INCISAL ATTRITION – INDICATIONS FOR CONVENTIONAL TREATMENT
Clinical judgment dictates the exact point in time to intervene. From clinical observation, there appears to be no serious acceleration of generalized attrition until:
- the incisal edge shows cratering of the dentin
- the width of the dentin exposed is large enough to accept a 330 bur.
Then it is time to treat.
By the time exposed dentin has become the width of the 330 bur, penetration into the tooth is easy, there is little risk of undermining perimeter incisal edge enamel, and pulpal regression has begun.
INDICATIONS FOR INCIPIENT TREATMENT
However, earlier treatment may seem desirable, for example, when premature enamel attrition and fracture is compromising the appearance of younger maxillary incisors, see Incisal Attrition Incipient . If a 330 bur is used when the dentin opening is very limited, the perimeter enamel becomes weak from over-cutting and thinning of the natural enamel thickness, and subsequently prone to iatrogenicly-induced crumbling. We have better things to do with our time. Use the right sized bur.
Other indications for early treatment are :
- dentin staining is darkening and spoiling an otherwise perfect smile.
- the maxillary lingual enamel wall begins to crumble, when the antagonist tooth is malposed.
Early interception is desirable while neighboring teeth are still relatively normal in form. If postponed, the final appearance of the restored teeth will be compromised by an overall loss of vertical dimension and shortening of the clinical crown due to passive eruption, i.e. teeth erupting out of the alveolus to compensate for the attrition of the incisal edge.