Retrospective long term monitoring of tooth wear using study models

Abstract

Objective Tooth wear is recognised as a common feature of European dentitions. However, little is known about its progression in susceptible patients. The aim of this study was to assess the degree and progression of tooth wear in patients by examining study casts taken of their teeth on two separate occasions. Design Over 500 sets of study casts taken during an 18-year period from patients referred for a variety of restorative procedures, were examined at Guy's Dental Hospital. Of these, 34 cases were found to have consecutive models taken at two time intervals and these were used to assess the progression of tooth wear. Study models from 19 females and 16 males, with an average age of 26 years (range 18-60) at the time of their first presentation and were all examined by a single operator. The Smith and Knight tooth wear index was used to assess the degree of tooth wear at presentation and then at another time which was a median of 26 months (interquartile range 14 -50 months) later. Results The most common initial TWI score per surface was 1, with 54% of surfaces affected at the first assessment and 57% at the second. Score 2 was less common (14% at both assessments) and the scores for 3 and 4 combined were relatively uncommon with 5% of surfaces effected. Minimal progression of tooth wear was observed on study casts with only 7.3% of surfaces involved. Conclusion In this sample, tooth wear was a slow, minimally progressive process.Tooth wear is increasingly recognised as a common feature of European dentitions with alarmingly high levels observed in children and adults. [1][2][3] Despite this data indicating that tooth wear is prevalent, little is known about its progression. The major problem with measuring tooth wear accurately is the identification of reproducible reference points that are themselves not eroded by acids.An area that has shown promise on the measurement of tooth wear is laser profilometers which scan replicas of the worn teeth. [4][5][6] However, their use remains within the confines of clinical research. Therefore comparing changes on study models of patients with worn teeth remains the most convenient clinical method to measure tooth wear. If the activity is recognisable from obvious changes on sequential study casts then there is justification to treat the wear with conventional restorative techniques. On the other hand if the patient's main concern is preservation of tooth tissue, reviewing the wear would be a more effective management.Knight et al 7 reported longitudinal measurement of wear from observations of orthodontic stone casts of patients over an average of 20 years. The authors measured occlusal/incisal wear in the pre-treatment and post orthodontic treatment records of 223 patients treated and they reported that wear could be predicted from the appearance of the study casts taken when they were in the mixed dentition stage. Pintado et al 8 measured wear over two years on 18 adults and also reported that attrition had progressed. Yet there remains scarce information on whethe...

Wear characteristics of current aesthetic dental restorative CAD/CAM materials: Two-body wear, gloss retention, roughness and Martens hardness

“…As the lesion progresses, there is a tendency towards the reduction of the cusp height and flattening of the occlusal inclined planes (Mehta et al, 2012) leading to a loss of vertical dimension as also shown in the present two-body wear experiment in Figures 2 to 4. Wear assessments from a group of patients suggest that wear is normally a slow process (Bartlett, 2003). How well this phenomenon can be imitated experimentally, with the help of artificial masticators to assess the adequacy of restorative materials, still remains a matter of discussion (Heintze 2012;Lambrechts et al, 2006).…”

Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear

“…Several researchers appear to support the view that once tooth wear has been diagnosed, wear progression appears to occur at a relatively slow rate, particularly in cases where preventative advice has been successfully implemented. 28,29 However, sporadic bursts of wear activity may occur amongst these patients associated with lifestyle changes and personal circumstances, which may have the potential to produce severe wear. This concept supports the need for a 'screening tool', which will help to detect clinically significant pathological wear and help to monitor wear progression over an extended period of time (particularly where practitioners within a given dental practice may change over such a given long period of time).…”

A proposed system for screening tooth wear

“…11,12 These studies imply that dietary advice reduces the rate of tooth wear and eliminates the need for clinical intervention. Currently work from our research group supports the conclusion that tooth wear is a slow process once preventive advice has been successfully implemented.…”

“…Currently work from our research group supports the conclusion that tooth wear is a slow process once preventive advice has been successfully implemented. [11][12][13] Therefore, with these • Presents a convenient and simple way to record tooth wear in practice.…”