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Information for patients undergoing treatment for toothwear with resin composite restorations placed at an increased occlusal vertical dimension FJ Trevor Burke Dental Update 2024 41:1, 707-709.
Toothwear is affecting increasing numbers of the population. In the past, treatment of patients whose teeth were affected by toothwear often involved the reduction of these teeth for crowns; a severe form of toothwear. Contemporary management of such cases is by the bonding of resin composite restorations to the worn and wearing surfaces, with these restorations being placed at an increased occlusal vertical dimension. The advantage of the technique is its minimal-or non-intervention nature and its high reported degree of patient satisfaction. There are, however, short-term disadvantages to the technique, such as the potential for lisping, pain from the teeth which will be subject to axial orthodontic tooth movement, and difficulty in chewing on the posterior teeth if these are discluded. It is therefore important, as with any treatment, that the advantages and disadvantages are fully explained to the patient. This paper therefore describes the clinical technique and presents a Patient Information Leaflet that the author has used for over five years.
Clinical Relevance: Patients should be advised regarding the disadvantages and advantages of any technique.
Article
Toothwear (TW), alternatively known as tooth surface/substance loss (TSL) is increasing in incidence, especially in younger people, as has been demonstrated in the 2009 Adult Dental Health Survey in England and Wales, so its treatment is increasingly relevant.1 In the past, TW was often treated by crowning affected teeth,2 thereby protecting their surfaces from further TW, but resulting in preparation of the affected teeth and the potential for adverse pulpal sequelae. This has been considered to be a strange way to treat teeth which were already compromised by wear.3
The cause of TW may be considered to be multifactorial, being mainly due to erosion, attrition and abrasion, with abfraction also being a source of TW. However, the problem becomes increasingly significant when two or more factors present together. TW has been termed pathological when extensive areas of dentine are exposed,4 and may be measured by indices such as those proposed by Smith and Knight in 19844 or, more recently, by the relatively easy-to-use index proposed by Bartlett and colleagues.5,6
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