Clinical presentation of two phenotypes of tooth wear patients

Restorative options for moderate and severe tooth wear: A systematic review

OBJECTIVES

This systematic review aimed to evaluate the failure of different types of restorative treatments for tooth wear.

STUDY DESIGN

A search was conducted in Medline, Cochrane, Web of Science, SCOPUS, and Embase (October 2023) with no limits for publication year or language. Randomized and non-randomized studies comparing restorative options to treat moderate to severe tooth wear were included. Two reviewers independently selected studies, extracted data and assessed the risk of bias. Failure data was obtained from each study and organised into either 'major failure,' with the need to replace the restoration, or 'minor failure,' where the restoration was repaired or refurbished. Studies that did not bring comparisons or sufficient data to calculate failures were excluded.

RESULTS

3977 articles were found; 43 studies were eligible for analysis. For RCT studies (n = 6), direct composite showed a mean annual failure rate (AFR) of 10.54 % for minor failures and 8.38 % for major failures. For non-RCT studies (n = 37), these were 3.97 % and 0.4 % respectively. For RCT studies, indirect composite showed a mean AFR of 12.84 % for minor failures and 10.41 % for major failures. For non-RCT studies, these were 2.9 % and 0.15 % respectively. For RCT studies, indirect ceramic showed a mean AFR of 0.09 % for minor failures and 0.13 % for major failures. For non-RCT studies, these were 0.83 % and 0.33 % respectively.

CONCLUSION

Indirect restorations demonstrated lower failure rates; however, they can be more invasive and require more operator time than alternatives. Direct methods showed greater failures but offer a minimally invasive modality. (CRD42022358586) CLINICAL SIGNIFICANCE: This study will provide clinicians with a more informed view of the success, survival and failure rates of materials when deciding how to restore tooth wear.

Changes in Oral Health-Related Quality of Life after (non-)restorative treatment of tooth wear in adult patients: A systematic review

OBJECTIVE

Literature was systematically reviewed to determine the impact of tooth wear management on the Oral Health Related Quality of Life (OHRQoL) amongst adult patients with tooth wear.

DATA

A protocol was developed, a priori (PROSPERO CRD42022343108) following the PRISMA guidelines. To assess risk of bias and certainty of evidence the RoB2-tool, JBI-tool, and GRADE were used.

SOURCES

PubMed, Scopus, Cochrane Library, Embase and Web of Science were searched. The first search took place on 21.10.2022, subsequently updated in May 2024.

STUDY SELECTION

Inclusion criteria were RCT's, quasi-RCT's, prospective- or retrospective-studies with adult patients with moderate to severe tooth wear, treated restoratively and/or with counseling and monitoring that were also assessed for OHRQoL during at least two time points. Exclusion criteria were, studies with children, OHRQoL only measured once, narrative and systematic reviews, conference abstracts, technical reports, consensus papers, and any other type of non-clinical study.

RESULTS

Six papers were included in this review. Overall, qualitative analysis revealed an increase in OHRQoL after restorative treatment, and no change in OHRQoL after one year of counseling and monitoring. Some studies showed a slightly negative effect on esthetics in the years post-treatment, and some of the dimensions of the Oral Health Impact Profile (OHIP) did not change or demonstrated minor change only. For the RCT's, blinding of participants and operators was not possible, as the participants had an awareness of the treatment. For the non-RCT's, the primary issue was the lack of control, with a general high risk of bias.

CONCLUSION

The provision of restorative treatment in patients with moderate to severe tooth wear frequently results in a positive impact on OHRQoL. Further research is required to substantiate the importance of OHRQoL for the treatment of (tooth wear) patients.

CLINICAL SIGNIFICANCE

The outcomes may help dentists and researchers better understand the advantages of using PROMS in their clinical work or research as valuable outcomes.

Diagnostic accuracy of clinical signs to detect erosive tooth wear in its early phase

BACKGROUND

Agreement exists about most of the clinical features of erosive tooth wear, though no evidence supports their validity in diagnosing the condition.

OBJECTIVE

This study aimed to determine the accuracy of clinical signs for diagnosing erosive tooth wear in a young adult general population.

METHODS

We conducted a cross-sectional study of dental students. In the first session, two examiners independently determined the presence of erosive tooth wear based on glazed enamel surfaces, morphological changes on non-occlusal surfaces, flattening of convex areas, or any type of concavity. In the second session, one examiner recorded the presence of clinical signs according to the Tooth Wear Evaluation System. The diagnostic accuracy of each clinical sign, both alone and combined, was assessed by calculating their sensitivity and specificity for detecting erosive tooth wear and performing multivariate logistic regression models.

RESULTS

Of the 147 participants (78 women and 69 men; median age, 22 years) we included, 76.2% had erosive tooth wear. The single clinical signs with greatest balance between the sensitivity and specificity were 'convex areas flatten' (63% and 71%, respectively) and 'dull surface' (47% and 89%, respectively). Multivariate logistic regression revealed that 'preservation of the enamel cuff' (odds ratio, 22) and the combination of 'smooth silky shining, silky glazed appearance, and dull surface' (odds ratio, 68) had the best predictive values.

CONCLUSIONS

The most accurate clinical signs for detecting early erosive tooth wear were dull surface, flattened convex areas and preservation of the enamel cuff.

5.5-year-survival of CAD/CAM resin-based composite restorations in severe tooth wear patients

OBJECTIVES

Aim of this prospective study was to assess full mouth rehabilitation of severe tooth wear patients using minimally invasive CAD/CAM resin-based composite (RBC) restorations and direct veneers by evaluating restoration survival up to 5.5-years.

METHODS

Twenty-two patients with generalized severe tooth wear with functional and/or esthetic problems were included. Following minimally invasive preparation, CAD/CAM RBC restorations (LAVA Ultimate,3M) were adhesively luted, direct RBC veneers (Filtek Supreme XTE, 3M) were applied in the aesthetic region. Patients were recalled after 1m,1y,3y,5y and seen in between recalls by their general dentists or at the clinical study center if complaints occurred. Failures were categorized as F1 (severe deficiencies requiring replacement/extraction), F2 (localized deficiencies requiring re-cementation/repair) and F3 (small chippings requiring refurbishment/monitoring). Survival of indirect restorations was evaluated using lifetables and Kaplan-Meier-graphs, distinguishing between failure categories and tooth type (front teeth=FT, premolars=PM, molars=M). F1 + F2 and F1 + F2 + F3 failures were analyzed using Cox regression on the variables tooth type/ location, age, gender and VDO increase (p < 0.05).

RESULTS

568 indirect restorations and 200 direct veneers in 21 patients evaluated for up to 5.5-years. For indirect restorations, 96 failures were recorded (F1:6;F2:41;F3:49) and annual failure rates were 0.29%(FT), 1.56%(PM), 2.93%(M) for F1 +F2 and 0.53%(FT), 2.42%(PM), 6.11%(M) for F1 + F2 + F3. Reasons for failure were chipping fracture (48), adhesive fracture (32), complete debonding (7), caries (4), endodontic treatment (1) and reasons unknown (documentation general dentists, 4). Molar tooth type had a statistically significantly increased probability of failure compared with front teeth and premolars for F1 + F2 + F3 (p < 0.006). Direct veneer restorations showed 18 failures (F1:2;F2:9;F3:7).

SIGNIFICANCE

Minimally invasive CAD/CAM RBC restorations combined with direct RBC veneers showed an acceptable clinical mid-term survival for restorative rehabilitation of severely worn dentitions.

Patients with gastroesophageal reflux disease (both reflux oesophagitis and non-erosive reflux disease): Prevalence and severity of erosive tooth wear and saliva properties

BACKGROUND

The prevalence between erosive tooth wear (ETW) in association with reflux oesophagitis (RO) has been reported. However, the severity of both diseases and the relationship between ETW and non-erosive reflux disease (NERD) is unclear.

OBJECTIVES

The prevalence and severity of ETW were investigated in RO, NERD and healthy controls.

METHODS

135 patients with RO, 65 with NERD and 40 healthy controls were recruited for this case-control study. A modified tooth wear index was used to evaluate the prevalence and severity of ETW. Salivary secretion and buffer capacity were assessed prior to endoscopy. The prevalence and severity of ETW, saliva properties among each group were analysed using Pearson's chi-squared test.

RESULTS

A total of 135 cases (56.3%) were categorised as the patient with ETW (55 with mild RO, 49 with severe RO and 31 with NERD). There was a significant relationship between the prevalence of RO and ETW, while there was no significant correlation between the prevalence of NERD and ETW. There was a significant difference related to the severity between RO and ETW. For salivary secretion, there was a significant difference between with and without ETW in patients with mild RO, severe RO and NERD. There was a significant difference between with and without ETW for salivary buffer capacity in patients with mild and severe RO.

CONCLUSION

There was a significant association of the prevalence and severity between RO and ETW. Clinical signs such as ETW and salivary buffer capacity depended on the severity of RO.

Wear behaviour of direct composite restorations in tooth wear patients: a 5-year clinical study

OBJECTIVE

This study aimed to investigate the wear behaviour of direct composite restorations after 5 years and associated patient factors.

METHODS

38 patients (6 females, 32 males; 35.2 ± 7.6y) from the Radboud Tooth Wear Project with generalized moderate to severe tooth wear were treated with direct composite restorations on all teeth. Ethical approval was sought and granted before the study was undertaken. Intraoral 3D scans were recorded at 1 month (baseline) and 5 years (recall) after treatment. The amount of height loss was measured at six index teeth (first molars and upper central incisors). Patient factors (age, vertical dimension of occlusion increase, bite force, aetiology score, jaw position and bearing/ non-bearing cusps) were included in the analysis. Multilevel multiple regression with bootstrapping was used to analyse the influence of these factors on wear behaviour of restorations. Observer reliability was tested by paired t-tests and Band-Altman plots (p<0.05) RESULTS: After 5 years, the mean height loss was 0.23± 0.19 mm for incisors and 0.43± 0.24 mm for molars (p≤0.001). Patient factors did not show any significant influence on height loss of the composite restorations, while bearing cusps showed significant more wear compared to non-bearing cusps (p≤0.001). The observer reliability tests confirmed the repeatability (correlation of 0.809, DME 0.103).

CONCLUSIONS

Wear of composite restorations is a significant and relevant factor over time in patients treated with severe tooth wear. Within the limitations of this clinical study, patient factors were found not to have a significant effect on wear behaviour of direct composite restorations.

Long-term results of a randomized clinical trial of 2 types of ceramic crowns in participants with extensive tooth wear

STATEMENT OF PROBLEM

Evidence is sparse regarding the long-term outcomes of restorative treatment of patients with extensive tooth wear.

PURPOSE

The purpose of this long-term prospective randomized clinical trial was to evaluate the performance and success rate of pressed lithium disilicate (LD) and translucent zirconia (TZ) crowns in participants with extensive tooth wear.

MATERIAL AND METHODS

A total of 62 participants with extensive tooth wear (17 women, 45 men; mean age 44.8 years; range 25-63 years) received a total of 713 crowns, LD=362 and TZ=351. Both types of crowns had chamfer preparations and were adhesively luted with dual-polymerizing composite resin cement (PANAVIA F 2.0; Kuraray Noritake Dental Inc). The restorations were clinically reevaluated on average 14, 31, 39, 54, and 65 months after insertion of the crowns according to the modified United States Public Health Service (USPHS) criteria.

RESULTS

After an observation period of up to 6 years, the survival rate for both types of crowns was 99.7%, with 1 lost LD crown after 1 year as a result of loss of retention and 1 lost TZ crown after 3 years because of tooth fracture at the cemento-enamel junction. The success rates were similar for both types of crowns: 98.6% for LD and 99.1% for TZ. Reasons for failures were that 3 participants in each group developed apical lesions, minimal ceramic fractures, or their crowns were rebonded after loss of adhesion. Assessment of color at baseline was significantly different with a better match for LD (84.8% Alfa, 15.2% Bravo) than for TZ crowns (36.5% Alfa, 63.5% Bravo), including TZ crowns with veneered porcelain (P<.001). Secondary caries and cracks did not occur. A post hoc analysis of clinical performance did not indicate any significant differences between extensive tooth wear with primarily mechanical or chemical factors.

CONCLUSIONS

No differences were found between the 2 types of ceramic materials concerning the long-term success and clinical performance, except that TZ crowns were rated by a blinded clinician as less esthetic than LD crowns. The use of high-strength ceramic materials, as well as reliable adhesive bonding, are probably the key factors in the long-term success of ceramic crowns in participants with extensive tooth wear independent of the specific etiology.

Correlations between dental wear and oral cavity characteristics: Mandibular torus, palatine torus, and oral exostoses

OBJECTIVE

This study evaluates the correlations amongst mandibular torus, palatine torus, oral exostoses to dental wear/loss and temporomandibular damage.

METHODS

The sample consists of 504 skulls from the Hamann-Todd Osteological Collection; 223 African American and 281 European Americans aged between 30 and 80 years. The sample was analyzed using Pearson's Chi-square for significance of sex, age, ancestry, and wear as well as the interactions between the demographic variables and the presence of mandibular torus, palatine torus and oral exostoses.

RESULTS

Wear was statistically significant by age and sex but not ancestry. The maxillary exostoses varied significantly by age, ancestry and wear but not sex. Mandibular torus frequencies varied significantly by wear, sex and ancestry. The palatine torus varied significantly across wear groups, sex and ancestry.

DISCUSSION

The etiology of nonmetric oral cavity characteristics, mandibular torus, palatine torus and oral exostosis, is complex. The degree to which traits' presence and expression is the result of genetic and environmental interactions is not fully understood. More than age, sex or ancestry, the degree of dental wear and tooth loss influences the presence and expression of the oral cavity traits. The sample can be characterized as the presence of exostoses in higher frequencies in young African American males with little tooth loss. Males of both ancestral groups with heavy wear have higher frequencies of mandibular tori than females. The palatine torus is more common in edentulous European American females.