noncariouslesionsandmanagement-220428043949.pptx

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1. NON CARIOUS LESIONS 1 1

2. Non carious destruction A ttr i tion Abrasion Abfraction Erosion Localized non-hereditary enamel hypoplasia Localized non-hereditary enamel hypocalcification Localized non-hereditary dentinal hypoplasia Localized non-hereditary dentin hypocalcification Discoloration Malformation Amelogenesis imperfecta Dentinogenesis imperfecta Trauma 2

3. Attrition 3 It can be defined as surface tooth structure loss resulting from direct frictional forces between contacting teeth Continuous ,age dependent process usually physiologic Affects occluding surfaces and results in flattening of their inclined planes and in facet formation ‘ R e v e r s e cusp ’ is se e n i n sev e r e c a s e s Accelerated by parafunctionaL mandibular movement noticebly brusixm

4. Can precipitate any of following: Physiologic surface attrition (proximal surface faceting) Results from surface tooth structure loss and flattening wideni ng of the proximal contact areas. Therefore area proximally is increased in dimension and is susceptible to decay. 4

5. Mesiodistal dimension of teeth are decreased ↓ Overall reduction of arch length ↓ Interproximal space will be decreased in dimension ↓ Thereby interfering physiology of interdental papillae ↓ More plaque accumulation ↓ P e riod o ntitis 5

6. Occluding surface attrition Loss ,flattening, faceting and/or reverse cusping of occluding elements → loss of vertical dimension of tooth If wear is severe ,generalized and accomplished in relatively shorter time →vertical loss on face as well as loss of vertical dimension If wear is over a long period of time alveolar bone can grow occlusally →vertical dimension loss is seen but not imparted to face. Deficient masticatory capabilities ,blunting of cusps may compel patient to apply more force on teeth. Cheek biting is sequelae of occlusal surface attrition Decay at occluding area leads to more exposed dentin Tooth sensitivity 6

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8. ■ Severe generalized attrition from tooth grinding with abrasion of exposed dentin The diestone cast shows flat enamel facet with well defined margins resulting from attrition Severe attrition 8

9. ATTRITION DUE TO BRUXISM. 9

10. Treatment modalities 10 Extraction of pulpally involved teeth Parafunctional activities ,bruxism should be controlled Myofunctional,TMJ,or any stomatognathic system disorders should be diagnosed and resolved Occlusal equilibrium should be performed Protect sensitive dentinal areas and actual caries should be obliterated Restorative modalities should be done.

11. An acrylic resin maxillary occlusal splint for correction of bruxism 11

12. Abrasion 12 Defined as surface loss of tooth structure resulting from direct friction forces between the teeth and external objects or from frictional forces between contacting teeth components in the presence of an abrasive medicine Pathologic process Sometimes abrasion rate is faster than the dentin deposition rate →direct or indirect pulpal involvement

13. ■ Cervical abrasion in unopposed premolar tooth resulting from incorrect tooth brushing and dentifrices Abrasion results in a more rounded and less well defined occlusal appearance 13

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15. TOOTH BRUSH ABRASION. 15

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17. Toothbrush abrasion most predominant Occur cervically,usually to the most facially prominent teeth in the arch Its surface extent, depth and rate of formation is dictated by: The direction of brushing strokes. The size of the abrasive. The percentage of abrasives in the dentrifice Type of abrasive Diameter of brush bristles Type of bristle Forces used in brushing Type of tooth tissues being abraded 17

18. Signs and symptoms of toothbrush abrasion: The lesion may be linear in outline, following the path of brush bristles. The peripheries of the lesion are very angularly demarcated from the adjacent tooth surface. The surface of the lesion is extremely smooth and polished, and it seldom has any plaque accumulation or carious activity in it. The surrounding walls of abrasive lesion tend to make a v-shape ,by meeting at an acute angle axially. Probing or stimulating (hot, cold or sweets) the lesion can elicit pain. 18

19. Other oral habits which create abrasion: a.Chewing tobacco b.Toothpick c.Cutting sewing thread with incisor teeth d.Holding and pulling nails with front teeth Iatrogenic Dentures with porcelain teeth opposing natural teeth Use of cast alloy with higher abrasive resistance than tooth enamel in a restoration opposing natural teeth 19

20. Treatment modalities 20 Diagnose the cause of the presented abrasion. Correct or replace the iatrogenic dental work,habit Restorative treatment if habits are not broken. Abrasive lesions at non occluding tooth surfaces should be critically evaluated If teeth are sensitive ,desensitize exposed dentin before starting restorative treatment is started Restorative treatment

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22. Abfraction 22 Syn.idiopathic erosion Cervical wedge shaped defects or abfractures caused by strong eccentric occlusal forces Caused due to excessive occlusal stresses and Only a single tooth may b affected leaving the neighbouring teeth uninvolved More number of teeth are affected in bruxists and in older patients These lesions can progress around existing cervical restorations and extend subgingivally The lingual surfaces of mandibular teeth are rarely affected.

23. treatment modalites 23

24. Er o s ion 24 Defined as the loss of tooth structure resulting from chemico- mechanical acts in the absence of specific microorganism. Popular theories of causes and pathogenesis: Ingested acid Salivary citrates Secreted acids’ Mechanical abrasion Chelating microbial metabolic products Acid fumes Excessive tensile stresses at the tooth clinical cervix Refused acids’ Salivary flow

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26. ■ Progressive erosion results in occlusal scooping or cupping of the exposed softer dentin in posterior teeth and grooving in anterior teeth Extensive erosion in teeth of wine tester Teeth showing acid erosion 26

27. CLINICAL MANAGEMENT OF NON-CARIOUS LESIONS 27

28. Non-carious lesions require clinical attention if any of the following factors exist : Tooth sensitivity Compromised esthetic Risk of tooth fracture Pulpal damage Caries Poor periodontal health 28

29. Treatment options 29 Dentin desensitization Restorations Endodontic therapy Periodontal therapy

30. 1) Dentin desensitization 30 Used in situations where minimal amount of dentin is exposed (less than 1mm) & patient experiences hypersesitivity. This managed by any of the method suggested for dentin desensitization such as : Fluoride varnishes or fluride iontophoresis Dentin bonding agents Use of desensitization tooth pastes

31. 2) Restortions 31 Indicated in following situations Considerable loss enamel and dentin Esthetic is compromised Deep lesion affecting the strength of the tooth and pulpal integrity Caries beginning in the cervical lesion Significant sensitivity of the exposed dentin Choice of restorative material : Class v non carious lesion with any of the permanent restorative material presently available. Of these, Amalgam, direct gold, cast gold inlays and ceramic inlays are no longer preffered as they require some amount of cavity preparation to make the restoration retentive.

32. Currently composite resins and glass ionomer cements are used.Because they are adhesive and do not require extensive cavity preparation. Composite resin restorations : Steps a) Tooth preparation : No cavity preparation is necessary for class v non carious lesions.Shape of the defect is amendable for filling .However enamel margin beveled to increase the surface area for bonding & to produce esthetic . b) Pumice prophylaxis : Clean the surface of any debris or plaque. 32

33. Shade selection Isolation Acid etching & dentin bonding f)Composite resin placement g)Finishing & polishing Compomer Restoration : New variety introduced in 1990s Combines the durability of composite & fluoride releasing ability of GIC. Available as a single component light curable material in a syringe. Steps is same as that of composite restoration 33

34. Indicated for class V cavities. Glass Ionomer Cements : Chemically cured GIC have an excellent track record for restoring class V noncarios defects. Nowadays resin-modified GIC are referred. 3) ENDONTIC THERAPY : When cervical tooth loss is extensive reslting in pulpal involvement, endodontic therapy is necessary followed by post placement & full coverage in the form of crown 34

35. Management of Attrition Pulpally involved tooth should be extracted or undergo endontic therapy. Para-functional activities, notably bruxism, controlled with proper discluding-protecting occlusal splints. Occlusal equilibration – by selective grinding of tooth surfaces (include rounding and smoothening the perepheries of occlusal tables. Restorative modalities- Metallic restoration in 58

36. Management of Abrasion 36 Remove the cause. Treated with fluoride solution to improve its caries resistance. Lesion is exceeding 0.5mm into dentin, it should be restored. Tooth is sensitive then desensitize the exposed dentin before starting restorative treatment. (Desensitization by 8-30% Na or Stannous fluoride for 4 to 8 min ) Restoration by Direct tooth coloured materials(in anterior) & metallic restoration in posteriors.

37. Management of Erosion 37 Remove the cause. If restoration is the choice of treatment, metallic restoration is ndicated because it is resistant to erosion.