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An assessment of stress analyses in the theory of abfraction.
Wedged-shaped lesions at the cemento-enamel junction of teeth have been attributed primarily to biomechanical loading forces that cause flexure and failure of enamel and dentin. This theory, termed abfraction, remains controversial. This review examined studies on mechanical properties of enamel and dentin and studies on bite forces and mastication as background information. Abfraction is based principally on a few early finite element analysis and photoelastic models showing stress concentration at the dental cervical area without actually showing enamel and dentin fracture. However, a review of more recent dental stress analyses has been contradictory. Particularly, analyses of the periodontal ligament and alveolar bone, not modeled in previous studies, have shown that those structures may dissipate occlusal loading forces from the cervical areas. In addition, some models may not fully represent intricate dental anatomy and complex occlusal function. Therefore, the key basis of the abfraction theory may be flawed.
Conservative treatment of the worn dentition with adhesive composite resin.
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[Calculus removal efficiency and injury potential of vertically oscillating metallic and carbon ultrasonic tips].
This laboratory study investigated the efficiency and aggressiveness of metallic and carbonic inserts of a vertically oscillating ultrasonic device (Vector-system) at different power settings. The following parameters concerning periodontal treatment were assessed under standardized conditions: calculus and tooth substance removal, mean surface roughness and micro morphological appearance of the treated roots. Concerning the calculus removal potential, no significant differences were found between the types of insert used. The carbon fibre inserts, however, showed significantly more tooth substance loss than the metallic inserts. These findings were confirmed by micromorphological SEM analysis. In view of these results, the repeated use of these carbon fiber inserts during periodonatal sustaining therapy cannot be recommended.
Clinical conditions and lesions mimicking salivary gland disease, part 1.
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Enamel mineralization by calcium-containing-bicarbonate toothpastes: assessment by various techniques.
Surface defects such as scratching, acidic erosion, and natural dimpling of the tooth enamel can significantly affect its cosmetic appearance. There are many analytical techniques that can be used to view the surface of enamel and to assess the effect of surface treatments. Light microscopy, scanning electron microscopy (SEM), profilometry, and atomic force microscopy (AFM) can usefully be applied to viewing mineral surfaces and obtaining information about surface morphology and smoothness. Energy-dispersive x-ray fluorescence and other surface-ionizing techniques can give information about surface chemistry. Microhardness instrumentation can be used to determine surface hardness, while gloss meters and reflectometry can provide measurements of gloss and whiteness. In this study, four sets of in vitro experiments were performed, which illustrate the value of three of these techniques. Specially formulated calcium-containing toothpastes, designed to fill in surface defects in tooth enamel, were evaluated in four experiments for their ability to effect cosmetic improvements in etched tooth enamel: (1) two calcium-containing, sodium-bicarbonate-based toothpaste formulations were shown by SEM to smooth tooth enamel without introducing new scratches. In contrast, a commercial whitening toothpaste removed similar scratches but also created new ones; (2) calcium-containing dentifrices were shown by SEM and hardness measurements to put mineral onto the surface of enamel and to harden it. The effects of uneven dispensing of the two-phase, bicarbonate-based, calcium-containing formulation were shown to be small; (3) a number of different calcium-containing toothpastes were shown by SEM to deliver mineral onto the etched enamel surfaces, whereas a conventional fluoride toothpaste did not; and (4) AFM was used to follow the smoothing of an etched enamel surface after serial treatments with a calcium-containing, bicarbonate-based toothpaste. After 15 in vitro cycles, surface roughness was reduced by more than 50% and peak height was reduced by about two thirds. The results illustrate the effectiveness of the three analytical techniques and show that the calcium-containing toothpastes can deposit mineral into enamel surface deformities under a wide variety of conditions and from a wide variety of formulas.
Using spectrophotometer technology in the assessment and monitoring of tooth wear.
Using such tools as spectrophotometers and practice performance standards is becoming a more recognized means of acquiring valid information regarding the current oral care status of patients, as well as to help guide and educate them through their prescribed treatment processes. Applying these tools consistently, over the range of patients within a practice, allows the detection of important patterns and problems in the oral health status of individual patients, including patterns of tooth wear. This article demonstrates the manner in which practice performance techniques and assessment instrumentation such as spectrophotometers have empowered one practice to favorably impact patients in the identification and subsequent management of tooth wear.
Applications of digital images derived from toothprints thermoplastic bite impression wafers.
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Three patient reports illustrating the use of dentin adhesives to cement crowns to severely worn teeth.
PURPOSE: Severely worn and broken down teeth present clinical treatment planning dilemmas. Extreme examples of worn teeth present in patients suffering from bulimia nervosa and dentinogenesis imperfecta. Bulimia nervosa typically presents early in adult life with a myriad of clinical features and a most important dental sign of eroded palatal surfaces on the maxillary teeth. Dentinogenesis imperfecta is a relatively uncommon disorder that presents with varying severity of unsupported enamel and results in teeth more susceptible to wear. MATERIALS AND METHODS: Dental treatment for both conditions when wear has resulted in the complete loss of the tooth can either be directed toward restoring remaining tooth tissue or extraction and replacement with implants or dentures. This article presents the clinical management of three case histories, each with one or more severely broken down teeth, which were restored with adhesively retained crowns. RESULTS: Treatment lasted nearly 10 years in one patient and failed after 6 years in another. The third patient was treated more recently. CONCLUSION: All three case histories serve as examples of using adhesive cements to retain indirect restorations as a possible prosthodontic management strategy.
Full-mouth rehabilitation of a patient with bulimia nervosa. A case report.
Anorexia and bulimia nervosa are eating disorders seen mainly in adolescents or young patients. The dentist should be in the position to recognize early signs of the disorder and alert the patient (and the patient's parents, if necessary) of the possible physical, psychologi cal, and dental consequences. Such dental treatment may help motivate the patient to confront the problem. In this paper the full-mouth rehabilitation, using a combination of galvano- and metal-ceramic restorations, of a young patient suffering from bulimia nervosa is described.
Usual and unusual orofacial motor activities associated with tooth wear.
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Enamel microabrasion in conjunction with carbamide peroxide bleaching.
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Simplified restorative correction of the dentition using contact lens-thin porcelain veneers: a report of three cases.
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Tooth wear in the elderly population in South East Local Government area in Ibadan, Nigeria.
It is the aim of this study to determine the pattern and degree of tooth wear in the elderly population in the South East Local Government Area in Ibadan. The study was carried out on 690 elderly individuals who were 65 years old and above, living in various wards in South East Local Government Area, in Ibadan. A multistage sampling technique was used to select elderly individuals for the study. Two interviewers, 2-record clerks and 2 examiners were trained for the study and the examiners were calibrated. The index of Eccles J.D was used to determine the severity of tooth wear. The results highlight the high prevalence of tooth wear, mainly attrition in the elderly in this local government area. Six hundred and forty (92.8%) of the elderly had tooth wear. Of these 58.59% were males and 41.41% females. Attrition was observed in 618 (89.6%) elderly individuals. The mandible exhibited a higher prevalence of tooth wear than the maxilla and was statistically significant. Severe tooth wear was observed in only 5.74% of the teeth whilst moderate and mild tooth wear were observed in 26.91% and 30.88% respectively. Unlike the Western European countries, attrition being the most common type of tooth wear in these elderly individuals suggests that the aetiological factors responsible for tooth wear are different. Common habits such as crushing of bones and chewing of sticks for routine oral hygiene care could be contributing factors to tooth wear in this environment.
[Rehabilitation of an abraded occlusion with Procera-ZrO2 all-ceramic crowns. A case report].
The rehabilitation of a patient with advanced tooth wear by means of Procera ZrO2 ceramic crowns is described. A healthy, 60 year old patient complained about front teeth esthetics and impaired function due to reduced tooth height. He was aware of bruxism and wished full mouth rehabilitation. The clinical examination showed that tooth wear was generalized, but most teeth could be maintained in both jaws. A staged procedure was planned, starting with a splint therapy and a provisional fixed prosthesis to reestablish correct vertical dimension of occlusion (VDO) and stable occlusal contacts. The new ZrO2 material with the Procera technique was chosen to restore all teeth in both jaws, except the mandible front teeth. In the second treatment phase, crown lengthening of the maxillary front teeth was performed and one implant placed to replace a maxillary premolar. After final tooth preparation, impression taking and bite registration the ZrO2 crown-copings were scanned, processed and completed by veneering. A flat occlusal scheme with stable front teeth guidance was established. The advantage of the presented treatment is the esthetic result in combination with a material of high mechanical and biological quality.
Restoration of a fractured tooth with an abfraction lesion prior to placement of a ceramic casting.
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The Dahl principle: creating space and improving the biomechanical prognosis of anterior crowns.
There is an increased demand for restoration of anterior teeth based on esthetic requirements. Oftentimes, the teeth restored are compromised and have minimal remaining dentin after undergoing root canal treatment. Reduction of nonaxial forces by controlling incisal guidance is essential in improving the long-term prognosis of such situations. Another common complication when crowning anterior teeth is the lack of palatal space for restorative material. This is often evident in patients with anterior tooth wear and deep overbite. This article describes the Dahl principle, a conservative method for controlling incisal guidance and gaining palatal space for restorative material. A case presentation is used to illustrate the concepts discussed.