Current concepts on the management of tooth wear: part 2. Active restorative care 1: the management of localised tooth wear

Current concepts on the management of tooth wear: part 2. Active restorative care 1: the management of localised tooth wear

I N B R I E F

Identies the need for active restorative intervention for any patient presenting with pathological tooth wear.

Describes possible approaches to the successful restoration of a dentition presenting with localised pathological tooth wear.

Discusses how contemporary treatment protocols have been signicantly inuenced by advances in understanding of adhesive dentistry and occlusion.

PRACTICE

S. B. Mehta,1 S. Banerji,2 B. J. Millar3 and J.-M. Suarez-Feito4

VERIFIABLE CPD PAPER

This second of the four part series of articles on the current concepts of tooth wear management will focus on the provision of active restorative care, where the implementation of a preventative, passive approach may prove insufcient to meet the patients expectations, or indeed prove to be sufciently adequate to address the extent of the underlying pathology to the desired level of clinical satisfaction. The active restorative management of cases presenting with localised tooth wear (of either the anterior, posterior, maxillary or mandibular variety) will be considered in depth in this paper, including a description of the commonly applied techniques and treatment strategies, where possible illustrated by case examples.

LOCALISED MAXILLARY ANTERIOR TOOTH WEAR

Maxillary anterior teeth are most commonly involved in localised tooth wear, especially where erosion is a major factor.

The decision on how to optimally restore these teeth will depend on the interplay between ve factors:1. The pattern of anterior, maxillary tooth surface loss

2. Inter-occlusal space availability3. Space requirements of the dental restorations being proposed

4. The quantity and quality of available dental hard tissue and enamel respectively

5. The aesthetic demands of the patient.

The pattern of anterior maxillary tooth wear has been classied by Chu et al.3

into three categories in order to facilitate restorative treatment planning:1. Tooth wear limited to the palatal surfaces only

2. Tooth wear involving the palatal and incisal edges, with reduced clinical crown height

3. Tooth wear limited to labial surfaces only.

For cases involving visible surfaces such as the latter two categories, restorative techniques will involve the use of tooth coloured aesthetic materials. Metallic restorations, such as metal palatal veneers,

THE NEED FOR ACTIVE RESTORATIVE INTERVENTION

While for many cases of pathological...