The Management of Advanced Tooth Wear Using the T-Scan/BioEMG Synchronization Module

Introduction

The masticatory system may be considered a morphological-functional unit that is subject to dynamic transformations that occur throughout a patient’s life (Ash & Nelson, 2003). As in every dynamic system, key elements may become damaged over time. In the case of the masticatory system, tooth wear (occlusal wear) has been thought of a basic physiological adjustment mechanism whereby the patient’s central nervous system detects unwanted opposing occlusal surface frictional events and attempts to remove them. These premature occlusal surface contacts (which are often undetectable via traditional means) are systemically “self-removed”, often without the appearance of clinical symptoms (Bartlett, 2003; Bartlett, Anggiansah, Owen, Evans, & Smith, 1994). To some degree, limited tooth wear appears to be a universal finding.

In adults, the distinction between physiological and pathological tooth wear is by no means easy to define, but extreme tooth wear is considered to be an abnormality (Smith & Knight, 1984). It has been frequently suggested that the clinical presentation of occlusal wear depends upon (Bartlett, 2003):

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  The degree of wear.

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  The localization of tooth structure damage.

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  The progression of wear over time.

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  The contributory etiological factors.

The clinical examination of occlusal wear often reveals the flattening of occlusal surfaces, the presence of enamel discoloration, the presence of enamel cracks and fractures, dentine exposure, and in extreme cases, pulp denudation. Wear damage to the clinical crowns of teeth often results in short teeth and flattened occlusal surfaces. This often leads to the clinical loss of occlusal vertical dimension(OVD) (Davies, 2002).

Pathologic tooth wear may be very destructive to the masticatory system. Presently, there are no strict guidelines to instruct clinicians as when to commence intervention, and how to best manage any needed reconstructive treatment (Johansson, Johansson, Omar, & Carlsson, 2008). Most often, the decision to intervene in ongoing occlusal wear depends upon the clinician’s experience and the patient’s needs.

Today, there are many methods and materials available to use in the restoration of worn teeth. However, there exists controversy with Dental Medicine, concerning the most appropriate and effective approaches that a clinician could follow to treat wear. It has been suggested that definitive restorative procedures should not be performed without first identifying the etiological factors contributing to excessive occlusal wear (Bartlett, 2003). Moreover, the treating of these etiologic factors should combine preventive procedures that can limit further tooth structure degradation with clinician-recommended, patient lifestyle alteration advice (Bartlett, 2003).

Costly, conventional fixed and removable prosthetic treatment tends to be the rehabilitation mainstay in the treatment of advanced tooth wear, especially in cases where the occlusal vertical dimension has been decreased. Such treatment is complex and may be highly invasive, requiring that optimal occlusal post treatment function be obtained with the newly installed restorations, to limit the failure potential from parafunction of the new restoration, long-term. Therefore, desirable treatment goals when restoring the worn dentition should be to install well-fitting, high quality restorations, which function under favorable (low muscle activating) occlusal conditions (Kerstein & Radke, 2012):

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  Short Disclusion Time (DT) in excursions (< 0.5 seconds per excursion).

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  Short Occlusion Time (OT) in closure (< 0.2 seconds from 1^st contact to last).

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  With a high degree of force equality per tooth and arch-half (~ 50% per arch half; ~ 25% per quadrant; counterpart cross-arch tooth with nearly equal force %).