Restorative management of the worn dentition: 3. Localized posterior toothwear

The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues, viz. enamel and dentine. Tooth wear can be divided into the subtypes mechanical wear (attrition and abrasion) and chemical wear (erosion). Because of its multifactorial aetiology, tooth wear can manifest itself in many different representations, and therefore, it can be difficult to diagnose and manage the condition. A systematic approach is a sine qua non. In the below-described tooth wear evaluation system (TWES), all necessary tools for a clinical guideline are present in different modules. This allows the dental clinician, in a general practitioner setting as well as in a referral practice setting, to perform a state-of-the-art diagnostic process. To avoid the risk of a too cumbersome usage, the dental clinician can select only those modules that are appropriate for a given setting. The modules match with each other, which is indispensable and essential when different modules of the TWES are compared. With the TWES, it is possible to recognise the problem (qualifying), to grade its severity (quantifying), to diagnose the likely causes and to monitor (the progress of) the condition. In addition, a proposal for the classification of tooth wear is made. Further, it is possible to determine when to start a treatment, to make the decision which kind of treatment to apply and to estimate the level of difficulty of a restorative treatment.

A composite approach to the management of worn maxillary first molar teeth

A lady with extrinsic acid erosion was referred to the restorative department at Bristol Dental Hospital by her General Dental Practitioner (GDP) for restoration of worn maxillary first molar teeth. These teeth were both causing symptoms of dentinal sensitivity and two attempts had been made to restore them with composite by her GDP. The restorations failed because there was insufficient space to bond the composite in place, which was due to dento-alveolar compensation of the first molars into the space created by the wear. Following relevant preventive advice, the maxillary first molar teeth were restored with 'high' direct composite resin, which allowed for adequate strength in bulk for retention while acting as fixed intrusion devices. These cured the patient's sensitivity and within four months her occlusion compensated for the composites and had re-established.