Generalized Tooth Wear Research Articles

Association of tooth wear with freeway space among different age groups in patients with generalized tooth wear.

Objective: To determine the association of tooth wear with freeway space among different age groups in patients with generalized tooth wear reporting to Khyber College of Dentistry, Peshawar. Study Design: Descriptive, Cross-sectional study. Setting: Department of Prosthodontics, Khyber College of Dentistry, Peshawar. Period: 3rd May 2020 to 29th January 2021. Methods: For this study, a total of 180 subjects were observed to identify the occurrence of tooth wear within the age group of 25-34 years, considering a prevalence rate of 3%. The sample size was determined with a 95% confidence level and a margin of error of 3%. Moreover, a non-probability consecutive sampling technique was used for data collection. Results: Data from 180 subjects were collected within a study duration of 7 months. The mean age of the subjects was 40.36±9.048 (SD) yrs. The chi-square test determined the association between tooth wear and freeway space, revealing a statistically insignificant (p-value of 0.16) relationship between the two variables. Conclusion: Freeway space was found to be statistically insignificant to the rate and degree of tooth wear.

Techniques for the restorative management of localized and generalized tooth wear

This narrative review describes techniques and materials available to restore the worn dentition. Emphasis is given to application of composite resin as this material can be bonded to worn surfaces and is easily adjusted either within an existing or at an increased vertical dimension. The relevance of the differences in the composition of glass ceramics and polycrystalline ceramics for restoration in various wear scenarios are discussed. Removable dentures are still appropriate in certain circumstances, but require an understanding of their limitations. CPD/Clinical Relevance: Young and old patients with a range of aetiologies and presentations expect dentists to know how best to restore their disordered, worn dentition.

Aesthetic and Functional Rehabilitation of a Patient with Generalized Tooth Wear

Tooth wear alternatively known as Tooth Surface Loss (TSL) is becoming a considerable health problem around the world with an upsurge in prevalence. Management of these patients is a significant challenge in dental profession. Accurate diagnosis is vital with the help of detailed history, examination and appropriate investigations. Identification of possible etiologies supplemented by preventive measures plays a major role in management. Further, minimally invasive treatment strategies should always be promoted. Comprehensive care even with simple restorative and prosthetic techniques can successfully satisfy aesthetic and functional demands of the worn dentition. Keywords: Adhesive restorations, Comprehensive management, Free-end saddles, Reorganized approach, Tooth wear

The Restoration of Severe Generalized Dental Erosive Wear using Direct Composite: A Case Report

Introduction: This case report describes a conservative restorative approach in the management of severe generalized tooth wear. Case report: The male, aged 57 years, was mainly concerned with the poor appearance of his teeth with short and discolored upper incisors. History revealed that he suffered from gastric reflux for 25 years, for which he was prescribed Ranitidine and was advised to self-medicate with cider vinegar. Furthermore, he divulged that he ground his teeth at night and during the day and had a high intake of carbonated cola drinks. On examination, dentine was exposed in several areas, and to a significant extent, on the incisal aspects of the lower incisors, the palatal surfaces of the upper incisors, and the occlusal surfaces of the molars. Mandibular tori were present. The primary diagnosis was erosive tooth wear with elements of attrition and abrasion. The intervention included dietary advice and restoration with direct composite resin at an increased occlusal vertical dimension of 1.5mm on the retruded axis. The patient reported no functional problems and was pleased with the aesthetic result. Conclusion: Vinegar is promoted to have health benefits, especially with respect to glucose response, but the dental implications are overlooked. This paper reviews the literature on vinegar as a medicament and considers its role as a co-factor for erosion in this case. The clinical steps used to restore the eroded dentition by direct composite are described. The use of this approach is a safe, conservative and successful treatment option without recourse to complex and biologically costly conventional alternatives. The application of direct composite in tooth wear cases meets the European consensus requirements.

Clinical performance of direct composite resin restorations in a full mouth rehabilitation for patients with severe tooth wear: 5.5-year results.

ObjectivesTo evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation. MethodsA convenience sample of 34 patients were recruited to a prospective trial between December 2010 and June 2013. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the DSO-technique. Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analysed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05). ResultsAnnual failure rates (for all levels of failure, ‘Level 3- ‘) of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months. The completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations. ConclusionsAt 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure. Clinical significanceDirect resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance.

Biological outcomes and patient-reported outcome measures (PROMs) of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions by means of the "3-step technique": part 2 of the 6-year outcomes of a retrospective clinical study.

To evaluate biologic and esthetic outcomes, as well as the patient-reported outcome measures (PROMs), of full-mouth rehabilitations in patients suffering from generalized erosive and/or abrasive tooth wear following the 3-step technique. Patients who received a minimally invasive full-mouth rehabilitation according to the 3-step technique and who were treated at the University of Geneva and/or in a private practice were considered for inclusion. The minimum service time of the restorations was 12 months. The biologic outcomes were analyzed by assessing pocket probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP). Furthermore, secondary caries, tooth vitality, and sensitivity to temperature were evaluated using the modified United States Public Health Service (USPHS) criteria. The esthetic outcomes were rated with the White Esthetic Score (WES). Finally, PROMs were evaluated using visual analog scales (VAS). A total of 19 patients with 406 restorations (149 direct composite resins, 110 indirect composite resin/ceramic onlays, and 147 composite resin/ceramic veneers) were examined after a mean follow-up of 71.8 ± 28.6 months. Periodontal parameters were good (mPPD = 2.9 ± 0.4; mPI = 0.1 ± 0.2; and mBOP = 0.05 ± 0.1). No secondary caries were found, and no abutment tooth had lost vitality. A total of 36 abutment teeth had moderate sensitivity, but none presented pronounced sensitivity. The rehabilitations exhibited good esthetic outcomes (mWES = 8.4 ± 1.9). Patients reported satisfying esthetic results of their rehabilitations (mean VAS = 9.2 ± 1.6) and considered their treatment as comfortable (mean VAS = 8.2 ± 2.1), while the least favorably rated parameter was the cost of treatment (mean VAS = 4.1 ± 3.2). Minimally invasive full-mouth rehabilitations of patients with generalized tooth wear by means of the 3-step technique exhibit very good clinical medium-term results with respect to biologic and objective/subjective esthetic outcomes. The patient satisfaction with this treatment was high.

Impact of restorative treatment of tooth wear upon masticatory performance

ObjectiveThe restorative treatment of generalized tooth wear involves an increase in vertical dimension of occlusion and a comprehensive alteration of occlusal morphology. The aim of this study was to assess the impact of a direct adhesive restorative treatment on masticatory performance parameters. Materials and methodsA sample of 23 fully dentate adult generalized tooth wear patients (17 male, 6 female, age 41.7 ± 8.3 years) undergoing direct composite restorative treatment was selected. Before and one month after restorative treatment with resin bonded composite restorations, masticatory performance was evaluated using 1) a comminution test, 2) a maximum voluntary bite force recording and 3) the sum score of five items related to eating and chewing from the Oral Health Impact Profile (OHIP-49) questionnaire. Statistical analysis was performed using a paired t-test, and analysis per OHIP item was done by a McNemar test (p < 0.05). ResultsThere was no statistically significant difference in median particle size (X50) calculated before and after treatment (4.19 ± 0.97 and 4.03 ± 0.76, respectively, p = 0.327). Maximum voluntary bite force decreased significantly after treatment (baseline 389 ± 90 N, one month recall 323 ± 173 N, p = 0.028). The sum score of the five OHIP items significantly decreased after treatment (baseline 10.6 ± 4.8, one month recall 6.6 ± 2.5, p = 0.001), with the item regarding unsatisfactory diet showing the largest significance (p = 0.029). ConclusionsThis study indicates that the restorative treatment of generalized tooth wear using direct resin bonded composite has no significant short-term effect on masticatory performance as measured with a comminution test, although the self-reported ability to eat and chew, as measured by the sum score of all pertaining OHIP items, did significantly improve. Clinical significanceOn individual level, food comminution could be influenced by restorative treatment with increase of vertical dimension of occlusion, but at group level no significant effect is observed. Nevertheless, tooth wear patients do perceive improved ability to eat and chew foods, which is clinically relevant.

The One step-No prep technique: A straightforward and minimally invasive approach for full-mouth rehabilitation of worn dentition using polymer-infiltrated ceramic network (PICN) CAD-CAM prostheses.

To introduce a novel approach for full-mouth rehabilitation of severely worn dentition using polymer-infiltrated ceramic network (PICN) computer-aided-design and manufacturing (CAD-CAM) restorations, without tooth tissue preparation and provisional phase. Three patients with generalized tooth wear, suffering from dental pain, masticatory dysfunction, bruxism and neck and back pain, were selected and treated in collaboration with physiotherapists. Occlusal analyses were performed and full-mouth diagnostic wax-ups were designed on the basis of estimated tissue loss. Deficient direct restorations were replaced and low-thickness PICN (Vita Enamic) restorations (up to 0.2 mm) were CAD-CAM designed from wax-ups, milled, tried-in and then bonded within two consecutive days. To mask palatal veneers, either buccal direct composites or glass-ceramic veneers were later performed. An occlusal splint was realized. Clinical results were shown to be successful after a follow-up of 22, 18, and 13 months, respectively. The absence of provisional phase did not engender any inconveniences. Patient reported outcomes were very positive, showing a reduction in neck and back pain and a well-being increase. The proposed protocol is particularly minimally invasive and straightforward compared to classical techniques. PICNs exhibit several advantages compared to other materials. Preliminary results of this multidisciplinary approach are promising but deserve further clinical research. The development of CAD-CAM technologies offers the possibility of improving treatment of severe worn dentition, reducing chairtime and need of tooth tissue preparation, and introducing a new class of composite materials (hybrid ceramics), which exhibit interesting properties for this indication. The influence of the proposed multidisciplinary approach, particularly the collaboration with physiotherapists, needs to be further explored with respect to treatment of associated symptoms, such as masticatory muscles hypertrophy and neck pain.

A contemporary approach for the management of generalized tooth wear

Abstract: This paper describes the treatment of a 39-year-old female patient with generalized tooth wear. The causes of the tooth wear were identified and controlled. Following diagnostic planning, a full mouth reconstruction at an increased vertical dimension utilizing a reorganized approach was carried out. Crown lengthening surgery was performed on the maxillary anterior teeth prior to the restorative phase. The restorative treatment included a combination of indirect and direct composite resin restorations and adhesive cast restorations. Very satisfactory functional and aesthetic outcomes were achieved. CPD/Clinical Relevance: This paper demonstrates a practicable approach that can be applied for patients with tooth wear. The approach is conservative which eliminates the need for full coverage crowns to restore aesthetics and function.

A Case of Generalized Tooth Wear caused by Bruxism and its Rehabilitation

Bruxism may lead to dental problem such as tooth wear, fracture, crack of tooth, muscles of mastication discomfort, temporomandibular joint (TMJ) dysfunction syndrome and periodontal signs such as gingival recession and tooth mobility. This article presents a case report in which bruxism caused severe tooth wear that lead to great muscular discomfort with TMJ pain. The initial treatment approach was the installation of an inter-occlusal acrylic device in centric relation of occlusion for re-establishment of the occlusal stability. Vertical dimension of occlusion, anterior guides and return of normal muscle activity were observed within 3 months. After subsiding primary symptoms, oral rehabilitation therapy was approached by means of metal bond ceramic restoration and new inter-occlusal device was provided for protection of restoration. Satisfactory aesthetics, improved function, occlusal stability were obtained after oral rehabilitation therapy. No specific trouble occurred during 1 year follow up period. DOI: http://dx.doi.org/10.3329/cdcj.v10i1.13747 City Dent. Coll. J Volume-10, Number-1, January-2013

Management of Tooth Wear: An Interdisciplinary Approach

ABSTRACTAimsThis case report aims to describe a conservative interdisciplinary approach to restore generalized tooth wear complicated with malalignment of teeth.IntroductionTooth wear is the surface loss of dental hard tissue, i.e., usually multifactorial in origin, excluding other than caries, trauma, or developmental disorder. Severe tooth wear impact the appearance, comfort, function, or longevity of the tooth. Prosthodontic management of patients with tooth wear has been well documented, although prosthodontic treatment is designed to correct minor malocclusion, patients with moderate-to-severe malocclusion accompanied by generalized tooth wear may require preprosthetic orthodontic intervention.Case reportThis case report describes a 47-year-old male patient with generalized tooth wear complicated with lack of interocclusal space and malalignment of teeth. Preventive measures were carried out to address the etiological factors of tooth wear. After orthodontic treatment, definitive restoration was placed in reorganized occlusion at an increased vertical dimension, which restored esthetic and function.ConclusionIn this clinical report, generalized tooth wear with insufficient space for restoration, complicated by malalignment of teeth, was managed by way of an interdisciplinary approach which allowed a conservative full-mouth rehabilitation. After orthodontic treatment, a reorganized restorative approach was undertaken at an increased vertical dimension, providing an esthetic and functional solution. An occlusal night guard was provided to protect the dental restorations.Clinical SignificanceInterdisciplinary approach allows a conservative management for patient with tooth wear complicated by malalignment of teeth.How to cite this articleLeung TM, Botelho MG, Yang Y, Ho EHT. Management of Tooth Wear: An Interdisciplinary Approach. Int J Experiment Dent Sci 2016;5(2):139-145.

AŞIRI DİŞ AŞINMASI OLAN BİR HASTANIN TAM ARK RESTORASYONU VE ISIRMA KUVVETİNİN DEĞERLENDİRİLMESİ: VAKA RAPORU

Aim: The Cleft Lip and Palate (CLP) is variation of a Aesthetic and functional restoration of the severely worn dentiton leads to some challenges due to the insufficient restorative space. In the present case report, 60 years-old male patient had generalized tooth wear, anterior cross-bite, aesthetic problems and impaired masticatory function. After the detailed examination, 2 mm increase of occlusal vertical dimension (OVD) in posterior teeth has been decided. Before treatment, cephalometric radiographs were taken and maximum bite force was measured as 20 kg/kuvvet. Then, for adaptation of patient to the increased OVD, patient used the fixed provisional restoration for 1 month. A second cephalometric radiograph was taken with the provisional restoration at increased OVD. After 1 month, patient did not report any muscle pain or joint discomfort and thus permanent full mouth restoration was completed. One week later of permanent cementation of restorations, patient reported satisfactory masticatory function and at this appointment the bite force was measured as 32 kg/kuvvet

Oral findings and dental treatment in a child with West syndrome

West syndrome (WS) is a rare, severe form of epilepsy that typically manifests early in infancy. It is considered a malignant condition that combines episodes of spasms that occur in clusters (infantile spasm), hypsarrhythmia on the electroencephalogram, and neuropsychomotor delay. Although WS has been widely investigated from a medical standpoint, few reports have focused on the oral findings in patients with this syndrome. This article reports the case history of a 7-year-old child diagnosed with WS. The major clinical features were generalized tooth wear and gingival enlargement, altered chronology and sequence of dental eruption, primary canine cusp-to-cusp relationship, ectopic dental eruption, and mildly arched palate. Multiple white spot lesions were also observed, possibly associated with poor oral hygiene, due to a fermentable carbohydrate-rich diet, and continuous use of sugar-containing medications. Dental care management of patients with special needs is discussed and the dental treatment for this child with WS is described.

Patterns of dental wear in the early Maori dentition

AbstractThe levels of tooth wear were surveyed in 50 pre‐contact Maori skulls (23 of them female) from New Zealand. In addition to a generalized tooth wear index, we evaluated occlusal wear for erosion and abrasion. Occlusal microwear was also investigated using scanning electron microscopy (SEM) images and, finally, the occlusal slope was determined at the level of the first molar teeth. The general pattern of wear was one of severe occlusal reduction with no significant differences between males and females. Both silicone impressions and SEM views confirmed a large component (30%) of erosion. While most individuals had flat wear planes, 33% of males and 44% of females showed reversed Monson's curves. Accentuated Monson's curves were found in 23.8% of males. While these results confirm early studies of the excessive wear experienced by pre‐contact Maori, our study shows for the first time that erosion played a significant role in the dental wear of these people. Copyright © 2001 John Wiley &amp; Sons, Ltd.

Vertical height differences in subjects with severe dental wear

The present study aims to determine differences in vertical facial dimensions as a result of severe dental wear. The sample consisted of 35 subjects (mean age 48.4 years) who had advanced dental wear recognized by loss of more than one-third of the estimated original incisor crown length. The control group comprised 40 subjects (mean age 26.1 years) with acceptable occlusions and no signs of severe generalized tooth wear. Lateral skull radiographs were taken for both the study sample and the control group with the mandible in the maximum retruded position, from which measurements were made using a digitizer. The results showed no significant differences for total face height (n-gn) between the groups (P > 0.05) although for the study sample, upper face height was greater (P < 0.05) and lower face height was smaller (P < 0.05). Smaller values for tooth length were found in the wear sample, with the mean differences in tooth length being 5.0 mm for upper incisors and 3.3 mm for lower incisors. The overbite was smaller in the wear sample and the lower incisor position differed from controls in this group. It is concluded that the differences in face height together with differences in lower incisor position through dento-alveolar development contribute to maintenance of total facial height, so compensating for loss of vertical height through severe dental wear.