Composite vertical bite reconstructions in eroded dentitions after 5·5 years: a case series

Clinical performance of a new biomimetic double network material

BACKGROUND

The development of ceramics during the last years was overwhelming. However, the focus was laid on the hardness and the strength of the restorative materials, resulting in high antagonistic tooth wear. This is critical for patients with bruxism.

OBJECTIVES

The purpose of this study was to evaluate the clinical performance of the new double hybrid material for non-invasive treatment approaches.

MATERIAL AND METHODS

The new approach of the material tested, was to modify ceramics to create a biomimetic material that has similar physical properties like dentin and enamel and is still as strong as conventional ceramics.

RESULTS

The produced crowns had a thickness ranging from 0.5 to 1.5 mm. To evaluate the clinical performance and durability of the crowns, the patient was examined half a year later. The crowns were still intact and soft tissues appeared healthy and this was achieved without any loss of tooth structure.

CONCLUSIONS

The material can be milled to thin layers, but is still strong enough to prevent cracks which are stopped by the interpenetrating polymer within the network. Depending on the clinical situation, minimally- up to non-invasive restorations can be milled.

CLINICAL RELEVANCE

Dentistry aims in preservation of tooth structure. Patients suffering from loss of tooth structure (dental erosion, Amelogenesis imperfecta) or even young patients could benefit from minimally-invasive crowns. Due to a Vickers hardness between dentin and enamel, antagonistic tooth wear is very low. This might be interesting for treating patients with bruxism.

Impact of erosive conditions on tooth-colored restorative materials

OBJECTIVES

To give an overview of the impact of erosive conditions on the behavior of tooth-colored restoratives and performance of dental adhesives.

METHODS

Acid-induced erosive lesions of enamel and dentin often need restorative procedures for rehabilitation. Nowadays, mostly tooth-colored restoratives (ceramics or resin composites), which are adhesively fixed to the dental substrate are used for this purpose. In some cases it might be necessary to seal the exposed dentin before achieving this goal in order to combat hypersensitivities and to protect those teeth from further erosive and abrasive loss. Moreover, it is conceivable that patients will fall back into their old "erosive behavior" after the application of restoratives. The following overview describes in how far intra-oral erosive conditions might affect the integrity of restorative materials, such as composite resins and ceramics, or of dentin sealants. Additionally, the use of erosively altered enamel and dentin as substrate for adhesive technologies is elucidated.

RESULTS

In the literature, information of the behavior of tooth-colored restoratives under still persisting erosive conditions are limited and mostly based on in vitro-studies. There is information that the adhesion of dental adhesives to eroded dentin is compromised as compared to regular dentin. The impact of erosive conditions relevant for the oral cavity on ceramics and resin composites seems to be rather low, although only few clinical studies are available.

SIGNIFICANCE

The review showed that erosive conditions might have only little impact on behavior of tooth-colored restorative materials, such as composites and ceramics. Dentin sealants also seem to be rather resistant against erosive conditions and might therefore serve as an intermediary treatment option for exposed dentin surfaces. The adhesion of dentin adhesives to eroded dentin might be increased by mechanical pre-treatment of the substrate, but needs further investigation.

Is dental erosion really a problem?

Dental erosion is the non-carious dental substance loss induced by direct impact of exogenous or endogenous acids. It results in a loss of dental hard tissue, which can be serious in some groups, such as those with eating disorders, in patients with gastroesophageal reflux disease, and also in persons consuming high amounts of acidic drinks and foodstuffs. For these persons, erosion can impair their well-being, due to changes in appearance and/or loss of function of the teeth, e.g., the occurrence of hypersensitivity of teeth if the dentin is exposed. If erosion reaches an advanced stage, time- and money-consuming therapies may be necessary. The therapy, in turn, poses a challenge for the dentist, particularly if the defects are diagnosed at an advanced stage. While initial and moderate defects can mostly be treated non- or minimally invasively, severe defects often require complex therapeutic strategies, which often entail extensive loss of dental hard tissue due to preparatory measures. A major goal should therefore be to diagnose dental erosion at an early stage, to avoid functional and esthetic impairments as well as pain sensations and to ensure longevity of the dentition.

Dental erosion and its growing importance in clinical practice: from past to present

Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.