INCISAL ATTRITION – March 27,2019
This 60 year old male shows abrasion and shortening of his lower incisors due to malocclusion and perhaps mild parafunction. There is no erosion present, and no fracture of labial and lingual faces of the teeth.
Usually the wear of incisors is secondary to abraded cuspids which no longer disclude the incisors in function.However, in this case the cuspids have only very minor exposure of dentin near the cusp tip and are virtually full length. The malocclusion present is decoupled incisors due to crowded incisors of both jaws. In order to incise, the mandible must protrude and slide to the left. When the patient performs this excursion, the lower incisors mate with the uppers perfectly, producing the wear pattern seen. Thus, we are observing the results of 60 years of the patient’s normal masticatory envelope. The only tooth destruction is tooth shortening by about 10-15%.
The dentin of these incisors is smooth and polished; so the purpose of treatment is to harden the incising surface to reduce wear, always a goal in treating incisal attrition, but without the more normal indication of restoring eroded dentin and lutng a perimeter of fracturing enamel, as seen in cases with more pathological erosion/parafunction patterns.
WHY OMNICHROMA FOR THIS CASE?
You can see that the blending of the resin is very attractive and the restored teeth (33-32-31-41-43 International quadrant tooth numbering system) are virtually identical to the tooth not restored, #42, which is lingually displaced and has not shortened because it is not in occlusion.
This outcome is superior than what is achieved with the author’s normal metameric resins, Estelite Sigma Quick A3.5 for cases with a Vita shade A to B, or Z-250 shade D3 for shades in the Vita C to D., the assumption being that the patient is over 50 and hence has teeth in the Vita 3.5 or darker range. See Incisal Attrition Restorations in the Handbook of Composite Excellence
Another property of Omnichroma, however, according to its technical bulletin Tokuyama’s Omnichroma Technical Bulletin is lower wear and lower abrasivity against opposing teeth than many other popular resins, including Estelite, its prdecessor.(Page 20). Consult the page in the brochure for a clearer image.
Thus this writer is led to expect that the lifespan of these restorations will exceed 20 years, as that has been the outcome of treatment in more extreme cases using the above resins.
Hence Omnichroma appears to deserve a place in this class of treatment.