Minimally invasive management of erosive tooth surface loss using a combined direct and indirect approach: a case report

This article describes the management of a patient with generalized (primarily erosive) tooth surface loss. It specifically looks at minimally invasive techniques using improvements in material science to achieve this in an efficient and predictable manner within a general dental practice setting. CPD/Clinical Relevance: The use of minimally invasive techniques within a general dental practice setting are highlighted.

The effect of mouthwashes on fluoride dentifrices in preventing dental abrasion or erosion

Erosive tooth wear (ETW) refers to the chemical dissolution of mineralized tissues by acids of non-bacterial origin. It occurs in the primary as well as the permanent dentition. In this study, our objectives were to investigate and compare the impact of chlorhexidine gluconate (CHX), essential oils (EO), and cetylpyridinium chloride (CPC) on ETW protection produced by conventional fluoride kinds of toothpaste. A clinically relevant in-vitro erosion/abrasion pH cycling model was employed to test the effect of the aforementioned mouthwashes on modulating the ability of NaF and SnF2 types of toothpaste. The mean dentin surface loss associated with NaF toothpaste was significantly lower than for the SnF2 toothpaste. On the other hand, enamel surface loss with SnF2 toothpaste was significantly lower than for the NaF toothpaste. Also, the surface loss of erosion was significantly higher when associated with abrasion than without brushing and for both enamel and dentin. There was no significant difference in the surface loss among all types of mouthwash. Commonly used types of mouthwash containing antimicrobial agents or additional fluoride do not impact fluoride toothpaste action on erosion/abrasion. Also, considering erosion only, the tested SnF2 dentifrice provided better protection against surface loss of enamel than the other.

McNamara's Fallacies in Dentistry. 2: Tooth Surface Loss Fallacies

Given the number of perceived myths and fallacies in relation to tooth substance loss, this article seeks to address these using a wide variety of clinical cases as examples and by way of scientific references. CPD/Clinical Relevance: The incidence of tooth wear is increasing, so an understanding of the myths and truths surrounding its treatment is valuable.

Three-Dimensional Surface Texture Characterization of In Situ Simulated Erosive Tooth Wear

This in situ erosive tooth wear (ETW) study tested enamel 3-dimensional (3D) surface texture outcomes for the detection and differentiation of ETW lesions simulated in clinically relevant conditions. Twenty participants enrolled in this 3-arm crossover intraoral ETW simulation and wore their own partial denture for 14 d holding 2 human enamel specimens (per arm). In each arm, participants were assigned to 1 of 3 different dental erosion protocols: severe (lemon juice/pH 2.5), moderate (grapefruit juice/pH 3.5), and no erosion (bottled drinking water, control). Enamel specimens were evaluated by white-light scanning confocal profilometry for 3D surface texture and surface loss (ETW model validation). Individual point clouds were analyzed using standard dental microwear texture characterization protocols for surface roughness and anisotropy. Fractal complexity ( Asfc), texture aspect ratio ( Str), and arithmetical mean height ( Sa) values were generated at baseline, 7 d, and 14 d. Data were analyzed by analysis of variance models suitable for the crossover design with repeated measurements, and correlation coefficients were used to examine the relationship between outcomes. Asfc and Sa differentiated ETW severity (no erosion < moderate < severe, P < 0.001) at days 7 and 14. Asfc and Sa were lower at baseline compared to days 7 and 14 ( P < 0.001) for moderate and severe challenges. Asfc increased from day 7 to 14 ( P = 0.042) for the severe challenge. For Str, ETW severity did not have a significant effect overall ( P = 0.15). Asfc and Sa were highly positively correlated ( r = 0.89, P < 0.001), while Asfc and Sa were not correlated overall with Str ( r < 0.1, P ≥ 0.25). Enamel surface loss increased with ETW severity (no erosion < moderate < severe, P < 0.001) at days 7 and 14, validating the ETW simulation model. Complexity ( Asfc) and roughness ( Sa) outcomes were able to detect and differentiate ETW levels, with Asfc being able to monitor the progression of severe lesions. No clear characterization of ETW lesions could be provided by the anisotropy ( Str) parameter.

Temperate Alpine glacier surface dynamics linked to collapsing subglacial conduits

&lt;p&gt;If tongues of temperate Alpine glaciers are subjected to high temperatures their topography may change rapidly due to the effects of differential melt related to aspect and debris cover. Independent of local surface melt, the position of subglacial conduits may have an important influence on ice creep and so on changes in topography at the ice surface. This reflects analyses that suggest that subglacial conduits at glacier margins may not be permanently pressurised; and that creep closure rates are insufficient to close subglacial conduits completely. Rapid climate warming may exacerbate this process, due both to surface-melt driven glacier thinning and over-enlargement of conduits due to high upstream melt rates. Over-enlarged conduits that are not permanently pressurised would lead to the development of structural weaknesses and eventual collapse of the ice surface into the conduits. We hypothesise that this collapse mechanism could represent an important and alternative driver of rapid glacier retreat.&lt;/p&gt;&lt;p&gt;In this paper we combine: (1) an extensive survey of glacier margin collapse in the Swiss Alps with (2) intensive monitoring of the dynamics of such collapse at the Otemma Glacier in the south-western Swiss Alps. Daily UAV surveys were undertaken at a high spatial resolution and with precise and accurate ground control. These datasets were used to generate surface change information using SfM-MVS photogrammetry. Surfaces of difference showed surface loss that could not be related to ablation alone. Combining them with three-dimensional ground-penetrating radar (GPR) surveys in the same zone showed that the surface loss was coincident spatially with the positions of sub-glacial conduits, for ice thicknesses between 20 m and 50 m. We show that this form of subglacial conduit collapse is also happening for several other glaciers in the Swiss Alps, and that this mechanism of snout collapse and glacier retreat has become more common than has hitherto been the case. It also leads to temporal patterns of glacier margin retreat that differ from those that might be expected due to glacier mass balance and ice mass flux effects alone.&lt;/p&gt;

Treatment of Tooth Wear Associated with Reduced Occlusal Vertical Dimension Using Direct Composite Restorations and a Removable Prosthesis

Tooth wear is increasing in prevalence within the United Kingdom. Treatment of tooth surface loss can be daunting for both the clinician and patient. However, use of additive resin composite restorations is a minimally invasive treatment modality. This case illustrates the treatment of tooth surface loss in both the maxillary and mandibular arches with direct composites restorations using putty indices generated from a diagnostic wax-up recorded in centric relation. The tooth surface loss had resulted in reduced restorative space on the right hand side. The restorative treatment involved increasing the anterior vertical dimension, enabling the provision of a cobalt-chrome partial denture. This case shows the restoration of form, function and aesthetics using a reorganised occlusal approach.

Is there a role for casein phosphopeptide–amorphous calcium phosphate (cpp-acp) in paediatric dentistry?

In the age of minimally invasive dentistry, products with the ability to prevent and reverse common dental diseases are becoming increasingly popular. Casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) contains the compounds casein, phosphate and calcium, which all have the ability to remineralize enamel. Dental caries, visible demineralization following removal of orthodontic appliances, non-carious tooth surface loss and dentine hypersensitivity due to structural anomalies are frequently seen in children and young people. The evidence for CPP–ACP and fluoride-containing CPP–ACP is positive for managing dental caries and non-carious tooth surface loss, specifically erosion, but is less clear in the management of visible demineralization following orthodontic appliance removal and dentine hypersensitivity owing to structural anomalies. When recommending CPP–ACP-containing products, dental practitioners should be aware of medical and social contra-indications that preclude its use. CPD/Clinical Relevance: CPP–ACP may have a role in the management of common paediatric dental conditions.