REGRESSIVE ALTERATIONS OF TEETH

Dr. Indira Priyadarshini

INTRODUCTION
Regressive alterations are the group of
retrogressive changes in the teeth. Which
occur due to non bacterial causes and results
in wear and tear of the tooth structures with
impairment of function.
These regressive changes are results from
General ageing process
Chronic injury to the tissues

Enamel
Attrition
Abrasion
Erosion
Abfraction
Dentine
Dentinal sclerosis
Dead tracts
Secondary dentine
Pulp
Reticular atrophy of pulp
Pulp calcifications
Resorption of teeth
External
Internal
Hypercementosis
CEMENTICLES

ATTRITION

Defined as the physiologic wearing away of a tooth

as a result of tooth contact, as in mastication and
occlusion.
Term- Latin verb ATTRITUM refers to the action of
rubbing against another surface.
Up to some degree it is physiological when the
amount of tooth loss is extensive and begin to affect
the esthetic appearance and function ,the process is
considered as pathologic.

The rate and severity depends on several

factors.
1. Diet quality
2. Dentition
3. Force of the masticatory muscles
4. Chewing habits

CLINICAL FEATURES

Occlusal , incisal, proximal surface.

Primary &permanent dentition
Primary dentition : amelogenesis and dentinogenesis
imperfecta
M>F
According to Robinson there is also shortening of dental arch due to
proximal attrition
APPEARANCE:
As a small polished facet on the cusp tip or ridges or slight flattening of
an incisal edge
Advanced Conditions: when enamel is completely worn it appear as
yellow or brown staining of the exposed dentine. Thus there is formation
of secondary dentin to protect pulp.

Treatment

Correction of development
abnormalities.
Correction of parafunctional habits.
Protection of tooth by metal or metal
ceramic crowns , where structural
defects exists.
Construction of occlusal guards in
bruxism habit is persists.

ABRASION

Abrasion is the pathologic wearing of

tooth structure or restoration
secondary to the mechanical action of
an external agent.
The term Latin verb ABRASUM
means to scrape off and implies wear
or partial removal through a
mechanical process.

Etiology and pathogenesis

Different foreign substances produce different patterns of

tooth abrasion .
Though the etiology is varied , the pathogenesis under these
different conditions is essentially identical .
a. Tooth brush abrasion
b. Habitual abrasion
c. occupational abrasion
d. prosthetic abrasion
e. Ritual abrasion

Tooth brush abrasion

Most common type .

Horizontal direction .
Horizontal cervical notches on buccal surfaces of exposed
radicular cementum and dentin at the CEJ in the teeth with
some gingival recession .

Habitual abrasion

Pipe smokers ,Tooth picks / Dental floss

Occupational abrasion
Develops when objects / instruments are
habitually held between the teeth by people during
work .

Prosthetic abrasion.

Ritual abrasion.

CLINICAL FEATURES:

Appear as V shaped or wedge ditch on the root side of the

CEJ in the tooth with some gingival recession.
Lesions are more wide than deep
Premolar and cuspids are more commonly affected
Exposure of dentinal tubules

Consequent irritation to odontoblast process

Secondary dentine formation.

Treatment
Avoidance of abnormal brushing habits .
Restorative treatment .

EROSION
Irreversible loss of hard dental tissues by a chemical processes not involving
bacterial action
CAUSE
. Extrinsic- Citrus fruits, acidic beverages, environmental acids & vit C
occupationalexposure(chromic,hydrochloric,sulphuric,nitric)

Intrinsic- Gastroeosophageal reflex disease(GERD) & Vomiting

.SALIVA AS A MODIFYING FACTOR 1) Salivary PH
2) Buffering capacity
3) Flow rate of saliva

CLINICAL FEATURES

Broad concavities with in the smooth surface enamel

Cupping of occlusal surface with dentine exposure

Increased incisal translucency

Wear on non occluding surface Raised amalgam

restorations

Hypersensitivity

Pulp exposure in deciduous teeth

Erosion

ABFRACTION

Grippo 1991
It is pathologic loss of enamel and dentine caused by
biomechanical loading force
Loss of tooth surface at the cervical areas of teeth caused by
tensile and compressive forces during tooth flexure
Studies need to prove the hypothetical phenomenon
CLINICAL FEATURES
Deep narrow V shaped notch
Affects the buccal / cervical areas of teeth
Often affects a single tooth with adjacent tooth unaffected
Most commonly affects bicuspids and molars

Abfraction

TREATMENT-

Diminish the frequency & severity of the acid challenge

-Use of straw for cool drinks
- Acidic drinks should be drunk quickly rather than sipped
- A patient with alcholism should be treated in rehabiltation program

Enhance the defense mechanism of the body

- Stimultion of salivary flow rate by use of sugarless chewing gums

Improve chemical protection- Antacids

Decreased abrasive forces use of soft tooth brushes

Topical fluoride

Provide mechanical protection composites, occlusal guards

Monitor stability Use of casts or photos to document tooth wear status

DENTINAL SCLEROSIS(Transparent dentin)

Characterized by calcification of dentinal tubules
Cause:
DC
Abrasion
Aging process

Appearance: Translucent zone in transmitted light ( refractive index)

- Apical third of root
- in crown midway between DEJ & surface of pulp.
- Dentine underlying the cavity
- The exact mechanism of dentinal sclerosis or the deposition of
calcium salts in the tubules is not understood
- Sclerotic dentin is more calcified than reparative dentin

Source of Ca salts:
Dental lymph
saliva
Result:
Decreased conductivity of odontoblastic process
Slows the advancing carious process

Dye cant penetrate through this dentine

DEAD TRACTS

Dead tracts are empty dentinal tubules filled with air. These
appear dark in ground section of dentin under transmitted
light and white under reflected light

The dead tracts are formed due to degeneration of

odontoblastic process in the dentinal tubules. This occurs due
to exposure of dentin following attrition, abrasion or erosion

Dead tracts develop in the region of cusp or incisal edge due

to death of odontoblasts as a result of overcrowding.

SECONDARY DENTINE
-Formed in response to normal or abnormal stimulus
- Physiological secondary dentin Age & Tooth eruption. This type of
secondary dentin is produced more slowly than primary dentin.

Physiological secondary dentin is similar to primary dentin and is

seperated by deep stained resting line
- Reparative secondary dentin/Tertitary dentin Result of irritation. There is
decreased

size of pulp chamber and tubules are tortuous in nature

Characteristic features:

Contain irregular dentinal tubules , deposits contain less Ca, Phosphorus

and collage nous matrix per unit volume than primary dentine
Not evenly distributed around the periphery of pulp chamber
Greater deposition on the roof and floor of chambers leads to asymmetric
reduction in its size and shape. pulp recession .

R/F:
Seen in in pulp horn areas as well as on the proximal
wall of teeth
Seen on routine radiographic investigations
H/P
This type of secondary dentine is rapidly formed at a
rapid rate and odontoblasts may become entrapped
producing a superficial resemblance to bone osteodentine

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