Tooth wear
Sorenson3 to be what happens with full coverage preparations for ceramic veneered crowns. We feel strongly that
many experienced dentists would recognise that most sane patients would reject the destructive options if those known figures mentioned above were explained to them in advance, and in writing, in order to obtain their informed consent for the ‘dental destruc- tion’ illustrated in these case reports, especially given that there were other viable, non destructive options available to them. For example, instead of this
irreversibly damaging porce- lain pornography4 some direct composite bonding applied to the upper incisors to lengthen them and composite additions to the canines to reintroduce canine guidance, would have predictably changed this sort of ‘pseudo class three’ into a class one occlusion in relatively short order, but without taking any pulpal risks or doing any structural damage to these teeth. If the colour happened to
have been an important issue for the patient then, again in our view, conventional night guard vital bleaching with ı0 per cent carbamide peroxide could have sorted out that perceived colour problem safely and predictably in advance of some non destruc- tive direct resin composite bonding being done to change the shapes of the teeth. Such an additive rather than destructive approach can sort out these apparent tooth surface loss problems, probably in a few visits, with minimal biologic or structural damage being done to the shortened upper teeth. Direct resin composite bonding would probably have been predictable, because the composite resin material indi- cated here only needed to be resistant to further acid attack, the source of which should have been determined prior to treatment. By way of contrast to the destructive philosophy, a different case with moderate
Fig 2a
Fig 2b
Fig 2c Fig 2a-d
This moderate tooth surface loss was dealt with by conventional night guard vital bleaching, followed later by a additive approach with direct free hand resin composite bonding and then three adhesive bridges. No unnecessarily destructive dentistry was carried out
wear is shown in Figure 2a-d (above) being treated with an ‘additive approach’ rather than a ‘subtractive’ one. In spite of these alterna-
tive, biologically sensible approaches being proven5,6,7 and readily available, we are very perturbed to see case reports using an outdated and grossly destructive full coverage crown approach to these mainly structurally sound upper teeth, to produce a ques- tionable biologic and ‘cosmetic’ result under the guise of using a semi adjustable articulator. In those cases, the ‘air rotor
attack’ did more damage in one visit than many previous, or successive years of wear might have caused, if the erosive acid attacks had been identified in order to eliminate them. This sort of aggressively destructive treatment for the apparently mild tooth surface loss was and remains, in our sincerely held opinion, the wrong treatment from a biologic perspective. We believe that it can result in about 40 more years of struc- tural damage being done by a dental bur in a short period of time. This was something that
we feel can not now be justified ethically, or biologically, given our modern understanding of the longer term biological costs of damaging worn but mainly sound teeth.
ABOUT THE AUTHORS
John Craig, BDS, DGDP(UK), FFGDP, FDS (RCSEd), qualified in 1966 and was a GDP for 40 years, mainly in Falkirk. He had a long involvement with postgraduate dental education in Scotland and was chair of SDVTC for seven years.
The adaptive class three
shown here was probably just that – adaptive – and in our experience this occurs as a
Continued »
Fig 2d
As chair of the steering group which set up the FGDP in Scotland and the first Director of the West of Scotland Division, he was instrumental in laying the foundations of the FGDP in Scotland. He was a member of the BDA Rep Body/Rep Board for many years, vice-chair of the BDA Executive Board and President of the BDA in 2005. In 2003 he was awarded an FDS (ad Hominem) by the Royal College of Surgeons of Edinburgh.
Martin Kelleher MSc, FDSRCPS, FDSRCS is a consultant in restorative dentistry at King’s College London Dental Institute. He has lectured nationally and internationally on a large variety of topics and is a past president of the British Society for Restorative Dentistry as well as serving on the board of Dental Protection Ltd for 10 years.
He is on the GDC specialist lists in restora- tive dentistry and prosthodontics and is the author or co-author of many peer reviewed papers, a number of chapters in books, and some controversial opinion articles. He is in private restorative practice in Bromley, Kent.
Scottish Dental magazine 49
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