Tooth wear

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Tooth wear
Other namesNon-carious tooth substance loss
Oral Manifestation of Bulimia..jpg
Lower teeth shows signs of tooth wear likely caused by erosion
Specialty Dentistry

Tooth wear refers to loss of tooth substance by means other than dental caries. [1] Tooth wear is a very common condition that occurs in approximately 97% of the population. [2] This is a normal physiological process occurring throughout life; but with increasing lifespan of individuals and increasing retention of teeth for life, the incidence of non-carious tooth surface loss has also shown a rise. [3] Tooth wear varies substantially between people and groups, with extreme attrition and enamel fractures common in archaeological samples, and erosion more common today. [3] [4] [5]

Contents

Tooth wear is predominantly the result of a combination of three processes; attrition, abrasion and erosion. [3] These forms of tooth wear can further lead to a condition known as abfraction, [3] where by tooth tissue is 'fractured' due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is often difficulty identifying a single causative factor. [3] However, tooth wear is often a combination of the above processes. Many clinicians, therefore, make diagnoses such as "tooth wear with a major element of attrition", or "tooth wear with a major element of erosion" to reflect this. This makes the diagnosis and management difficult. [1] Therefore, it is important to distinguish between these various types of tooth wear, provide an insight into diagnosis, risk factors, and causative factors, in order to implement appropriate interventions. [1] Tooth wear evaluation system (TWES) may help determine the most likely aetiology of tooth wear. [6] Heavy tooth wear is commonly found on the occlusal (chewing) surface, but non-carious cervical lesions from tooth wear are also common in some populations. [7]

Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by Paul Broca. [8] In 1984, Smith and Knight developed the tooth wear index (TWI) where four visible surfaces (buccal, cervical, lingual, occlusal-incisal) of all teeth present are scored for wear, regardless of the cause. [8] A more recent index Basic Erosive Wear Examination (BEWE) from 2008 by Bartlett et al., is now also in use. [9]

Causes

Attrition

Attrition is loss of tooth substance caused by physical tooth-to-tooth contact. [2] The word attrition is derived from the Latin verb attritium, which refers to the action of rubbing against something. [2] Attrition mostly causes wear of the incisal and occlusal surfaces of the teeth. Attrition has been associated with masticatory force and parafunctional activity [2] such as bruxism. A degree of attrition is normal, especially in elderly individuals. [10]

Abrasion

Abrasion is loss of tooth substance caused by physical means other than teeth. [10] The term is derived from the Latin verb abrasum, which means ‘to scrape off’. [2] It tends to present as rounded ditching around the cervical margins of teeth, commonly described as ‘shallow’, concave or wedge shaped notches. [1] Causative factors have been linked to this condition and include vigorous, horizontal tooth brushing, using toothpaste with a relatively high RDA value (above 250), [11] pipe smoking or nail biting. It has also been shown that improper use of dental floss or Toothpicks can lead to wear on the interproximal (in-between) surfaces of the teeth. [2]

Erosion

Erosion is chemical dissolution of tooth substance caused by acids, unrelated to the acid produced by bacteria in dental plaque. [1] Erosion may occur with excessive consumption of acidic foods and drinks, or medical conditions involving repeated regurgitation and reflux of gastric acid. [10] It is derived from the Latin word erosum, which describes the action ‘to corrode’. [2] This is usually on the palatal (inside) surfaces of upper front teeth and the occluding (top) surfaces of the molar teeth [12] . Dental erosion is rarely seen in the archaeological record, but certain cases have been described which suggested acidic fruits and/or plants were regularly consumed. [7]

Abfraction

Abfraction is a form of noncerious cervical lesion, where there is a loss of tooth substance at the cervical margins, purportedly caused by minute flexure of teeth under occlusal loading. This occlusal loading is one factor that interacts with chemical, biological,and behavioral factors in which result in this abfraction. [13] The term is derived from the Latin words ab and functio meaning ‘away’ and ‘breaking’ respectively. [2] Abfraction presents as triangular lesions along the cervical margins of the buccal surfaces of the teeth where the enamel is thinner and therefore, in the presence of occluding forces, is prone to fracture. [1] Whether abfraction exists or not is debated.

Diagnosis

Tooth wear indices are useful tools for carrying out epidemiological studies and for general use in dental practices. [9]

Basic erosive wear examination

The Basic Erosive Wear Examination was first described by Bartlett et al. in 2008. [14] The partial scoring system is based on the surface area affected. Within a sextant (i.e. teeth in mouth divided into 6 parts), the most severely affected tooth surface (buccal, occlusal or lingual/palatal)(see dental terminology) is recorded according to the severity of the wear (see Table 1). A cumulative score is then matched to a risk level and guidance for its management by a clinician. The management includes steps which identify and eliminate main aetiological factors, preventative treatment and also any operative and symptomatic intervention required by the patient. The frequency of repeating the index ranges from 6–12 months depending on the risk level of patients. [14]

Table 1: Basic Erosive Wear Examination Scoring
BEWE ScoreClinical appearance description
0No erosive tooth wear
1Initial loss of surface texture
2Distinct defect, hard tissue loss <50% of the surface area
3Hard tissue loss ≥50% of the surface area

Tooth wear index

The Tooth Wear Index (TWI) (see Table 2) was developed by Smith and Knight in 1984. TWI scores each visible surface (buccal/B, cervical/C, lingual/L and occlusal-incisal/O/I) (see dental terminology). [15] This index has been widely used in epidemiological studies. [16]

Table 2: Tooth Wear Index Scoring
ScoreSurfaceCriteria
0B/L/O/INo loss of enamel surface characteristics
CNo loss of contour
1B/L/O/ILoss of enamel surface characteristics
CMinimal loss of contour
2B/L/OLoss of enamel exposing dentine for less than one third of surface
ILoss of enamel just exposing dentine
CDefect less than 1mm deep
3B/L/OLoss of enamel exposing dentine for more than one-third of surface
ILoss of enamel and substantial loss of dentine
CDefect less than 1-2mm deep
4B/L/OComplete enamel loss- pulp exposure- secondary dentine exposure
IPulp exposure or exposure of secondary dentine
CDefect more than 2mm deep- pulp exposure- secondary dentine exposure

Other indices

Treatment

Once the cause of tooth wear has been identified and a preventative regime has been put in place, the patient should be reviewed for 6–12 months to establish that the intervention has been successful before any active management is carried out. Once this has been achieved a decision needs to be made whether or not it is necessary to carry out restorative treatment or if it can simply be managed by non-invasive methods. [27]

Where restorative treatment is necessary, it must be decided whether to conform to the existing occlusion (typically for moderate wear, where only a few teeth are affected) or reorganise the occlusion (severe wear, unstable occlusion). Where the occlusion is reorganised, it can first be tested using a reversible method (i.e. a hard occlusal splint). A decision is made after full occlusal assessment including assessment of contacts in intercuspal position (ICP) and retruded contact position (RCP) as well as analysing casts articulated in a semi-adjustable articulator to use for a diagnostic wax up of any proposed restorative work. [28]

Active restorative management depends upon the location of the wear (localised or generalised), the severity of the wear, and the patient's occlusal vertical dimension (OVD), which may have changed as a result of tooth wear. There are three potential scenarios of tooth wear: [29]

  1. Excessive wear with loss of OVD
  2. Excessive wear without loss of OVD but with space available
  3. Excessive wear without loss of OVD but with limited space available

Scenario 1 is relatively common, whereas scenario 2 is quite rare and tends to occur when the wear is rapidly occurring. Scenario 3 occurs due to a phenomenon called dentoalveolar compensation whereby the dentoalveolar tissues compensate for wear of teeth by increasing the bony support in order to maintain a constant OVD. This makes things difficult as there is no room to build the teeth back up to their original height without increasing the OVD. [29]

The options for restoring this loss in tooth height are: [30]

  1. Increasing the OVD - this is the traditional approach and involves restoring all teeth to an increased height in order to create a new ICP at an increased OVD
  2. Occlusal adjustment - this is typically used for anterior teeth only, whereby the patient's occlusion is reorganised into the RCP position to utilise increased space in this position
  3. Crown lengthening or orthodontic extrusion - this is useful when crowns are to be placed in a worn dentition but there is inadequate crown height and you do not want to change the OVD
  4. Relative axial tooth movement - this is the most commonly used method and can be used for localised or generalised wear, the idea is to prop the bite open thereby causing the extrusion of worn teeth to provide extra crown height for restoration, this can be done using simple direct restorations or more complex indirect restorations, this idea was first established by Dahl and is often referred to as the Dahl effect

Pulp vitality must also be taken into consideration prior to treatment, when teeth have severe wear it is possible that they have become non-vital.

See also

Related Research Articles

<span class="mw-page-title-main">Bruxism</span> Disorder that involves involuntarily grinding or clenching of the teeth

Bruxism is excessive teeth grinding or jaw clenching. It is an oral parafunctional activity; i.e., it is unrelated to normal function such as eating or talking. Bruxism is a common behavior; reports of prevalence range from 8% to 31% in the general population. Several symptoms are commonly associated with bruxism, including aching jaw muscles, headaches, hypersensitive teeth, tooth wear, and damage to dental restorations. Symptoms may be minimal, without patient awareness of the condition. If nothing is done, after a while many teeth start wearing down until the whole tooth is gone.

<span class="mw-page-title-main">Bridge (dentistry)</span> Dental restoration for missing teeth

A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.

<span class="mw-page-title-main">Crown (dental restoration)</span> Dental prosthetic that recreates the visible portion of a tooth

In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

<span class="mw-page-title-main">Dental abrasion</span> Medical condition

Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.

<span class="mw-page-title-main">Dental erosion</span> Medical condition

Acid erosion is a type of tooth wear. It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is the most common chronic condition of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to consumption of fruit juices because they tend to be considered as healthy. Acid erosion begins initially in the enamel, causing it to become thin, and can progress into dentin, giving the tooth a dull yellow appearance and leading to dentin hypersensitivity.

<span class="mw-page-title-main">Abfraction</span> Loss of tooth structure not caused by tooth decay

Abfraction is a theoretical concept explaining a loss of tooth structure not caused by tooth decay. It is suggested that these lesions are caused by forces placed on the teeth during biting, eating, chewing and grinding; the enamel, especially at the cementoenamel junction (CEJ), undergoes large amounts of stress, causing micro fractures and tooth tissue loss. Abfraction appears to be a modern condition, with examples of non-carious cervical lesions in the archaeological record typically caused by other factors.

<span class="mw-page-title-main">Dentinogenesis imperfecta</span> Medical condition

Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. It is inherited in an autosomal dominant pattern, as a result of mutations on chromosome 4q21, in the dentine sialophosphoprotein gene (DSPP). It is one of the most frequently occurring autosomal dominant features in humans. Dentinogenesis imperfecta affects an estimated 1 in 6,000-8,000 people.

Dentin hypersensitivity is dental pain which is sharp in character and of short duration, arising from exposed dentin surfaces in response to stimuli, typically thermal, evaporative, tactile, osmotic, chemical or electrical; and which cannot be ascribed to any other dental disease.

<span class="mw-page-title-main">Talon cusp</span> Rare dental anomaly resulting in teeth having more than one cusp

Talon cusp is a rare dental anomaly resulting in an extra cusp or cusp-like projection on an anterior tooth, located on the inside surface of the affected tooth. Sometimes it can also be found on the facial surface of the anterior tooth.

<span class="mw-page-title-main">Dental attrition</span>

Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism, which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure as enamel does not regenerate.

<span class="mw-page-title-main">Occlusal trauma</span> Damage to teeth due to excessive force

Occlusal trauma is the damage to teeth when an excessive force is acted upon them and they do not align properly.

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

In dentistry, the hydrodynamic or fluid movement theory is one of three main theories developed to explain dentine hypersensitivity, which is a sharp, transient pain arising from stimuli exposure. It states that different types of stimuli act on exposed dentine, causing increased fluid flow through the dentinal tubules. In response to this movement, mechanoreceptors on the pulp nerves trigger the acute, temporary pain of dentine hypersensitivity.

<span class="mw-page-title-main">Cracked tooth syndrome</span> Medical condition

Cracked tooth syndrome (CTS) is where a tooth has incompletely cracked but no part of the tooth has yet broken off. Sometimes it is described as a greenstick fracture. The symptoms are very variable, making it a notoriously difficult condition to diagnose.

The Dahl effect or Dahl concept is used in dentistry where a localized appliance or localized restoration is used to increase the available interocclusal space for restorations.

In dentistry, overeruption is the physiological movement of a tooth lacking an opposing partner in the dental occlusion. Because of the lack of opposing force and the natural eruptive potential of the tooth there is a tendency for the tooth to erupt out of the line of the occlusion.

<span class="mw-page-title-main">Tooth mobility</span> Medical condition

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.

A complete denture is a removable appliance used when all teeth within a jaw have been lost and need to be prosthetically replaced. In contrast to a partial denture, a complete denture is constructed when there are no more teeth left in an arch, hence it is an exclusively tissue-supported prosthesis. A complete denture can be opposed by natural dentition, a partial or complete denture, fixed appliances or, sometimes, soft tissues.

<span class="mw-page-title-main">Non-carious cervical lesions</span> Dental condition

Non-carious cervical lesions (NCCLs) are a group of lesions that are characterised by a loss of hard dental tissue at the cementoenamel junction (CEJ) region at the neck of the tooth, without the action of microorganisms or inflammatory processes. These lesions vary in shape from regular depressions that look like a dome or a cup, to deep wedge-shaped defects with the apex pointing inwards. NCCLs can occur either above or below the level of the gum, at any of the surfaces of the teeth.

Occlusion according to The Glossary of Prosthodontic Terms Ninth Edition is defined as "the static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues".

References

  1. 1 2 3 4 5 6 Kaidonis JA (August 2012). "Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk". British Dental Journal. 213 (4): 155–61. doi: 10.1038/sj.bdj.2012.722 . PMID   22918343.
  2. 1 2 3 4 5 6 7 8 Suchetha A (2014). "Tooth Wear - A Literature Review". Indian Journal of Dental Sciences. 5 (6): 116–120.
  3. 1 2 3 4 5 Bhushan J, Joshi R (2011). "Tooth Wear - An Overview With Special Emphasis On Dental Erosion". Indian Journal of Dental Sciences. 5 (3): 89.
  4. ↑ Towle, Ian; Irish, Joel D.; Groote, Isabelle De (2017). "Behavioral inferences from the high levels of dental chipping in Homo naledi" (PDF). American Journal of Physical Anthropology. 164 (1): 184–192. doi:10.1002/ajpa.23250. ISSN   1096-8644. PMID   28542710. S2CID   24296825.
  5. ↑ Smith, B. Holly (1984). "Patterns of molar wear in hunter–gatherers and agriculturalists" (PDF). American Journal of Physical Anthropology. 63 (1): 39–56. doi:10.1002/ajpa.1330630107. hdl: 2027.42/37625 . ISSN   1096-8644. PMID   6422767.
  6. ↑ Wetselaar, P.; Lobbezoo, F. (January 2016). "The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions". Journal of Oral Rehabilitation. 43 (1): 69–80. doi:10.1111/joor.12340. PMID   26333037.
  7. 1 2 Towle, Ian; Irish, Joel D.; Elliott, Marina; De Groote, Isabelle (2018-09-01). "Root grooves on two adjacent anterior teeth of Australopithecus africanus" (PDF). International Journal of Paleopathology. 22: 163–167. doi:10.1016/j.ijpp.2018.02.004. ISSN   1879-9817. PMID   30126662. S2CID   52056962.
  8. 1 2 López-Frías FJ, Castellanos-Cosano L, Martín-González J, Llamas-Carreras JM, Segura-Egea JJ (February 2012). "Clinical measurement of tooth wear: Tooth wear indices". Journal of Clinical and Experimental Dentistry. 4 (1): e48–53. doi:10.4317/jced.50592. PMC   3908810 . PMID   24558525.
  9. 1 2 Lussi A, Ganss C (2014-06-24). Erosive tooth wear : from diagnosis to therapy. Vol. 20 (2nd ed.). Basel. ISBN   9783318025538. OCLC   875630033.{{cite book}}: CS1 maint: location missing publisher (link)
  10. 1 2 3 Odell EW, ed. (2010). Clinical problem solving in dentistry (3rd ed.). Edinburgh: Churchill Livingstone. pp. 285–287. ISBN   9780443067846.
  11. ↑ Shellis, R. Peter; Addy, Martin (2014), Lussi, A.; Ganss, C. (eds.), "The Interactions between Attrition, Abrasion and Erosion in Tooth Wear", Monographs in Oral Science, 25, Basel: S. KARGER AG: 32–45, doi:10.1159/000359936, ISBN   978-3-318-02552-1, PMID   24993256 , retrieved 2021-07-23
  12. ↑ "Dental Erosion | American Dental Association". www.ada.org. Retrieved 2024-04-19.
  13. ↑ Template:Nascimento MM, Dilbone DA, Pereira PN, Duarte WR, Geraldeli S, Delgado AJ. Abfraction lesions: etiology, diagnosis, and treatment options. Clin Cosmet Investig Dent. 2016 May 3;8:79-87. doi: 10.2147/CCIDE.S63465. PMID: 27217799; PMCID: PMC4861607.
  14. 1 2 Bartlett D, Ganss C, Lussi A (March 2008). "Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs". Clinical Oral Investigations. 12 (Suppl 1): S65–8. doi:10.1007/s00784-007-0181-5. PMC   2238785 . PMID   18228057.
  15. ↑ Smith BG, Knight JK (June 1984). "An index for measuring the wear of teeth". British Dental Journal. 156 (12): 435–8. doi:10.1038/sj.bdj.4805394. PMID   6590081. S2CID   35419496.
  16. ↑ Bardsley PF (March 2008). "The evolution of tooth wear indices". Clinical Oral Investigations. 12 (Suppl 1): S15–9. doi: 10.1007/s00784-007-0184-2 . PMC   2238784 . PMID   18228055.
  17. ↑ Eccles, J. D. (December 1979). "Dental erosion of nonindustrial origin. A clinical survey and classification". The Journal of Prosthetic Dentistry. 42 (6): 649–653. doi:10.1016/0022-3913(79)90196-3. ISSN   0022-3913. PMID   292776.
  18. ↑ Millward, A.; Shaw, L.; Smith, A. J.; Rippin, J. W.; Harrington, E. (September 1994). "The distribution and severity of tooth wear and the relationship between erosion and dietary constituents in a group of children". International Journal of Paediatric Dentistry. 4 (3): 151–157. doi:10.1111/j.1365-263X.1994.tb00124.x. ISSN   0960-7439. PMID   7811669.
  19. ↑ Linkosalo, E.; Markkanen, H. (October 1985). "Dental erosions in relation to lactovegetarian diet". Scandinavian Journal of Dental Research. 93 (5): 436–441. doi:10.1111/j.1600-0722.1985.tb01336.x. ISSN   0029-845X. PMID   3864217.
  20. ↑ Maureen., O'Brien (1994). Children's dental health in the United Kingdom, 1993 : a survey carried out by the Social Survey Division of OPCS, on behalf of the United Kingdom health departments, in collaboration with the Dental Schools of the Universities of Birmingham and Newcastle. Great Britain. Office of Population Censuses and Surveys. Social Survey Division., University of Birmingham. Dental School., University of Newcastle upon Tyne. Dental School. London: H.M.S.O. ISBN   978-0116916075. OCLC   32250617.
  21. ↑ Lussi, A. (April 1996). "Dental erosion clinical diagnosis and case history taking". European Journal of Oral Sciences. 104 (2 ( Pt 2)): 191–198. doi:10.1111/j.1600-0722.1996.tb00067.x. ISSN   0909-8836. PMID   8804886.
  22. ↑ O’Sullivan, EA (2000). "A new index for the measurement of erosion in children". Eur J Paediatr Dent. 1: 69–74.
  23. ↑ Bardsley, P. F.; Taylor, S.; Milosevic, A. (2004-10-09). "Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation". British Dental Journal. 197 (7): 413–416, discussion 399. doi:10.1038/sj.bdj.4811722. ISSN   0007-0610. PMID   15475904. S2CID   2186540.
  24. ↑ Fares, J.; Shirodaria, S.; Chiu, K.; Ahmad, N.; Sherriff, M.; Bartlett, D. (2009). "A new index of tooth wear. Reproducibility and application to a sample of 18- to 30-year-old university students". Caries Research. 43 (2): 119–125. doi:10.1159/000209344. ISSN   1421-976X. PMID   19321989. S2CID   46065628.
  25. ↑ Mulic, A.; Tveit, A. B.; Wang, N. J.; Hove, L. H.; Espelid, I.; Skaare, A. B. (2010). "Reliability of two clinical scoring systems for dental erosive wear". Caries Research. 44 (3): 294–299. doi:10.1159/000314811. hdl: 10852/34967 . ISSN   1421-976X. PMID   20516691. S2CID   21372549.
  26. ↑ Margaritis, Vasileios; Mamai-Homata, Eleni; Koletsi-Kounari, Haroula; Polychronopoulou, Argy (January 2011). "Evaluation of three different scoring systems for dental erosion: a comparative study in adolescents". Journal of Dentistry. 39 (1): 88–93. doi:10.1016/j.jdent.2010.10.014. ISSN   1879-176X. PMID   21035516.
  27. ↑ Mehta, S. B.; Banerji, S.; Millar, B. J.; Suarez-Feito, J.-M. (January 2012). "Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear". British Dental Journal. 212 (1): 17–27. doi: 10.1038/sj.bdj.2011.1099 . ISSN   1476-5373. PMID   22240686.
  28. ↑ Mehta, S. B.; Banerji, S.; Millar, B. J.; Suarez-Feito, J.-M. (February 2012). "Current concepts on the management of tooth wear: part 3. Active restorative care 2: the management of generalised tooth wear". British Dental Journal. 212 (3): 121–127. doi: 10.1038/sj.bdj.2012.97 . ISSN   1476-5373. PMID   22322760.
  29. 1 2 Dyer, K.; Ibbetson, R.; Grey, N. (April 2001). "A question of space: options for the restorative management of worn teeth". Dental Update. 28 (3): 118–123. doi:10.12968/denu.2001.28.3.118. ISSN   0305-5000. PMID   11819971.
  30. ↑ Ibbetson, R (June 1999). "tooth surface loss: Treatment planning". British Dental Journal. 186 (11): 552–558. doi:10.1038/sj.bdj.4800167. ISSN   1476-5373. PMID   10405470. S2CID   11008538.
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