presntation 3 advanced restorative techniques using tooth
TRANSCRIPT
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Advanced restorative techniques
using tooth-coloured restorative
materials
Summary
• Multiple tooth composite build-ups
Toothwear
• An increasing problem
• Patients keeping their teeth for longer
• New ‘insults’ to integrity of tooth structure
Erosion
Abrasion
Burke et al., Dental Update 2011;38:165-168
Attrition
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Management
• Erosion
– Identify and address cause
• Attrition
– Correct habits if possible
– Parafunction
• Splint
• Hypnosis
• Masseteric botox
• Abrasion
– Identify and address cause
How can we restore what is left?
Do it with composite
• Semi-reversible
• Requires planning
• No specialist in-put required
• Follow some basic rules
BDJ 2011;211:E9
With some degree of maintenance, repeated
use of composite resin restorations to treat
localised anterior tooth wear at an increased
occlusal vertical dimension is a viable
treatment option over a ten-year period.
Initial evaluation (dentist)Duplicate in stone and vacuum-formed
stent
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Initial hygiene phase therapy
• Must have good standard of OH
• Must be dexterous enough to use floss
• Periodontal condition must be stable
Preservation of interdental spaces
Etch widely Composite application
Polishing and flossing Lower arch
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Completed case Increased OVD
The Dahl principle
Minor axial tooth movement
Dahl BL, et al., J Oral Rehab., 1975;2:209-214
The Dahl principle
The Dahl principle
Poyser et al., British Dental Journal 2005; 198: 669–676
The Dahl principle
• Younger patients
– Initial intrusion and
– Maximise over-eruption of non-contacting teeth
– May take up to 3 months
• Older patients (40+)
– Mainly intrusion
– Some over-eruption
– May take up to a year
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Your patient……..
Your patient
• 65 yrs fit and healthy
• Does not like the appearance of his teeth
• Can eat ok but tends to nibble
• What can you do?
Initial presentation Initial presentation
Diagnosis
• Toothwear
• Periapical periodontitis 32
• Generalised moderate chronic periodontitis
First steps
• Develop some thinking time
• Make sure OH is ideal
– Hygiene phase therapy
– Lots of instruction re interdental cleaning
– MUST be able to do this
• Sort out endo
= dentist
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Develop some thinking time Back to complete denture prosthetics
• Upper and lower record blocks
• Mandible closes along a retruded arc
– ie get the mandible back as it closes
• Stop at an appropriate height
– = RCP?
– = Approx height pt would have had if no wear
• Occlusal plane is usually a very good guide
Occlusal plane Re-design the teeth?
Ask for technical help Ask for technical help
Undercut for claspUndercut for clasp
Cingulum rests
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Ask for technical help Ask for technical help
Ask for technical help Start treatment
Wedgets Isolate
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Etch everywhere! Dry
Initial composite More composite!
Cure, cure, cure Polish and floss
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Upper arch Completed composite
P/P
Now its your turn!