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ePaper created 2018-02-16, 10:54:19 | version 1.38.0
| case report aesthetic and restorative dentistry ‘ No-prep’ interceptive rehabilitation —of tooth wear using a free-hand technique driven by a functional wax-up Author: Dr Didier Dietschi, Switzerland Treatment rationale Excessive abrasion (attrition) and erosion are two common conditions affecting dental hard tissue and occur in an increasing number of patients.1, 2 Both can be considered growing challenges in dentistry, because with such patients, especially in cases of severe parafunction, the etiology can rarely be suc cessfully and permanently eliminated.35 Therefore, continuous monitoring to control related patholo gies is required. The most frequent causes of erosion are unbalanced dietary habits with a high consumption of acidic food or beverages (such as fruit, carbonated drinks, fruit juices and vinegar), as well as abnormal intrinsic acid production, such as in bulimia nervosa, acid refl ux and hiatal hernia. Insuffi cient salivary fl ow rate or buffer capacity and, in general, salivary composition changes induced by various diseases, medications and aging are other etiological cofactors.69 As regards abra sion, awake and sleep bruxism are two different forms of parafunctional activities that can severely affect tooth integrity.4, 5 Preventive and restorative mea sures are therefore mandatory to correct and limit the extent of further tissue and restoration destruction. An important clinical fi nding is that a large number of patients affected by hardtissue loss present combined aetiologies, challenging the dental team to determine a multifactorial preventive and restor ative approach.1–9 The dental consequences of abrasion and erosion are manifold and involve a loss of enamel, with progres sive exposure of large dentin surfaces, which signifi cantly affects the occlusal, facial and lingual tooth anatomy and has biological consequences, too. Ob jective symptoms or complaints reported by patients are shortening of teeth, discoloration, tooth displace Fig. 1 26 cosmetic dentistry 1 2017