Abstract
This chapter introduces the air indexing method for detecting and quantifying cervical dentin hypersensitivity (CDH) as a companion to the T-Scan Occlusal Analysis System which evaluates force and timing values for occlusal contacts of teeth. This chapter will also highlight an evidence-based retrospective investigation undertaken between 1979 and 1996 that evaluated associations and/or correlations between diagnosed CDH and its resolution following occlusal adjustment. This retrospective's method described the detection, diagnosis, and treatment of the signs and/or symptoms of the common clinical finding amongst patients with CDH. Stress physics will illustrate how small occlusal contacts magnify the impact that applied occlusal contact force has on the cervical regions of teeth. This resultant cervical stress is etiologic for how non-carious cervical lesions (NCCLs) form and degrade tooth roots. This chapter also explains how biocorrosion from endogenous and exogenous sources produces loss of dentin's protective proteins, glycoproteins, and cementum, which add to the effects of applied occlusal force, thereby creating CDH symptoms and NCCLs. CDH appears resultant from the co-factors of occlusal forces that produce cervical stress, along with biocorrosion, that are both modified by occlusal surface friction. The air indexing method of CDH diagnosis is an objective diagnostic means to detect and quantify CDH symptoms during the formation of cervical lesions. This chapter presents the clinical benefits of melding the T-Scan Occlusal Analysis System with the Air Indexing Method when clinically assessing and treating cervical hard tissue pathologies. The clinician gains significantly more occlusal insight as opposed to using either methodology alone, when air indexing is combined with T-Scan's occlusal contact force and timing data. Lastly, this chapter introduces two case reports of how T-Scan guided occlusal adjustments can be effective at reducing CDH and prohibiting the progression of gingival recession.
TopBackground
Cervical stress distant from applied occlusal forces may result from chronic microtrauma or macrotrauma (Speck, et al., 1979). Chronic microtrauma is defined as the repetitive low force inter-arch contact of teeth over time. This type of trauma occurs during swallowing, habitual function, parafunction, or mastication (Dejak et al., 2003; Grippo, 1991; Grippo et al., 2004; Kydd, 1957; Shore, 1976; Straub, 1960). Microtrauma may exist with or without a food bolus.
Microtrauma may be considered as either physiologic or pathologic, when it results in premature signs and/or symptoms of Occlusal Disease (OD) by disrupting masticatory system health (Grippo et al., 2012-B; Ruiz & Coleman, 2008). The term Occlusal Disease (OD) first appeared in the literature in 1990 (Lytle, 1990), was further modified 17 years later (Ruiz, 2007), and then redefined again, one year afterward (Ruiz & Coleman, 2008). Occlusal Disease (OD) includes clinical findings of occlusal wear, fractures of teeth or restorations, hypersensitivity of teeth during mastication, cervical dentin hypersensitivity (CDH) (Coleman et al., 2003; Coleman & Kinderknecht, 2000-A), tooth hypermobility (Harrel et al., 2006), fremitus (Harrel, et al., 2006; Ruiz, 2007), abfractive stress (Coleman, et al., 2003; Grippo, 1991; Ruiz, 2003; 2005; 2007), vertical bone loss, or localized bone destruction (secondary to non-inflammatory or bacterial periodontal disease) (Harrel, et al., 2006), and masticatory muscle or TMJ pain (Gremillion, 2006; Ruiz, 2005; Sipila, et al., 2006). This comprehensive listing of OD conditions appears lastly in a 2008 publication (Ruiz & Coleman, 2008).
Key Terms in this Chapter
Microtrauma: The repetitive low-force interdigitation and compressions of teeth during inter-arch contact. It may be generalized or localized with or without active occlusal disease.
Biocorrosion: Electrical, biochemical, and/or electrochemical degradation of dental tissue. Its effect may degrade both hard and soft tissue.
Nociception: A neural polysynaptic muscular response to stimuli from distant receptors. A threshold of receptor stimulation must be reached, to affect the clinical detection of contractions of the muscle.
Cervical Dentin Hypersensitivity (CDH): Sensitivity of the CEJ to external stimuli, such as air, cold, tactile stimulation, electrical stimulation, and/or acid exposure.
Occlusal Disease (OD): The premature presence of wear facets, fractures of teeth or restorative materials, tooth hypermobility seen without gingival inflammation or periodontal bone loss, isolated CDH episodes, tooth fremitus, hypersensitivity of teeth during mastication without the presence of a cracked tooth, localized vertical bone loss secondary to periodontal bone loss, masticatory muscle or TMD pain, without respective anatomic pathology.
Friction: Friction results from mechanical surface interaction during motion, when the substrate surfaces are under solid, liquid, and/or gaseous applied force.
Cervical Stress: The resultant vectored deformation in the cervical regions of teeth upon the hydroxyapetite crystal arrangement, in response to tensile and/or compressive force applied on the tooth’s occlusal surface. Adequate periodontal bone levels assist in the tooth’s deformation by resisting the applied occlusal load, inducing the tooth to accommodate the load by flexing.