PhD
Deparlmenl nf Prosthetic Denlistry
Medical anrf Denial Health Center
Halntstad, Sweden
changes of Masticatory
Movement Characteristics
After Prosthodontic
Rehabilitation of
Individuals With Extensive
Tooth Wear
The masticatory cycles ot 11 men (mean age 51.5 years] with extensive tooth
wear were investigated before and after rehabilitation with fixed partial
dentures. Parameters such as the toolh wear index (1^) and masticatory
mandibular movement were recorded. Before treatment, the patients were
also given a questionnaire related to possible background tactofs of
importance to tooth wear. At baseline a mean score of 48,6 (range 0 to 100)
for the tooth wear index (1^) was found. The clinical recall examination 3
years atter prosthodontic rehabilitation displayed obvious wear of restorative
material for two patients, and, in another patient, one of the fixed partial
dentures had to be remade because of fracture of abutment teeth. Following
rehabilitation, the duration of the masticatory mandibular opening movement
increased and mandibular movement velocity decreased. The mandibular
closing angle, near to occlusal contact, became steeper after prosthodontic
treatment, indicating a changed mandibular movement pattern,
539
lournal ol Prostliodontic
One of the individuals was not rehabilit^iied because of economic reasons and one had moved
from the area and could not participate in the second examination. Gonsequently, nine patients
were finally included.
Most of the patients were rehabilitated in 1991.
Three years later, in 1994, the same patients were
reexamined by one of the authors.
Patients were restored using a fixed partial denture and/or single crowns. Some of the units had a
gold occlusal contact area to allow a gold-to-gold
contact, while other restorations had a porcelain-toporcelain occlusal contact (Table 1). Most of the
subjects were rehabilitated both in the maxillae and
mandible with an increased vertical dimension of
occlusion (VDOl. The new VDO was established
and tested using fixed provisional restorations prior
to the final rehabilitation. An increase of vertical dimension of occlusion is possible without complete
arch rehabilitation. By placement of an anterior device to increase the vertical dimension of occlusion, the lateral segments are allowed to extrude."
In this way it is possibie to restore parts of an occlusal table and still achieve occlusal stability.
The appearance of the individual chewing pattern and the masticatory cycle has been said by
many authors to be associated with the state of occlusion and influenced by prosthodonlic reconstruction.'""^- The basic form of the masticatory
cycle, however, seems not to be influenced by
prosthodontic rehabilitation.'^
The chewing pattern in individuals with extensive tooth wear has been discussed by Russell,'''
who reported that a ruminating form of masticatory
activity occurs more frequently for patients with
generalized wear.
Aspects of the restorative procedures for patients
with extensive occlusal tooth wear has also been
given.-*''^ Oral restorative treatment can be semiirreversible or irreversible. The semi-irreversible alternatives include resin composite restorations, removable partial dentures, and overdentures.
Irreversible methods include a variety of fixed
restorations. Other problems, such as increase of the
vertical dimension of occlusion and the retention of
cast restorations, are encountered when restoring
extensively worn dentitions'' that are a consequence
of the reduced height of abutment teeth.
However, there are no detailed reports as to
whether comprehensive occlusal rehabilitation will
alter the chewing pattern and decrease occlusal wear
in individuals with extensively worn dentitions.
The purpose of this investigation was to study the
masticatory pattern of individuals with diagnosed
extensive tooth wear and wear of restorative materials, before and after prosthodontic rehabilitation.
540
Measurement LEDs
Table 1
Patient
number
1
2
3
4
5
6
7
8
9
10"
rMandible
Maxillae
Type
FP,
se,
FP,
se,
FP,
FP,
FP,
FP,
FP,
se,
FP,
se,
Teetti
MC
MC
MC
MC
MC
MC
MC
MC
MC
MC
MC
MC
4-6(15-13)
7-11 (12-23]
2-5(17-14]
6-10(13-22]
2-5(17-14]
6-11 (13-23]
12-14(24-26]
3-15(16-27]
4-6(15-13)
7-11 (12-23)
12-14(24-26)
6-11 (13-23)
se. Me
FP, Me
se. Me
6-10(13-23)
11-15(23-27)
4-12(15-25)
se, MC
3-14(16-26]
Type
Teeth
FP, Me
21-19(34-36)
se. Me
29-27 (45-43)
FP, Me
FP, Me
30-28(46-44)
22-19(33-36)
FP, MC
29-27 (45-43)
s e , MC
26-23 (42-32)
FP, MC
22-18 (33-37)
FP, MC
31-27 (47-f3)
FP, MC
21-18(34-37)
Removable partial denture
se, Me
FP, Me
se. Gold
se. Me
27-22 (43-33)
30-20 (46-35]
31,19,18(47,36,37)
30-19 (46-36]
The following variables were quantitatively analyzed: (V the total cycle duration (TCD) and the
subdivided phases OP, CP, and OLP; (2) the mean
and maximum velocity in the OP and CP phases;
(3) the mean three-dimensional mandibular spatial
displacement in the OP and CP phases; and (4) the
541
Maticalor>'
Table 2 Patient Distribution and Number, Age, and Value of the Individual Tooth
Wear Index and Number ot Remaining Teeth at the First Examination
Patient
number
1
2
3
4
5
6
7
8
9
10
11
Mean
Age
1^
score
53
45
67
45
48
52
56
45.7
50 4
139
19.1
57.8
37
63
57
44
51.5
52.1
43.0
82.5
65,7
48.6
66.1
38.2
Number of
remaining
teeth
21
24
23
23
19
18
22
28
23
28
23
22.9
The degree of incisai or occiusai wear was evaluated by one of the authors for each single tooth in
accordance with the following criteria; 0 = no
wear or negligible wear of enamel; 1= obvious
wear of enamel or wear through the enamel to the
dentin in single spots; 2 = wear of the dentin up to
one third of the crown height; and i = wear of the
dentin more than one third of the crown height, or
excessive wear of tooth restorative material or dental materials of the fixed restorations (more than
one third of the crown height).^'^
Based on the scores of incisai or occlusal wear for
each tooth of a patient, an individual tooth wear
index (1^) was made. The purpose of this index was
to obtain one single value for the degree of incisai
and occlusal wear as presented by Ekfeldt et al.'^
Results
The number of patients, age, wear index (l^ at
baseline, and number of remaining teeth are presented in Table 2.
Wear
542
Table 3
Question
1. Do you spend much time in dusty or poiiuted environments?
2. Do you experience frequent acid rgurgitation or vomiting''
3. Do you sufter from gastric catarrh oi digestive problems?
4. Do you often clench or grind your teeth?
5. Do you suffer from headaches?
6. Do you suffer from pain in your jaws and/or neok?
7. Do you suffer from buzzing in your ears?
8. Do you oonsider your teeth to be extensively worn?
9. How long time have you considere your teeth to be worn?
less than 4 years
4-10 years
more than 10 years
2
1
3
5
3
4
3
9
Previousiy
but not at
at present
2
2
1
0
2
1
1
6
7
6
5
5
5
6
1
3
5
2
Atter
Difference
Mean
SD
Mean
SD
P)
743
230
304
210
102
85
182
161
58
64
20
153
28
68
134
31
23
57
52
7
13
5
805
300
332
173
78
70
132
138
60
54
16
93
73
54
49
28
19
66
46
6
13
5
ns
.05
ns
ns
.05
ns
.05
ns
ns
,01
ns
ns = not Significant.
Questionnaire
In the questionnaire, awareness of bruxism was reported by five individuals (Table 3). "Digestive
problems" and "frequent acid rgurgitation or
vomiting" were also relatively frequent (positive responses to questions relating to "lime spent in
dusly or polluted environments" were also frequently mentioned). Symptoms such as headache
and facial pain were common.
It is notable that seven individuals had been
aware of their worn teeth for more than 4 years. All
the individuals considered that they were in need
of restorative treatment for their worn dentitions.
543
Discussion
When extensively worn leeth are to be restored,
the etiologic factors involved must be thoroughly
considered, A mechanical action on the tooth is
generally the basic factor, but erosive factors also
contribute to the reduction in hardness of the
enamel, making the tooth more susceptible to
wear,''' Salivary factors, such as buffer capacity
and the pH of the saliva, must also be considered.
The mechanical effect depends on various factors,
including the type of contact between the teeth,
the development of forces when the teeth are in
contact, the time in relation to tooth contacts, and
the presence of abrasive factors in the oral cavity.
Similarly, gastrointestinal disturbances related to
alcoholism and diet (ie, acidic substances related
to bulimia) have also been found to be associated
witb tooth wear,''
Thus, many factors contribute to tooth
^^gg,,18,20,21 35 displayed by the answers to the
questionnaire. Awareness of bruxism and gastrointestinal disturbances such as "frequent acid rgurgitation or vomiting" were relatively often reported. The subject that displayed an almost
maximum individual tooth wear index (l^ score
(82,5) had previously been exposed to frequent
vomiting because of food allergy.
Sexual dimorphism, in which more tooth wear is
more present in males than in females in the
Western population is well documented in other
studies-'^'^; therefore the present study group
comprised males only. Bulimia is a disease that affects more female patients, therefore with bulimic
patients more women than men present with dental erosion.
Prosthodontic management of a severely worn
dentition can be very complicated and time consuming. Identification and possible elimination of
causative factors before prosthodontic rehabilitation is desirable. Incisai and/or occlusal tooth wear
seems to have intermittent active and inactive periods,'"-^^ Therefore, when recording anamnestic
data it is important to consider the time factor in
relation to the development of wear,^ In the present study, 70% of the subjects had been aware of
their worn teeth for more than 4 years.
Heavy bruxers should be informed that restoring
their teeth will not lead to cessation of bruxism.
Diurnal bruxism will not only lead to direct wear
of the incisai and occlusal surfaces of the restorations but most probably also cause material fatigue,'' Patients must accept that their restorations
will also be subjected to wear and tbat prosthodontic rehabilitation is an intermediate means that
544
References
T.
Conclusions
Male patients with extensive tooth wear were investigated before and after an oral rehabilitation
with fixed partial dentures. Parameters such as a
tooth wear index and masticatory mandibuiar
movements were recorded. From the results the
following conclusions could be made:
1. A mean score 48.6 (range 0 to 1001 for the
tooth wear index was found before rehabilitation.
2, The answers to the questionnaire displayed a
number of factors such as: "digestive problems," bruxism, and "time spent in dusty or
polluted environment," that could have contributed to incisai and occlusal tooth wear.
9, Number 6, 1996
545
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