Toothwear and Restoration of

Abrasion Lesions.
Dr. Jasmina Qamaruz Zaman
Dept of Operative Dentistry
Faculty of Dentistry
UKM
 TERMINOLOGY

Toothwear

Tooth surface loss (TSL)

 MECHANISMS
1. Physiological (normal ageing)

2. Pathological
a. Erosion
b. Attrition
c. Abrasion
d. Abfraction
e. Multifactorial
 EROSION

Loss of tooth structure

as a result of dissolution
due to acidic chemical attack,
other than those produced
by intra-oral bacteria.
 EROSION

A. Extrinsic source

B. Intrinsic sources
 EROSION
A. Extrinsic source:
1. Beverages
2. Foods
3. Industrial processes

B. Intrinsic sources:
1. Gastro-oesophageal reflux disease
2. Eating disorders
3. Pregnancy morning sickness
Erosion: Acid fumes
Erosion: ‘Cupping out’ of the dentine. This is because once exposed, dentine
dissolves faster than enamel.
Erosion: Note the proud amalgam restorations. This is because the
tooth has dissolved away from around the amalgam restoration.
Erosion: Gastric reflux – erosion on the palatal surfaces of
posterior teeth.
 ABRASION

Loss of tooth structure

by friction
from an external agent.
 ABRASION

Etiology:
1. Biting sewing thread
2. Pipe chewing
3. Pen/pencil biting
4. Tooth brushing
Abrasion: over vigorous tooth brushing. ‘V’ shaped or saucer shaped
notches at the cervical margins of teeth.
Abrasion: Pin chewing
Abrasion: sunflower seeds
 ATTRITION

Tooth surface loss due to

tooth to tooth contact
during function or parafunction.
 ATTRITION

Etiology:
1. Normal functional movement.
2. Bruxism.
Grinding of teeth during non-functional
movements of the jaw.
Attrition
Attrition – iatrogenic (from porcelain crowns)
 ABFRACTION

Loss of tooth structure

due to
flexural forces.
ABFRACTION

Teeth flex under

occlusal loads, stresses
are transmitted to the
cervical area causing
cervical enamel rods to
fracture and dislodge.
With increased flexural
movements V-shaped
cavity appear.
 Often, the cause of tooth wear is multi-
factorial ie. attrition, abrasion and erosion
occurs at the same time.
Multi-factorial
Multi-factorial
Restoration of Abrasion
Lesions
 Materials and techniques used to
restore abrasion cavities

1. Glass Ionomer cement (Conventional /

Resin Modified).
2. Composite resin
3. Sandwich technique.
 Glass Ionomer Cement
Advantages
 Chemical adhesion to enamel and dentin (retentive
features in the cavity design is less important).
 Release fluoride which prevent secondary caries.

Disadvantages (compared to composite resin)

 Less esthetic
 Opaque
 Benefits of Glass Ionomer
 Chemical Bond to tooth - no bonding agent
required
 Bonds to moist tooth
 Fluoride protection
 Excellent marginal seal - no shrinkage
 Thermal expansion = tooth
 Biocompatable - Ideal match for dentin
 Technique
1. Isolation (Rubber dam, cotton rolls, gingival retraction
cord)

2. Select and adapt a metal cervical matrix.

3. Clean the cavity with pumice and water to remove the

acquired pellicle – wash and dry the cavity gently.
 Technique
4. Apply dentin conditioner for 20-30 seconds – wash and dry.

5. Insert the GIC into the cavity – cover with the cervical matrix,
remove access material from around the matrix.

6. Paint the surface of GIC with dentine bonding agent (DBA)

immediately after removal of the matrix.

7. Light cure for 20seconds to cure the DBA. However, if you are
using RMGIC (Fuji II LC), you need to cure the GIC and DBA
for 40 seconds.
 Technique
8. Check the margins of the restoration, remove any excess material
using a pointed high speed bur.

9. Reapply the DBA and light cure for 20 seconds.

10. Do not polish the GIC restoration, polishing can only be done
24 hours later.

11. Polishing (after 24 hours) – use polishing discs: from dark

brown to light yellow.
This step is not necessary if you have used a cervical matrix.
Case 1

3 erosion / abrasion
cavities at the buccal
surface of the teeth.

Scrub the surface with

pumice and water –
wash and dry.
Case 1

Translucent cervical matrix is

applied.
For the simulation exercise
you will be using metal
cervical matrix. Choose and
adapt the matrix according
to the tooth contour.

Apply GIC into the cavity and immediately cover with the
cervical matrix, remove access material. LIGHT CURE THE
RMGIC FOR 20 SECONDS.
Case 1

Check the margins, remove any

excess material using a pointed
diamond bur.

Finished restoration, DBA was painted

onto the surface of the restoration
and light cured for 20 seconds.
Case 1

18 months later

3 years later
Case 2

Sharp angled lesion

along the gingival margin
under the old bridge.

Gingival tissue removed from

the lesion with
trichloracetic acid to
control bleeding.
Case 2

Dentin conditioner
applied – use a brush
for this purpose.

GIC applied and the

matrix is placed.
Case 2

A thin layer of resin bonding

agent was applied to seal the
surface against changes in
water balance.

Further re-contouring and

further coats of bonding
agent applied
Case 2

The finished restoration

The finished restoration 18

years later.
 Composite Resin
Advantages

 Excellent esthetics.
 Micro-mechanical retention – does not have to
rely on retention features of the cavity.
 Composite Resin
Disadvantage:
1. Need excellent moisture control, otherwise:
a. retention is compromised – loss of
restoration
b. microleakage – sensitivity, secondary caries
2. Polymerization shrinkage
Composite is applied in thin increments
(layers).
 Sandwich Technique

What is it?
It is a technique which requires the application
of both composite restoration and Glass
Ionomer Cement in the same cavity.
 Sandwich Technique:
Why is it recommended?
Glass Ionomer Cement is Composite is applied to:
applied to: • Replace Enamel and
1. Replace the missing Enhance esthetic.
dentin. • Provide a better
2. Release fluoride polished surface.
(protect the pulp) • Increase abrasion
3. Increase retention resistance.
4. Reduce microleakage.
 Steps

1. Choose the appropriate shade of composite

resin for the tooth.
2. Isolation
3. Follow the steps for GIC application.
Place just enough of the GIC to replace the
missing dentine, keep the enamel free from
GIC.
 Steps

4. i. Lamination of Conventional GIC:

a. Etch the GIC & enamel for 15 seconds.
b. Wash and dry lightly.
c. Apply DBA to GIC and enamel – light cure for
20 seconds.
d. Place the composite resin incrementally - light
cure each increment for 20 seconds and the
final increment for 40 seconds.
.
 Steps
4. ii. Lamination of RMGIC:
a. Etch the enamel only for 15 seconds.
- It is not necessary to etch the GIC because it
contains HEMA (resin) which can bond to the
resin in DBA.
b. Apply DBA to GIC and enamel – light cure for
20 seconds.
c. Place the composite resin incrementally – light
cure each increment for 20 seconds and the
final increment for 40 seconds.
 Steps

5. Polish the restoration using soflex discs.

6. Apply DBA and light cure for 20 seconds.
 CASE 1

CEJ

ENAMEL DENTINE
 OPEN SANDWICH
TECHNIQUE

GIC/RMGIC
RMGIC

CR

ENAMEL DENTINE
 CASE 2

CEJ

ENAMEL DENTINE
 CASE 2 SANDWICH
CLOSED
CEJ TECHNIQUE

GIC/RMGIC

CR

ENAMEL DENTINE
 Mixing Glass Ionomer Cement
1. Hand mix
a. Dispense 1 scoop powder and 1 drop liquid.
b. Divide the powder into equal parts.
c. Mix in ½ of the powder into the liquid.
By 10 seconds the first part of the powder should
be fully mixed.
d. Draw in second half and complete the mixing.
By 25 seconds the mix should be complete.
Mixing Glass
Ionomer Cement
2. Precapsulated
a. Tap or shake the capsule to loosen
the powder.

b. Depress plunger.
c. Click once in capsule
applier to activate.
e. Click twice to prime capsule
then syringe.
Any Questions?