A Conservative Approach for Restoring Anterior Guidance: A Case Report

Spazio Oral Dental Education, San Isidro, Lima 27, Peru.
Journal of Esthetic and Restorative Dentistry (Impact Factor: 0.84). 06/2012; 24(3):171-82. DOI: 10.1111/j.1708-8240.2011.00483.x
Source: PubMed

ABSTRACT One of the most common dental problems in today's clinics is tooth wear, specifically when related to bruxism. In such cases, the esthetics of anterior teeth may be compromised when excessive wear to the incisal surfaces occurs. Anterior tooth wear resulting from parafunctional bruxism can be conservatively treated with the use of direct resin composite restorations. This restorative approach has the advantages of presenting good predictability, load resistance, acceptable longevity, preservation of healthy dental tissues, and lower cost when compared with indirect restorations. The use of resin composites to solve esthetic problems, however, requires skill and practice. Thus, the present article demonstrates a conservative approach for restoring the esthetics and function of worn anterior teeth with the aid of direct resin composite restorations and selective occlusal adjustment. CLINICAL SIGNIFICANCE: A conservative approach to restore anterior teeth with excessive wear is possible with direct resin composites.

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    ABSTRACT: Bruxism is a parafunctional habit characterized by grinding and/or clenching of the teeth. It may happen while awake (awake bruxism) or while sleeping (sleep bruxism). In adults, the prevalence is 20% for the awake bruxism and 8% for the sleep bruxism. Peripheral, central, and psychosocial factors influence the disorder, which may predispose to pain in the masticatory muscles and neck, headache, decreased pain thresholds in the masticatory and cervical muscles, limitation mandibular range of motion, sleep disorders, stress, anxiety, depression, and overall impairment of oral health. The aim of this study is to compare two distinct physical therapy interventions with dental treatment in pain, mandibular range of motion, sleep quality, anxiety, stress, depression, and oral health in individuals with bruxism. Participants will be randomized into one of three groups: Group 1 (n = 24) intervention will consist of massage and stretching exercises; Group 2 (n = 24) will consist of relaxation and imagination therapies; and Group 3 (n = 24) will receive dental treatment. The evaluations will be performed at baseline, immediately after treatment, and at 2-month follow-up. Pain intensity will be assessed using the visual analogical scale, while pain thresholds will be determined using dolorimetry. Mandibular range of motion will be assessed using digital pachymeter. Sleep quality will be assessed by the Pittsburgh Sleep Quality Index, anxiety by the State-Trait Anxiety Inventory, stress by the Perceived Stress Scale-10, depression by the Beck Depression Inventory, and oral health will be assessed using the Oral Health Impact Profile - 14. Significance level will be determined at the 5% level. This project describes the randomization method that will be used to compare two physical therapy interventions with dental treatment in the management of pain, mandibular range of motion, sleep quality, anxiety, stress, depression, and oral health in individuals with bruxism. The study will support the practice of evidence-based physical therapy for individuals with bruxism. Data will be published after study is completed.Trial registration: NCT01778881.
    Trials 01/2014; 15(1):8. DOI:10.1186/1745-6215-15-8 · 2.12 Impact Factor
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    ABSTRACT: Nowadays direct and indirect resin composites are frequently applied to build up the occlusion when extensive tooth wear took place. To achieve long-lasting restorations it is essential to obtain knowledge about their interactions due to occlusal contacts. Therefore, the two- and three-body wear between frequently used direct and indirect resin composites was investigated. The two- and three-body wear of three direct resin composites and three indirect resin composites, with Clearfil AP-X, Filtek Z250, and Filtek Supreme XT as antagonists, were measured, using the ACTA wear device. The wear rates were determined and the surfaces were evaluated with SEM. The most remarkable outcome was that the two-body wear rate of the different composites opposing the Z250 wheel were significantly higher. Furthermore, it was shown that the three-body wear rate was independent on the antagonist and in general higher than the two-body wear rate. To reduce abrasion of the opposing resin composite surface the resin composite fillers should consist of a softer glass, e.g. barium glass or in case of a harder filler the size should be reduced to nano-size. Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
    Dental Materials 12/2014; DOI:10.1016/ · 4.16 Impact Factor
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    ABSTRACT: To study progression of tooth wear quantitatively in a convenient sample of young adults and to assess possible correlations with occlusal conditions.Methods Twenty-eight dental students participated in a three-year follow up study on tooth wear. Visible wear facets on full arch gypsum casts were assessed using a flatbed scanner and measuring software. Regression analyses were used to assess possible associations between the registered occlusal conditions ‘occlusal guidance scheme’, ‘vertical overbite’, ‘horizontal overbite’, ‘depth of sagittal curve’, ‘canine Angle class relation’, ‘history of orthodontic treatment’, and ‘self-reported grinding/clenching’ (independent variables) and increase of wear facets (dependent variable).ResultsMean increase in facet surface areas ranged from 1.2 mm2 (premolars, incisors) to 3.4 mm2 (molars); the relative increase ranged from 15% to 23%. Backward regression analysis showed no significant relation for ‘group function’, ‘vertical overbite’, ‘depth of sagittal curve’, ‘history of orthodontic treatment’ nor ‘self-reported clenching. The final multiple linear regression model showed significant associations amongst ‘anterior protected articulation’ and ‘horizontal overbite’ and increase of facet surface areas. For all teeth combined, only ‘anterior protected articulation’ had a significant effect. ‘Self reported grinding’ did not have a significant effect (p > 0.07).Conclusions In this study ‘anterior protected articulation’ and ‘horizontal overbite’, were significantly associated with the progression of tooth wear. Self reported grinding was not significantly associated with progression of tooth wear.Clinical significanceOcclusal conditions such as anterior protected articulation and horizontal overbite seem to have an effect on the progression of occlusal tooth wear in this convenient sample of young adults.
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