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The restorative implications of tooth wear are often complicated by the age of the patient, the destructive nature and aesthetic compromise of conventional fixed restorations and the lack of inter-occlusal space. This paper focuses on the fixed prosthetic treatment options for such patients and the utilisation of fixed restorations to create inter-occlusal space.
A variety of removable prostheses is available to restore the dentition which exhibits wear and extensive loss of teeth from the arch. Such treatment may be either interceptive or transitional in order to stabilise the occlusion or definitive as part of rehabilitation. Tooth surface loss may necessitate crowning with the provision of conventional removable partial dentures or decoronation and the use of overdentures. Extensive loading generated by parafunction is often considered to risk the failure of restorations stabilised by implants and so may contra-indicate treatment. Screening out unsuitable cases appears to result in few incidents of implant failure and new designs may further reduce the risk.
A worn dentition is a frequent clinical finding and presents two major challenges to the dental team. The first challenge is to ascertain the cause of the toothwear, the second is its management. This paper aims to present an overview of aetiologies associated with toothwear.
Dental wear, at first considered a pathological condition, is now regarded as a physiological mechanism of teeth adaptation to continuous masticatory stresses. Excessive wear is limited by characteristic structural adaptations of dental hard tissues showing a phylogenetic trend and specialisation. Enamel is the main tissue subjected to wear; however, advanced enamel wear exposes increasingly large areas of dentine. Enamel hardness and anisotropy are the major factors contrasting wear and microfractures. Anisotropy is mainly related to the different orientation of prism bundles (and of hydroxiapatite cristals). Enamel wear development is also related to differences in microhardness, density, mineral composition and protein distribution. Masticatory loads distributed along the enamel-dentine junction uniformly disperse in the underlying dentine. In spite of its structural characteristics, dentine is relatively isotropic by the functional point of view. Even if its lower hardness opposes less efficaciously to wear, its biomechanical characteristics successfully contrast microfractures. The study of microwear (namely the microscopic analysis of worn dental surfaces) can be made both on original surfaces and on high definition silicone-resin replicas. Scanning electron microscope observations allow identification of surface damage (microtraces) produced by different physical and chemical agents. Microwear analysis may provide indications about alimentary and non alimentary habits, masticatory biomechanics and pathological situations (e.g., bruxism).
The management of toothwear encompasses a broader approach than the active treatment of the problem, taking in as it does both passive and active interventions. This paper gives guidelines on how to assess and broadly manage toothwear rather than specific examples of treatment.
Presented is a case report describing clinical and radiographic dental findings in a patient with Wolf-Hirschhorn (4p-) syndrome. There is only one case study in the literature that describes dental findings in a patient with this disorder. There are no case reports that include radiographic documentation of dental abnormalities in patients with 4p- syndrome. This report presents a case of taurodontism in a patient with 4p- syndrome, an unreported dental finding.
This investigation was undertaken to establish the prevalence and distribution of tooth wear in different groups of medically compromised children and to assess the possible influence of gastroesophageal reflux, dietary factors, and parafunctional activity. Four groups of children including twenty-one with cerebral palsy were clinically examined and had in-depth, structured interviews, including information on medical history, medication, gastroesophageal reflux, feeding and drinking habits, parafunctional activity, and tooth-brushing procedures. All the children with cerebral palsy also had twenty-four-hour gastroesophageal pH monitoring. Of the fifty-one children in total, twenty-five had moderate or severe levels of dental erosion. No statistically significant differences were found between the groups as far as dietary influences, feeding habits, and tooth-brushing procedures. There was a significant association, however, between gastroesophageal reflux and erosion. It is concluded that in children with cerebral palsy this reflux may be much more important in the etiology of tooth surface loss than the parafunctional activity, which has classically been regarded as the cause.
OVERVIEW: The authors propose updated and revised nomenclature, definitions and classification for tooth surface lesions. Their objective is standardization, clarity and clinical utility for the dental practitioner. The article presents a schema of the pathodynamic mechanisms in the formation of tooth surface lesions--three basic physical and chemical mechanisms, their interactions and their dental manifestations. CONCLUSIONS AND CLINICAL IMPLICATIONS: The use of precise definitions will assist the practitioner in determining the etiology of various tooth surface lesions. Understanding the pathodynamic mechanisms and their many possible interactions, as set forth in the schema, will enable the practitioner to make an accurate differential diagnosis and to provide effective prevention and treatment. It also will assist dentists in communicating more effectively with their colleagues as well as with their patients. In addition, the schema helps identify areas in which future research is indicated.
Age estimation in unidentified bodies is inaccurate. Usually only a broad range of ages, such as 20-30 years or 30-50 years, can be given, especially when postmortem change has occurred. Thus there is a real need in routine forensic practice for greater accuracy. Takei (1970, 1981), looked at the relationship between teeth and age by using the 'Theory of Quantification'. Song and Jia (1987), extended the use of this technique, adding multiple stepwise regression analysis, to the statistical examination of data derived from the study of attrition of the occlusal surfaces of teeth. The computer model thus derived provides a basis for an accurate assessment of age from qualitative material. This paper discusses the technique and is based upon the findings made during a study of the degree of occlusal attrition in 880 people, living in rural and urban areas of the Liaoning province of the People's Republic of China.
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Changes in enamel during its development are permanently recorded, and commonly present as either demarcated opacity, diffuse opacity, or enamel hypoplasia. Developmental enamel defects may provide clues regarding their aetiology, and this may have application in clinical dentistry, dental epidemiology and anthropology. However, the usefulness of these applications may be hampered by many pitfalls encountered in the detection and diagnosis of developmental enamel defects. The defects may be masked by saliva, dental plaque, and incorrect lighting. In addition, confounding effects of post-eruptive changes such as dental caries, attrition, and traumatic loss of tooth structure may impair the detection of developmental enamel defects. The non-specificity of appearance of enamel defects may make aetiologic diagnosis of enamel hypoplasia difficult. Furthermore, difficulty is often encountered in the relative timing of events in enamel hypoplasia, due to limited data on the chronology of development of the human dentition. In this review, pitfalls in the clinical assessment of enamel defects are discussed, and guidelines to overcome some of these difficulties are presented.
Tooth wear is the result of three processes: abrasion (wear produced by interaction between teeth and other materials), attrition (wear through tooth-tooth contact) and erosion (dissolution of hard tissue by acidic substances). A further process (abfraction) might potentiate wear by abrasion and/or erosion. Both clinical and experimental observations show that individual wear mechanisms rarely act alone but interact with each other. The most important interaction is the potentiation of abrasion by erosive damage to the dental hard tissues. This interaction seems to be the major factor in occlusal and cervical wear. The available evidence seems insufficient to establish whether abfraction is an important contributor to tooth wear in vivo. Saliva can modulate erosive/abrasive tooth wear through formation of pellicle and by remineralisation but cannot prevent it.
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The potential role of dental function in TMJ osteoarthritis is examined in an ancient British population. Human skeletal remains from five archaeological sites in England (n = 369) were studied to assess the associations between the presence of osteoarthritis and dental function variables, in particular antemortem tooth loss and dental attrition. Individuals aged over 17 years with at least a portion of either the left or right TMJ were included in the study. Each individual was scored for the occurrence of arthritic lesions on the mandibular condyle and glenoid fossa, the level of dental attrition, and antemortem tooth loss. A loglinear analysis was performed with osteoarthritis as the dependent variable and tooth loss, attrition, sex, and age as the independent variables. Tooth loss and sex are not significantly associated with TMJ osteoarthritis when attrition and age are included in the analysis. Attrition is significantly associated with osteoarthritis even when the analysis corrects for age. The significant association of attrition with osteoarthritis suggests that dental functions may have an influence, separate from ageing, on the development of TMJ osteoarthritis.
Features of natural masticatory function, of physiological attrition, both occlusal and approximal, and of continuing tooth eruption in adult life need to be borne in mind in considering how the chronic inflammatory periodontal diseases and dental caries have become so widespread. Evidence is reviewed showing that teeth continue to erupt in adulthood, that natural masticatory function prevented plaque accumulation at the approximal risk site of onset of both CIPDs and caries, that epithelial attachment to cementum may be physiological, and that periodontal attachment studies must be age-related.
The authors studied the specific hardness, micromorphology, electric resistance and penetration by 22Na ions in teeth extracted from juvenile subjects with beginning abrasion of the enamel differentiating between tooth parts affected with attrition and tooth parts not affected. The structural or physicomechanical properties of the enamel and dentine were quantitatively evaluated with regard to their relation to caries disposition.