Practical Procedures in the Management of Tooth Wear

Subir Banerji is a Dental Practitioner, Director of the MSc in Aesthetic Dentistry and a Senior Clinical Lecturer at King's College London Faculty of Dentistry, Oral and Craniofacial Sciences, London, UK.

Shamir B. Mehta is a Dental Practitioner, Deputy Director of the MSc in Aesthetic Dentistry and a Senior Clinical Lecturer at King's College London Faculty of Dentistry, Oral and Craniofacial Sciences, London, UK.

Niek J.M. Opdam is a General Dentist and Associate Professor at the School of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.

Bas A.C. Loomans is a General Dentist, Assistant Professor and Project Leader of the Radboud Tooth Wear Project at the School of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.

Foreword ix

Acknowledgement xi

About the Companion Website xiii

1 Introduction and the Prevalence of Tooth Wear 1

1.1 Introduction 1

1.2 Physiological Wear and Pathological Wear: The Concept of Severe Tooth Wear 2

1.3 The Prevalence of TW 4

1.4 An Overview of the Challenges Associated with TW 6

1.5 Conclusion 7

References 9

2 The Aetiology and Presentation of Tooth Wear 11

2.1 Introduction 11

2.2 Intrinsic Mechanical Wear 12

2.3 Extrinsic Mechanical Wear 13

2.4 Non‐carious Cervical Lesions 14

2.5 Chemical Wear 15

2.6 Cofactors 20

2.7 Conclusion 20

References 23

Further Reading 24

3 The Clinical Assessment and Diagnosis of the Wear Patient 25

3.1 Introduction 25

3.2 The Initial Assessment: The Presenting Complaint and the History of the Presenting Complaint 26

3.3 Medical History 27

3.4 Dental and Socio‐behavioural History 29

3.5 Patient Examination 30

3.6 Special Tests 42

3.7 Summary 43

3.8 Conclusion 43

References 48

Further Reading 49

4 The Diagnosis of Tooth Wear, Including the Use of Common Clinical Indices 51

4.1 Introduction 51

4.2 The Use of Descriptive Means to Qualify and Quantify Tooth Wear 53

4.3 The Use of Clinical Indices for the Diagnosis of TW 57

4.4 Conclusion 61

References 65

5 Clinical Occlusion in Relation to Tooth Wear 67

5.1 Introduction 67

5.2 The Concept of the Ideal Occlusion 67

5.3 The Fabrication of Appropriate Study Casts and Records to Enable Occlusal Analysis 70

5.4 How and When to Take the Conformative Approach to Restorative Rehabilitation 80

5.5 How and When to Adopt a Reorganised Approach 82

5.6 The Placement of Dental Restorations in Supra‐occlusion: The Dahl Concept 85

5.7 Summary and Conclusions 88

References 92

Further Reading 94

6 Management of Tooth Wear: Monitoring and Prevention Strategies 95

6.1 Introduction 95

6.2 Counselling and Monitoring 95

6.3 Prevention 98

6.4 Preventive Measures in Case of Chemical Wear 98

6.5 Preventive Measures in Case of Mechanical Wear 99

References 101

7 The Role of Occlusal Splints for Patients with Tooth Wear 103

7.1 Introduction 103

7.2 The Role of Stabilisation Splints for the Management of Tooth Wear 103

7.3 Clinical Protocol for the Fabrication of a Stabilisation Splint: The Conventional Approach 105

7.4 The Use of CAD/CAM for Fabrication of a Stabilisation Splint 107

7.5 The Use of Soft (Vacuum‐formed) Occlusal Splints for the Management of TW 108

7.6 Summary and Conclusion 109

References 113

Further Reading 113

8 Treatment Planning and the Application of Diagnostic Techniques 115

8.1 Introduction 115

8.2 Developing a Logically Sequenced Treatment Plan for a Patient with Pathological Tooth Wear 116

8.3 Forming the Aesthetic Prescription for the TW Patient 121

8.4 The Preparation and Evaluation of the Diagnostic Wax‐Up 124

8.5 Summary and Conclusions 125

References 127

9 Concepts in the Restoration of the Worn Dentition 129

9.1 Introduction 129

9.2 The Additive/Adhesive Approach Versus the Conventional/Subtractive Approach for the Management of Worn Teeth 129

9.3 Concepts in Dental Adhesion 135

9.4 Some Pragmatic Considerations when Attempting to Apply Adhesive Techniques to the Management of TW 140

9.5 Summary and Conclusions 141

References 142

Further Reading 144

10 Dental Materials: An Overview of Material Selection for the Management of Tooth Wear 145

10.1 Introduction 145

10.2 The Use of Resin Composite to Treat TW 146

10.3 The Use of Cast Metal (Nickel/Chromium or Type III/IV) Gold Alloys 153

10.4 Adhesive Ceramic Restorations 154

10.5 Summary 156

References 157

Further Reading 160

11 The Principles and Clinical Management of Localised Anterior Tooth Wear 161

11.1 Introduction 161

11.2 Inter‐occlusal space availability 162

11.3 Restoration of Localised Anterior TW 163

11.4 Summary and Conclusions 179

References 180

12 The Principles and Clinical Management of Localised Posterior Tooth Wear 183

12.1 Introduction 183

12.2 The Canine–Riser Restoration 184

12.3 Techniques for the Restoration of Localised Posterior Wear Using Adhesively Retained Restorations 184

12.4 Restoration of Localised Posterior Wear Using Conventionally Retained Restorations 190

12.5 Management of the Occlusal Scheme When Using Indirect Restorations to Treat Localised Posterior TW (Other than in the Supra‐Occlusal Location) 191

12.6 Summary and Conclusions 193

References 194

13 The Principles and Clinical Management of Generalised Tooth Wear 197

13.1 Introduction 197

13.2 The Prosthodontic Approach to the Restorative Rehabilitation of Generalised Tooth Wear 199

13.3 Conclusions 203

References 205

14 The Prognosis of the Restored Worn Dentition: Contingency Planning, the Importance of Maintenance, and Recall 207

14.1 Introduction 207

14.2 Survival of Direct and Indirect Restorations 208

14.3 Repair and Replacement 209

14.4 Repair Techniques 210

14.5 Conclusions 214

References 216

Index 219