guidance, how

add composite to palatal aspect of canine to allow rise - posterior disclusion

27

composite build up techniques

free hand
impression - use of wax up and stent/putty ,eatrix

28

how to create a clear vacuum formed matrix

alginate imp/wax up/vacuum formed stent onto this/use as mould for build up

29

explanation to be given to patient when there anterior teeth have been built up

teeth buid up using white filling, bite will feel strange for a while, only front teeth will touch initially but the posterior teeth will follow after 3-6mth

30

what 3 categories can generalised tooth wear be split into

1. excessive wear with loss of OVD
2. excessive wear without loss of OVD but enough space
3. excessive wear without loss of OVD but no space available