• 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
• 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.
• 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 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.
• 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
• 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 .
• 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.

• Avoidance of abnormal brushing habits .
• Restorative treatment .
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
• 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
 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

 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 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.
 -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