Indications for the use of direct composite restorations in the management of tooth wear.

The increasing prevalence of tooth surface loss has been widely reported. Patients present with varying degrees of tooth wear and consideration is given to whether a prevention and monitoring approach, or a treatment and restoration approach, is appropriate. A missed diagnosis or excessively prolonged monitoring risks progression to the detriment of a successful outcome, with the potential compromise on the quality and quantity of tooth structure available for predictable adhesive dentistry. Direct composite resin (DCR) restorations can be considered as a viable treatment option for all extents of tooth wear, including cases that have progressed to a severe degree. This paper aims to review the indications for DCR restorations in the management of tooth wear, using clinical cases to demonstrate their effectiveness.

Clinical considerations in the application of direct composite for tooth wear.

Various techniques are available for the application of composite to restore worn teeth. Different techniques may be chosen based on the clinical presentation or clinician preference. However, for composite to be successful, there are numerous factors which must be considered in order to optimise the outcome. Pre-treatment steps, such as isolation for optimal moisture control and adequate surface preparation of the tooth, as well as the post build-up objectives of achieving a stable occlusion, good marginal adaptation and final aesthetics, are discussed in the paper.

Epidemiology, aetiology and prevention of tooth wear.

Tooth wear is a commonly reported finding globally; however, many patients are unaware of having tooth wear. Identifying early signs of erosion, abrasion or attrition and determining the risk factors contributing to a patient's tooth wear may help to prevent further loss of enamel and dentine in the future. Appropriate prevention should be instigated, or appropriate referral made to other health professionals, when conditions such as gastroesophageal reflux or eating disorders are suspected. This paper presents the epidemiology and aetiological factors for tooth wear, as well as identifying the common clinical presentations of tooth wear. Patient perspectives on tooth wear and preventive techniques that can be utilised are also discussed.

Gastrointestinal conditions related to tooth wear.

Gastro-oesophageal reflux disease (GORD) is a relatively common condition that occurs in adults and less commonly in children. It develops when the reflux of stomach contents into the oesophagus causes troublesome symptoms and/or complications. Signs and symptoms include heartburn, retrosternal discomfort, epigastric pain and hoarseness, dental erosion, chronic cough, burning mouth syndrome, halitosis and laryngitis. A proportion of patients will, however, have silent reflux. Strongly associated risk factors include family history, age, hiatus hernia, obesity and neurological conditions, such as cerebral palsy. There are different treatment options which may be considered for GORD, consisting of conservative, medical and surgical therapy. Dentists should be aware of the symptoms of GORD and dental signs of intrinsic erosion indicative of possible GORD so that they can question patients about this and, if appropriate, initiate a referral to a general medical practitioner.

The opinions of GDPs on the challenges of managing tooth wear in primary dental care.

As patients access most of their dental care within the primary care setting, it is relevant to consider how the experience and opinions of general dental practitioners (GDPs) influence the diagnosis, monitoring and treatment of their patients with tooth wear. This paper records the agreed outcomes of semi-structured discussions with three experienced GDPs. The aim is to continue the broader debate about how patients with tooth wear currently are and ideally could be managed within the primary care settings in England. The outcomes are also likely to be applicable to other countries, regardless of the local funding models for routine patient care.

Pathosis or Additional Maxillary Neurovascular Channel? A Case Report.

This case report highlights an incidental finding of an anatomic variation of a neurovascular channel in close proximity to the maxillary right permanent lateral incisor (tooth #7). A 32-year-old patient presented with discomfort and a history of trauma in childhood to the right maxillary central incisor (tooth #8). A periapical radiograph of tooth #8 revealed an incidental finding of a radiolucent area in the apical one third of the right maxillary lateral incisor (tooth #7) root with the appearance of inflammatory apical root resorption. A cone-beam computed tomographic scan taken to assess the suspected area of resorption revealed this to be a neurovascular channel within the bone passing distal to the apex of tooth #7, which has been superimposed over the root of tooth #7 on the periapical radiograph. This case report highlights that additional bone channels are a common finding in the maxillary alveolus. These channels can in fact be the canalis sinuosus (or branches of it), a bone channel that is a frequent anatomic variant arising from the infraorbital canal. The canalis sinuosus has been reported rarely in the literature, but it should be considered to be a potentially common finding in the maxillary incisal region. Clinicians are made aware of the presence of additional neurovascular bone channels such as the canalis sinuosus when interpreting radiographs for assessing periapical status of teeth and for surgical planning in the anterior maxilla.

Managing the Unstable Mandibular Complete Denture ­ Tooth Placement and the Polished Surface.

Constructing satisfactory conventional mandibular complete dentures is often challenging in comparison to the upper counterpart partially due to differences in the anatomy of the denture-bearing area. This problem is exaggerated in the atrophic mandible, where supporting structures are frequently ill-defined and suboptimal in quality. Implant-retained prostheses offer well recognized benefits but are not always a feasible options, so conventional methods must be relied upon. The importance of impression quality and registration has been reviewed previously. This article aims to discuss the influence of tooth placement, the polished surfaces and the neutral zone on the success of lower dentures. Clinical relevance: This article highlights the importance that polished surface contouring and tooth prescription can have on the outcome of lower dentures. Techniques for assessing and recording the neutral zone are explained, along with alternative occlusal schemes.