Minimal Intervention Dentistry: Part 5. Ultra-Conservative Approach To The Treatment of Erosive and Abrasive Lesions
Minimal Intervention Dentistry: Part 5. Ultra-Conservative Approach To The Treatment of Erosive and Abrasive Lesions
Minimal Intervention Dentistry: Part 5. Ultra-Conservative Approach To The Treatment of Erosive and Abrasive Lesions
PRACTICE
abrasive lesions.
Explains how to plan an initial
The therapeutic management of tooth wear lesions does not require the removal of diseased tissue. Nevertheless, diverse
etiological factors may be associated with the condition and they could be difficult to eliminate; this has to be considered
when planning therapy. Interceptive procedures should be reserved for such situations while regular monitoring is
recommended for other cases, in accordance with advice provided for using the Basic Erosive Wear Examination (BEWE).
Direct and indirect adhesive procedures with composite resins allow treatment of most clinical situations, including even
extensive restorations. The possibility of managing subsequent interventions should be considered when planning the
initial therapeutic approach.
EARLY DIAGNOSIS
Nowadays it is usual to detect early proximal
caries by retrocoronal X-ray. Detailed
examinations of caries predilection sites
are well documented. The process allowing
early identification of erosive and abrasive
lesions is generally poorly applied, as it Fig.3 Clinical exam highlights several initial Fig.5 Reflux from vomiting lead to acidic
cervical erosive lesions for this young patient dissolution of the lingual side of maxillary
remains controversial and more often
with anorexia incisors
associated with identifying oneor more risk
factors. Early erosive and abrasive lesions are
normally asymptomatic with the exception A sextant exam can be used to protection, temporisation and restoration if
of cervical buccal lesions, which can cause apply the BEWE classification criteria necessary. The treatment plan corresponds to
hypersensitivity symptoms. In fact, the early (Tables 1 and 2), 7 which provides a the BEWE score (Tables1 and 2).
lesions remain an enamel defect without any reference for following examinations. This Important patient recommendations
symptomology. Yet early diagnosis is the classification is simple enough for daily use include a suitable brushing method, the
best method in eliminating causative factors of a general practitioner. It is also possible use of an electric toothbrush that stops
at this early stage whether they originate that pre-identified risk factors will guide the when excessive pressure is applied and
from alimentation, traumatic brushing or a dental exam. Table 3 is based on clinical the use of specific mouthwashes and
systemic pathology. The diagnostics tools observations involving around 200patients toothpastes even in the current absence of
available are far less sophisticated than those who presented for a specialised consultation sufficient supporting clinical studies proving
available for the early detection of initial focused on eating disorders. It could be a effectiveness (Fig.6).9
caries such as laser fluorescence, and only eye help for a general practitioner to guide the Resin trays containing fluorinated gels
and practitioners determination are essential. initial clinical exam. can reduce sensitivity without any effect
The ultimate aim of early diagnosis is to on lesion development. However, patients
EXAMINATION SCREENING formulate a recall strategy, identification of presenting with caries free lesions can also
Actually, the trained eye of the practitioner aetiological factors and eliminating them have an increased risk of developing caries,
remains the main way for early diagnosis. wherever possible and finally to intercept with in particular in the case of anorexia and
However, it requires a good knowledge of measures designed to protect dental tissues. bulimia. It is therefore good practice to
initial tooth wear sites and of the medical Other diagnostic tools are of limited undertake an overall risk assessment and not
context. While it is simple to recognise an use. However, plaster cast models allow to focus solely on the most obvious (Fig.7).10
established tooth wear lesion, early lesions assessment of quantitative substance loss Ideally, dental surfaces should be isolated
often escape from a usual clinical exam and provide an objective future reference. from an aggressive acid environment by
focused on caries. Macro photos, if available, also permit using a layer of adhesive resin. However,
Drying the teeth before observation is objective assessment to follow lesion avoiding proximal overloading when using
required in the same way as dental caries. development and motivate the patient to this type of material requires a delicate
The main sites to observe are: modify harmful habits. touch and the low strength of these
The cusp tops for cup lesions (Fig.2) resins significantly limits their period of
The buccal surfaces of the maxillary PREVENTION, INTERCEPTION, effectiveness. Nevertheless, the use of the
teeth to reveal early tooth wear lesions PROTECTION, TEMPORISATION recently available 4-meta resin (Bondfill
by depressing surrounding gums (Fig.3) SB Sun medical) appears promising, based
The buccal surfaces of the anterior
Initial lesions on a personal evaluation of its effectiveness
maxillary teeth for early tooth wear Erosive lesions not requiring debridement in 15severe cases. The material remains in
lesions of extrinsic nature (Fig.4) of pathological dental tissues should be place three months after application and
The lingual surfaces of the anterior approached with strictly ultraconservative sensitivities have not reappeared. The short
maxillary region around the cingulum measures. It just remains to determine the setting time only allows oneor twoteeth to
are characteristic of intrinsic erosion optimum adapted treatment planning involving be treated in the same time. This resin layer,
(Fig.5). a combination of prevention, interception, which can be compared to Superbond, but
Table1 BEWE score interpretation Table2 Clinical approach based on BEWE score8
*Monitoring is required if erosion is detected, advices are always included in treatment planning
b b
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