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

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

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

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

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

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

Ask for technical help Ask for technical help

Ask for technical help Start treatment

Wedgets Isolate

Etch everywhere! Dry

Initial composite More composite!

Cure, cure, cure Polish and floss

Upper arch Completed composite

P/P

Now its your turn!