Professional Documents
Culture Documents
condition and degree of compliance to and gingival indices, and by measuring papilla must be assessed because these
go through a possibly lengthy gingival recession, probing depths and factors, together with loss of septal
treatment must be evaluated before tooth mobility. Radiographs are also bone, may lead to excessive embrasure
irreversible treatment is initiated. For required. Uncontrolled moderate or space.
restorative treatment planning, the advanced periodontal disease are
patient should be assessed in terms of considered as contraindications for
Periodontal, Endodontic, Coronal, advanced restorative care because Endodontic Assessment
Occlusal, Functional and Aesthetic further periodontal breakdown may Pain may be the reason that a patient
(PECOFA) factors. A systematic jeopardize any restorative treatment. seeks professional dental care. The
treatment approach should be used to Recession of gingival tissue margins pulpal status of the worn dentition
manage characteristic worn dentitions may expose unsightly restoration must be assessed by heat/cold,
involving different tooth surfaces and margins. In addition, reduced alveolar percussion and electric pulp tests, and
degrees of severity. For practical bone support may be associated with the periapical status by the use of
reasons, the worn dentition may be unwanted tooth movement. When radiographs. Because endodontic
classified according to location: existing clinical crown length is treatment through cemented
inadequate and extracoronal restoration extracoronal restorations may adversely
localized anterior toothwear; is required, surgical crown lengthening affect the strength of the restorations,
localized posterior toothwear; can be used, but the outcome relies on all necessary root canal treatment
generalized toothwear. the existing periodontal health and should be completed beforehand.
architecture.6 In the maxillary anterior Existing root canal fillings must be
region, the distance between the roots, carefully evaluated. Retreatment should
Periodontal Assessment the presence or absence of an be considered if the root filling is
The gingival and periodontal tissue interdental papilla, and the proximity of inadequate and/or associated with
health should be evaluated using plaque the midline fraenum to the interdental periapical pathology. If a post-retained
Tensile strength 519 448 45.5 (before bonding) 24.8 (ultimate tensile
(MPa)26 strength) (feldspathic).
Fragile in thin section
Handling properties:
Surface treatment required Require sandblasting May require heat treatment May require sandblasting Requires hydrofluoric
before bonding for oxide formation, before bonding acid etching. If surface
sandblasting or tin plating glaze is lost, it becomes
before bonding more abrasive
Marginal accuracy Accurate casting Accurate casting Large polymerization shrinkage Large firing shrinkage
Polishability Difficult in polishing and Easy for polishing and Easy for polishing and finishing Difficult in polishing and
finishing finishing finishing
Chemical stability Good corrosion resistance Good corrosion resistance High water absorption, staining Good
Retention of the final restorations Figure 3. Case 1: (a) Right buccal view, showing the posterior segment in occlusion. (b) Left
buccal view: the posterior segment is in occlusion.
depends on the quality and quantity
Aesthetic Assessment
Appearance is a major concern to the
patient when the anterior teeth are
affected by toothwear. Preoperative
assessment should include: Figure 7. Case 2: The right buccal view shows
the amount of posterior separation achieved
Figure 5. Case 2: An upper hard acrylic occlusal severity of tooth damage; immediately after cementation of the Dahl
splint at increased occlusal vertical dimension. appliance.
location of lip line; and
location of gingival margin.
CASE STUDY 1
A 27-year-old woman attended,
complaining of mild pain and sensitivity
around her front teeth, which had been
present for about 2 years. Her dental
Figure 9. Case 2: Space was created between condition had been stable during the Figure 11. Case 2: Postoperative frontal view.
the upper and lower incisors after decementation past 12 months. Her medical history
of the Dahl appliance. revealed no conditions predisposing to
gastric illness, but the patient had a patient had canine guidance in left and
stressful job in an airline company and right lateral excursions.
she consumed a large volume of citrus A soft vinyl occlusal splint was made
juices. to protect the teeth and to reduce
The patient had excellent plaque dentine sensitivity by home-use
control and good gingival health. Tooth fluoride gel application. After dietary
sensitivity was associated with dentine advice and a 6-month monitoring
exposure on the palatal surfaces of her period, the incisal edges of 1|1 were
upper anterior teeth. Enamel chipping repaired with resin composite
Figure 10. Case 2:Six gold palatal veneers were of 1|1 was also visible (Figure 1), with (Spectrum TPH, Dentsply, Milford,
cemented (321|123). minimal involvement of the labial DE19963-0359, USA) and the palatal
surfaces of other anterior teeth. surfaces were restored with nickel-
Occlusal relationships were analysed at chromium veneers at an increased OVD
tooth tissues or restorative the chairside with the study casts (0.5 mm between upper and lower
materials; articulated in the retruded contact central incisors) (Figure 2). The
physically strong in thin sections position (RCP). There was little posterior teeth were separated and
(have high flexural strength); discrepancy between RCP and the occlusal contacts were re-established
repairable in the mouth; and intercuspal position (ICP). The overjet after 4 weeks (Figure 3). A ‘long’
economical to use. and overbite were minimal, and the monitoring period before definitive
required for complex cases (see Figure 16. Dahl BL, Krogstad O. Long-term observations of 21. Chana H, Kelleher M, Briggs P et al. Clinical
an increased occlusal face height obtained by a evaluation of resin-bonded gold alloy veneers.
17). A suitable recall programme is also
combined orthodontic/prosthetic approach. J Oral J Prosthet Dent 2000; 83: 294–300.
necessary to maintain successful Rehabil 1985; 12: 173–176. 22. Hemmings KW, Darbar UR, Vaughan S. Tooth
outcomes. 17. Cheung SP, Dimmer A. Management of the worn wear treated with direct composite restorations
dentition: a further use for the resin-bonded cast at an increased vertical dimension: results at 30
metal restoration. Restor Dent 1988; 4: 76–78. months. J Prosthet Dent 2000; 83: 287–293.
18. Bishop K, Bell M, Briggs P et al. Restoration of a 23. O'Sullivan ET, Setchell DJ. Two-body method for
worn dentition using a double-veneer technique. testing tooth wear by restorative materials. J Dent
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