WORN DENTITION MANAGEMENT

1. POSTGRADUATE DEPARTMENT OF CONSERVATIVE
DENTISTRY AND ENDODONTICS
SEMINAR TOPIC:-
RESTORATIVE MANAGEMENT OF WORN
DENTITION - I
(AETIOLOGY )
Presented by-Ashish Choudhary
PG student
UNDER GUIDANCE OF :-
Prof. Dr Riyaz Farooq (HOD)
Dr Aamir Rashid (Asst. Prof.)
Dr Fayaz Ahmed (lecturer)

2. “ Rehabilitation of dentition is not
all about restoring the mouth with
28 crowns or an aesthetic smile ”
“Itz about Cosmetic Functional Oral Rehabilitation”

3. CONTENTS
• Introduction
• Abrasion
• Abfraction
• Attrition
• Bruxism
• Erosion
• Combined Mechanisms
• Severity of wear
• Diagnosis of tooth wear
• Role of wear in occlusion
• Restoration of worn dentition
• Rehabilitation of worn dentition

4. INTRODUCTION
The term ‘tooth wear’ (TW) is a general term
that can be used to describe the surface loss of
dental hard tissues from causes other than
dental caries, trauma or as a result of
developmental disorders
(Hattab F, Yassin O)
Int J Prosthodont 2000; 13: 101–107
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

5. It is a normal physiological process that is
macroscopically irreversible and is cumulative
with age
Lambrechts et al. in 1989 estimated the normal vertical
loss of enamel from physiological wear to be
approximately 20-38 μm per annum
J Dent Res 1989; 68: 1752–1754
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

6. Tooth wear’s multi-factorial aetiology
ABRASION
ABFRACTION
ATTRITION
EROSION
Clinically however, it is difficult (if not at times impossible)
to isolate a single aetiological factor when a patient
presents with tooth wear
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

7. A growing challenge in dentistry
It therefore implies continuous monitoring to control related
pathologies
Quintessence Int 2003;34:435-446
J Oral Rehabil 2008;35:476-494
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

8. Multifactorial preventive & Restorative approach
 involve different specialties,
 starting with preventive measures &
 ending up with full-mouth rehabilitation
 adhesive and partial restorations for intermediate stages
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 1 • SPRING 2011
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

9. Aspects which compound difficulties
associated with tooth wear management
include:
• Deriving an accurate diagnosis !!
• When to implement active restorative intervention??
• How to restore such severely worn dentitions, with the
aim of ultimately attaining a functionally and aesthetically
stable restored dentition??
•A lack of knowledge relating to the availability of
contemporary materials and their respective techniques of
application!!!
BDJ;2012 ; VOLUME 212 NO. 1
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

10. A modern approach to the treatment of tooth
wear is to prevent the progression of this
disease before a full prosthetic rehabilitation
would be needed
Such a treatment approach would become totally
ineffective because of potential biological
complications and inadequate biomechanical
rationale
J Prosthet Dent 2003;90:31-41
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

11. A modern treatment model involves
three steps:
1) Comprehensive etiological
clinical investigation
2) Treatment planning and execution
3) Maintenance
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 1 • SPRING 2011
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

12. RESTORATIVE OPTIONS
•Conventional fixed restorations
•Removable onlay/overlay prosthesis
•Minimal preparation adhesive restorations
Tooth wear and sensitivity-clinical advances in restorative dentistry; Martin Dunitz
 Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

13. AETIOLOGY
ABRASION
 derived from the Latin word abrasum (to
scrape off)
 can be defined as the surface loss of tooth
structure resulting from direct frictional forces
between the teeth and external objects or from
frictional forces between contacting components
in the presence of an abrasive medium
(Marzouk )
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

14. Hard
Toothbrush
Abrasive
Toothpaste
Intensive Horizontal
brushing technique
“well-defined, V-shaped notches”
in the cervical regions of one or
more facial tooth surface
Location of the abrasion (three-body wear) lesions
depends on tooth alignment and/or which hand is
holding the toothbrush
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

15.  In case of toothpaste abuse, the
anatomical detail of the affected surfaces is
faded with a sandblasted appearance
 When the enamel wears through to the dentine,
cupping or cratering will form
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

16. Occupational/Oral Habits causing
Abrasion :
Depression abrasion
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

17. Location and pattern of abrasion
may be related to the cause :
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

18. Classification:
(Vimal Sikri)
a) Notch N / V shaped
 Oblique occlusal and cervical walls meet
at certain depth.
 No definite axial wall.
b) C shaped defect (C)
 Cross section C shaped with rounded floors
c) Undercut concave (UC)
 Occlusal & cervical walls intersect with definite axial wall
d) Divergent box (DB)
 Axial wall present
 Occlusal and cervical walls diverge
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

19. 1) Shallow (S): 0.1 - 0.5 mm in depth
2) Deep (D): More than 0.5mm.
but no pulp exposure
3) Exposure (E): Pulp is exposed
 Premolars > Canines > Maxillary first molars
 Lingual surfaces are rarely affected
 Localized lesions may be present on teeth or tooth placed
facial to the remaining dental arch
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

20.  Initially may be linear lesion
 As lesion progresses, peripheries become
more angularly demarcated from adjoining areas
 Extremely smooth & polished surface of lesion
 Sometimes surface may exhibit scratches in it
 Surrounding walls tend to make a V shape
 Probing or application of heat, cold or sweets can elicit
pain.
 Intermittent in character
 In slowly progressive defects, reparative dentin formation occurs
over a period of time making them asymptomatic
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

21. Diagnose the cause of presented abrasion
Treat the cause: Habit : Break the habit
Iatrogenic : correct it
If the habit cannot be broken , the
Restorative treatment can by-pass the effect
of habit
Desensitization by F-solution (NaP/SnF 8-
30% for 4-8 min) or iontophoresis.
Restorative treatment
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

22. Restorative protocol
ABRASION
Anterior tooth or
Facially conspicuous
area of posterior tooth
Inconspicuous area in
posterior tooth
Adhesive tooth coloured
materials
Metallic restoration
(but if cavity preparation would
compromise the PD organ vitality)
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

23. Surgical retraction for restoration of non carious
cervical lesion -
 By doing miniflap surgical retraction, it provides
access to the subgingival lesions.
 Small vertical incisions are made on the mesial
& distal to the lesion and not involving the papilla
The incision should be made such a way that it
should not extend to the mucogingival junction
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

24. Noncarious Cervical Lesions:
graft or restore
When to graft:
 No attached gingiva
 No enamel defect
 Class I or II recession i.e. there is no loss of interdental
bone or soft tissue
 Papilla length and fullness are adequate
 Esthetics is important
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

25. When to restore:
 Adequate attached gingiva
 Defect is mainly in enamel
 Lesion is deeper than 2 mm horizontally
 Class III recession i.e. there is some loss of interdental bone
height or soft tissue fullness, making complete root coverage
not possible
 Esthetics is not of primary importance
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

26. When to graft and restore:
 No attached gingiva
 Defect in the enamel only
 Recession is significant (more or equal 2mm)
 Papilla length and fullness are inadequate
 Esthetics is important
Introduction
 Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

27.  Concept of “stress induced cervical lesion”
 derived from Latin words
ab – away, plus “fractio” – breaking
 Synonyms : Idiopathic cervical erosion
(Grippo)
Abfraction is the microstructural loss of tooth substance in
areas of stress concentration
(JADA2004)
Introduction
Abrasion
 Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

28. Abfractions are described as
“ wedge shaped defects” in the cervical region
of the tooth
 Loss of tooth structure resulting from repeated
tooth (enamel & dentin) flexure produced by
occlusal stresses
Introduction
Abrasion
 Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

29.  Occurs most commonly in the
cervical region of teeth, where
flexure may lead to a breaking away
of the extremely thin layer of enamel
rods, as well as microfracture of
cementum & dentin
 These lesions, frequently have a
crescent form along the cervical
line, where this brittle and fragile
enamel layer exists
Introduction
Abrasion
 Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

30. Mechanism of Formation of
Abfraction Lesion:
Compressive
forces Tensile forces
Kornfeld indicated that the cervical surface lesions tended to occur on
the part ofthe tooth opposing the side that had developed an occlusal
wearfacet caused by attrition
Introduction
Abrasion
 Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

31. Characteristics of Abfraction Lesion:
 Wedge-shaped defects limited to cervical area
 Deep, narrow, V-shaped
 Single tooth or Sometimes subgingival
 More common in mandibular dentition and
among those with bruxism, hyper or malocclusion
Rate of progression : 1 m per day (Xhonga et al)
Introduction
Abrasion
 Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

32. How it is different from Abrasion????
 A single tooth (but not adjacent teeth) is affected
 The deep, narrow,
“V-shaped notch” does
not allow the toothbrush
to contact the base of the
defect
 Gingivitis is present

33. ENAMEL DENTIN
 Hairline cracks
 Striations / molecular
slip planes” or “Lines of
Luder”
 Saucer shaped
 Semilunar shaped
 Cusps tip invagination
 Gingival - “McCoy notches”
 Circumferential
 Multiple
 Sub-gingival
 Lingual
 Interproximal
 Alternate
 Angular
 Crown margin
 Restoration margin
Jol. Esthetic Dentistry Vol. No. 3, No. 1 ; 1991
(McCoy )

34. Treat the cause before restoring
Occlusal loading on the tooth can be tested
in centric occlusion and in excursive
movements with occlusal marking paper
RESTORATIVE
TREATMENT
Introduction
Abrasion
 Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

35.  derived from the ‘Latin’ word attritum
 Surface tooth structure loss resulting from direct
frictional forces between contacting teeth (Marzouk)
 Attrition is mechanical wear of the incisal or occlusal
surface as a result of functional or parafunctional
movements of mandible (Sturdevant)
Prevalence of Attrition : 13% to 98%.
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

36.  Attrition process begins from the time it erupts
in the mouth and makes contact with reciprocating
tooth surface
 While a certain amount of attrition is
physiologic, excessive destruction of tooth
structure is not physiologic
Occlusal wear that
renders itself vulnerable
even to normal function
loading cannot be
regarded as normal
If occlusal wear occurs at a
rate faster than compensatory
physiologic mechanisms, this
is not physiologic
(Russel)
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

37.  Multifactorial etiology with age
 Canine guidance having significant influence
 Other Factors:
 Para functional habits such as bruxism & clenching
 Crowding
 Occlusal slides
 Cross bites
 Chewing habits and Diet
ATTRITION
 Continuing and Slow process
(vertical loss of enamel rarely exceeds 50 m / year)
Dental attrition has been
used in archaeology and
forensic sciences to
estimate human age
Teeth continue to erupt in adulthood
even in the absence of masticatory
function and concomitant attrition
(Newman)
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

38. Widening of the
proximal contact area
Surface area
Susceptible to decay
Proximal surface attrition
(proximal surface faceting)
M-D dimension
decreases
Drifting of teeth
Decrease Arch length
Altered Occlusion
↓ Embrasure space
Alteration of physiology
of interdental papilla
Difficult plaque control
Periodontitis
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

39. Occluding surface attrition
Flattening/Faceting of
occluding elements
In severe cases, dentine wears
faster than enamel leaving
“scooped area” surrounded by
peripheral rim of enamel
Reverse cusping
If the wear is severe,
generalized &
accomplished in a
relatively short time
Vertical loss might be imparted on the face as
a Loss of Vertical Dimension
Strain in stomato gnathic system
If attrition over a
longer period of
time
vertical
dimension loss
will be confined
to the teeth but
not imparted to
the face

40. Consequences of tooth wear
 Deficient masticatory capabilities of the teeth
 Cheek biting (cotton roll cheeks)
 Gingival irritation
 Decay
 Tooth sensitivity
 Interfering / deflecting points
 Predominantly horizontal masticatory movement /
TMJ problems
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

41. (modified from Richards and Brown)
Attrition index:
o - No wear
1- Minimal wear
2 - Noticable flattening ,
parallel to the occluding planes
3 - Flattening of cusps / grooves
4 - Total loss of contour / dentin exposure
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

42. SMITH AND KNIGHT 1984TOOTH WEAR INDEX:
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

43.  Diminished vermillion borders and drooping
commisures
 Wear facets with sharply defined line angles
 Restorations that wear at same rates as adjacent
enamel
 Asymptomatic teeth usually
 History of parafunctional habits
Loss of
posterior
teeth
Traumatic Anterior
Occlusion
* Role of Occlusal prematurities
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

44. TREATMENT MODALITIES
 Depends on the degree of Attrition:
MILD
MODERATE
SEVERE
 If surface attrition
Slower
 Intrapulpal
dentin
deposition
Faster
 Pulpal
exposures

45. In case of mild-moderate Attrition
MONITORING PHASE
1. Periodically Checkup
2. Instructions for oral hygiene
3. FLUORIDE application
4. Hard plastic interocclusal device
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

46. BUT if its severe!!!
1. Endodontic therapy or Extraction,
(in case of pulpally involved teeth)
2. Disocluding-protecting occlusal splints
(to control parafunctional activities)
3. DIAGNOSE & RESOLVE Myofunctional, TMJ, or any other
symptoms in the stomatognathic system
4. Occlusal equilibration
(Selective grinding, coinciding RCP with ICP)
 During the last three procedures
 Use of Fluorides
 Use of Temporary Restorations
 Evaluation of PERIODONTAL health
(fortunately favourable)
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

47. RESTORATIVE OPTIONS
(ONLY METALLIC!!!!!)
That too WHEN…….
 Noticeable loss of vertical dimension that has not
been compensated
 Extensive loss of tooth structure (localized or generalized)
 Reshaping not effective!!
 Superimposed decay
 Concern over proper maintainence of Periodontium
 Cracked or Endodontically treated
Introduction
Abrasion
Abfraction
 Attrition
Bruxism
Erosion
Combined
mechanisms
Severity of wear

48.  OCCLUSAL PARAFUNCTIONAL HABIT
May be: Sleep bruxism or Awake bruxism
 It is defined as the grinding of teeth during non
functional movements of the masticatory system: it
is a mandibular parafunction
Mechanical wear resulting from bruxism often
results in progressively greater wear towards the
anterior teeth ( with open bite as exception)
Introduction
Abrasion
Abfraction
Attrition
 Bruxism
Erosion
Combined
mechanisms
Severity of wear

49. 2 Aetiological Models :
Introduction
Abrasion
Abfraction
Attrition
 Bruxism
Erosion
Combined
mechanisms
Severity of wear
STRUCTURAL FUNCTIONAL
 Occlusal
Interferences
 Altered
maxillo-mandibular
relationships
 STRESS
 Children Brux
Bruxism produces surface loss, which is related to
the duration and force & frequency of parafunction

50. • Grooving of lateral borders of tongue
• Cheek biting
• Fractured porcelain restorations
•Cupping or cratering of occlusal surface
•Teeth grinding or clenching
•Teeth are worn down, flattened or chipped
•Increased tooth sensitivity
•Jaw pain or tightness in jaw muscles
•Earache
•Dull morning headache
•Chronic facial pain
Introduction
Abrasion
Abfraction
Attrition
 Bruxism
Erosion
Combined
mechanisms
Severity of wear

51.  No accepted cure as yet
 wearing of a full-width acrylic
NIGHT GUARD
 Occlusal therapy should only
be carried out after successful
stabilization splint usage, and
careful 'mock' equilibration on
accurately mounted study
models
IMPORTANCE OF USING
INTRERMITTENT
SPLINTS

52.  derived from latin verb erosum ( to corrode)
EROSION
 defined as loss of tooth structure resulting from chemico
mechanical acts in the absence of specific microorganisms
(Marzouk)
“If it is not abrasion or attrition,
it must be erosion”
Introduction
Abrasion
Abfraction
Attrition
Bruxism
 Erosion
Combined
mechanisms
Severity of wear

53. THE CULPRITS BEHIND DENTAL
EROSIONS…..
SOFT DRINKS
BULIMIA
NERVOSA

54. wine-tastersASPRIN
Lemon suckingCOKE SWISHING

55. HIATUS
HERNIA
RUMINATION
+
GERD
OTHERS: diabetes, high blood pressure, cerebral
palsy, salivary gland agenesis, Sj¨ogren’s and
Down syndromes, and drug abuse
GERD
(Gastroesophageal
reflux disease)

56. Polished / Melted
appearance
Maxillary palatal
surface involvement
common
Cervical shoulder
formation
“Inverted V-sign”
(with unaffected
mandibular
anteriors)

57. Inactive sitesActive erosion sites
“ski slope”
like depressions
Proud amalgam

58. CUPPING (depending on severity)
Pulp visible
through dentin
(in severe
cases)

59. Classification of dental erosion
Grade 1
Early erosion,
Early stage loss of enamel structures minimal
loss of enamel only just measurable
Dull surface appearance (active)
Smooth/shiny (chronic)
Grade 2
 Erosion in enamel
 Obvious loss of enamel, dentin not
exposed

60. Grade 3
 Erosion in dentin
 Localized lesions involving dentin for
less than one third of the surface
Grade 4
 1/3-2/3 rd of tooth surface has exposed
dentin
Grade 5
 more than 2/3 rd of tooth surface
has exposed dentin and/or the
pulp is exposed

61. Management of EROSION
Treatment of
aetiology
Preventive
measures
RESTORATIVE
options
 Complete analysis of diet,
occlusion, habits,
environmental factors
 Every attempt to correlate
to a cause
 Try to eliminate the
probable cause
 Diagnostic modalities
 Patient education
 Counseling
 Physcian consultation
 Use of sugarless chewing
gum
 Pilocarpine
 Do not rush to restore
 Observe the progression
of lesion (WATCH
strategy)
1. Diminish the frequency and
severity of the acid challenge
2. Enhance the defense
mechanisms of the body (increase
salivary flow and pellicle
formation)
3. Enhance acid resistance,
remineralization and rehardening of
the tooth surfaces
4. Improve chemical protection
5. Decrease abrasive forces
6. Provide mechanical protection
7. Monitor stability
 Desensitisation by using fluoride
rinses, gels, and varnishes as well
as high-fluoride toothpastes and
remineralizing toothpastes
 Tooth coloured filling material
 FULL COVERAGE
RESTORATIONS
 Endodontic intervention, if
required
 FULL MOUTH
REHABILITATION

62. COMBINED MECHANISMS OF
TOOTH WEAR
Attrition-abfraction: joint action of stress and
friction when teeth are in tooth-to-tooth
contact
Abrasion-abfraction: loss of tooth substance caused by
friction from an external material on an area in which
stress concentration due to loading forces may cause tooth
substance to break away
Toothwear: ABC of the worn dentition; 1st ed
Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
 Combined
mechanisms
Severity of wear

63. Corrosion-abfraction: loss of tooth substance
due to the synergistic action of a chemical
corrodent on areas of stress concentration
Attrition-corrosion: loss of tooth substance due to the
action of a corrodent in areas in which tooth-to-tooth
wear occurs. This process may lead to a loss of
vertical dimension, especially in patients with GERD
or gastric regurgitation
Abrasion-corrosion: synergistic activity of corrosion and friction
from an external material. This could occur from the frictional
effects of a toothbrush on the superficially softened surface of a
tooth that has been demineralized by a corrosive agent
Toothwear: ABC of the worn dentition; 1st ed
Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
 Combined
mechanisms
Severity of wear

64. Biocorrosion (caries)-abfraction: pathological loss of tooth
structure associated with the caries process, where an area is
micromechanically and physicochemically breaking away
due to stress concentration.
 A common site for this synergistic activity is the cervical
area of the tooth, where it may be manifested as root or
radicular caries.
Articulating paper markings
indicate eccentric loading, which
induced stress concentration in the
cervical region (abfraction) and
may have exacerbated the caries
(biocorrosion).
Toothwear: ABC of the worn dentition; 1st ed

65. MULTIFACTORIAL NATURE OF
TOOTHWEAR
Toothwear: ABC of the worn dentition; 1st ed
Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
 Combined
mechanisms
Severity of wear

66. MULTIFACTORIAL NATURE OF
TOOTHWEAR
Toothwear: ABC of the worn dentition; 1st ed
Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
 Combined
mechanisms
Severity of wear

67. SEVERITY OF TOOTH WEAR
Tooth Wear Index by
Smith & Knight
 Received
criticism
BDJ; VOL-212; NO.1;2012
Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
 Severity of
wear

68. BEWE (Basic Erosive Wear Examination)
(Bartlett ;2010)
 Scale from 0 to 3 for each sextant
0 (no wear),
1 (initial loss of surface texture),
2 (less than 50% loss of surface) and
3 (greater than 50% loss of surface)
 Tooth most severely affected in a particular sextant is the one
for which the score is based on
 On completion of the BEWE, an aggregate score is reached for all
sextants
 The latter score can be used as a guide to the clinical
management of the patient concerned
 However, further studies are needed BDJ; VOL-212; NO.1;2012
Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
 Severity of
wear

69. BDJ; VOL-212; NO.1;2012
THE ACE Classification (Vialati & Bresler)

70. STAGES OF TOOTH WEAR (Khan et al & Young)
Toothwear: ABC of the worn dentition; 1st ed
Introduction
Abrasion
Abfraction
Attrition
Bruxism
Erosion
Combined
mechanisms
 Severity of
wear