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Occlusal changes occur slowly throughout each person's lifetime via the process of physiological tooth wear (TW). Importantly, once the occlusal scheme has been irreversibly changed beyond a certain point, then a chain reaction of restoration failures may commence. The trigger varies for each individual and it cannot always be predicted when, where or if this occurrence will take place. Importantly, when the patient attends with failing or failed dental treatment, particularly following repeated attempts to resolve it, then a detailed investigation of the occlusion must precede treatment. Any immediate repair or replacement without consideration of the underlying aetiology would simply suffer the same consequences.
CPD/Clinical Relevance: Understanding the impact of occlusal changes on the overall survival of restorations and the health of the remaining dentition can help in early diagnoses, prevention and treatment.
Article
This paper will focus on the occlusal changes that can occur throughout an individual's lifetime. Physiological TW describes the loss of dental hard tissues by means other than caries, trauma or developmental disorders. This is an irreversible part of the ageing process, with an estimated vertical tooth surface loss of enamel at 20–38 µm per annum.1 The aetiology of TW is multifactorial in nature and the underlying factors are subcategorized into attrition, abrasion, abfraction and erosion. Therefore, the process of TW depends on numerous contributory factors including: diet, dental appliances/restorations, inherent occlusal issues, oral hygiene methods, psychological influences, parafunctional habits and underlying medical complications. The overall changes that occur to the occlusion may result in damaging premature contacts, deflective contacts and interferences, which can lead to occlusal overloading. Unfortunately, without early intervention, the resulting outcome could be disastrous.
Therefore, the importance of a thorough occlusal assessment on a regular and consistent basis cannot be over emphasized due to the constantly evolving nature of the dentition within the unforgiving oral environment. Not only is this information vital for correct diagnoses, but it will aid implementation of appropriate preventive measures and treatment planning. This calculated approach will avoid embarrassing situations, whereby recently fitted restorations repeatedly fail without warning. The dentist and patient are then left in a difficult position in terms of both financial compensation and the continuation of their professional relationship.
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