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ePaper created 2017-05-10, 09:20:47 | 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 pa- tients.1,2 Both can be considered growing chal- lenges in dentistry, because with such patients, especially in cases of severe parafunction, the etiology can rarely be successfully and perma- nently eliminated.3-5 Therefore, continuous mon- itoring to control related pathologies is required. The most frequent causes of erosion are unbal- anced dietary habits with a high consumption of acidic food or beverages (such as fruit, car- bonated 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 capaci- ty and, in general, salivary composition changes induced by various diseases, medications and aging are other etiological co-factors.6-9 As re- gards abrasion, awake and sleep bruxism are two different forms of parafunctional activities that can severely affect tooth integrity.4,5 Preventive and restorative measures are therefore manda- tory 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 hard-tissue loss present combined aetiologies, challenging the dental team to de- termine a multifactorial preventive and restor- ative approach.1-9 The dental consequences of abrasion and erosion are manifold and involve a loss of enam- el, with progressive exposure of large dentin sur- faces, which signifi cantly affects the occlusal, facial and lingual tooth anatomy and has bio- Fig. 1 14 cosmetic dentistry 2_2017