Clinicians should embrace new restorative solutions, including Tokuyama Dental America’s OMNICHROMA, to provide better patient care and more successful management of tooth wear.
For dental professionals, addressing noncarious cervical lesions (NCCLs) effectively can be both easy and rewarding. Early intervention is crucial, offering numerous benefits such as cost efficiency, minimal discomfort, and improved restoration longevity. Our patients are living longer, and with this increased longevity comes a greater likelihood of experiencing dental issues such as caries, xerostomia, gingival recession, periodontal disease, and, of course, tooth wear. Class V lesions, in particular, are prevalent among older adults and present unique challenges in treatment.
The OMNICHROMA composite family
•The OMNICHROMA composite family offers clinicians a complete direct restorative system with only 3 viscosities and 1 shade to choose from, streamlining the restorative process.
•Its products boast exceptional physical, mechanical, and esthetic properties, such as low shrinkage; low wear and abrasion; high compressive and flexural strength; high polishability and stain resistance; and unprecedented shade matching before and after bleaching.
•OMNICHROMA products save doctors time and money by eliminating the need for shade selection and, thus, decreasing inventory of excess products of incidental shades.
•OMNICHROMA’s use of structural color allows it to overcome the shade-matching challenges of Class V restorations.
Tooth wear is a general term used to describe surface loss of dental hard tissue from causes other than caries, trauma, or developmental disorders. Tooth wear is a multifactorial process that results from 3 main interacting mechanisms, each of which is age/time related, progressive, and omni-directional. The types of tooth wear are attrition, erosion, and abrasion. Though not technically tooth wear, abfraction is a common condition seen in aging patients. Abfraction is the loss of hard tissue due to eccentric occlusal loads leading to compressive and tensile stresses at the cervical fulcrum area of the tooth. It usually manifests with the classic wedge-shaped defects with sharp rims at the cementoenamel junction.
Patients are living longer, so the dental profession must help them manage their dental health, which affects overall health through the oral-systemic connection. The number of Class V lesions in older adults is increasing, and this may be attributed to the growing population of older adults and a lower rate of tooth loss. It may also be due to the increase in some etiologic factors such as inadequate brushing techniques in gingival recession cases, corrosive food and drink consumption, and occlusal stress concentrating factors (eg, occlusal interferences, premature contacts, habits of bruxism, and clenching). Treating NCCLs can be problematic. They can result in lack of retention, secondary decay, and improper placement of materials resulting in open margins, contouring, finishing and polishing.
How Do Patients View Tooth Wear?
Patients don’t know what to do about it.
Patients rely on their dentist’s knowledge of how and when to treat it.
They don’t want healthy tooth structure removed.
Patients don’t like needles (eg, for local anesthesia).
Many dentists take a wait-and-see approach to treating NCCLs. Treating cases of Class V NCCLs can be easy and profitable. Early intervention can take very little time and materials to arrest damage caused by years or even decades of this condition. The wait-and-see approach can lead to severe tooth wear and may evolve into complex Class V restorations. The costly options that a patient may be less likely to want or be able to afford include restorations, bite modifications, implants, tooth alignment, and/or nightguards.
Figure 1. Typodont pre-op view
Figure 2. Typodont pre-op lateral view
Figure 3. Class V preparation
Figure 4. Class V preparation with Radius bevel
Figure 5. Adhesion placement light cured
Figure 6. OMNICHROMA Flow placement on gingival margin light cured
Figure 7. OMNICHROMA Flow placement on Superior margin light cured
Figure 8. OMNICHROMA Flow placement on all 4 margins margin light cured (“caulk the window” technique)
Figure 9. OMNICHROMA initial placement with OptraSculpt
Figure 10. OMNICHROMA final placement with OptraSculpt
Figures 11 and 12. Final contouring with Optrasculpt Pad
Figures 11 and 12. Final contouring with Optrasculpt Pad
Figure 13. OMNICHROMA final contoured layer light cured
Figure 14. Precontouring with Red Scout Diamond
Figure 15. Precontouring with Red Scout Diamond lateral view
Figure 16. Final contouring with fine discs
Figure 17. Final polish with OptraGloss
Figures 18. Final polish with OptraGloss lateral view
Clinical photos: Courtesy of Frank J. Milnar, DDS
What Are the Benefits of Early Intervention and Treatment of Lesions?
Greater case acceptance by and lower cost for the patient and more profit for the dentist. With a thorough explanation of the causes and effects of tooth wear and the necessary treatment—along with the use of intraoral photography—patients will find it difficult to refuse treatment.
Less technical procedures for the dentist. Most cases of NCCLs are quite simple to restore when treated in the early stages because the patient’s bite has not yet been altered. Use composite to restore the teeth to their original size and shape to restore normal function. A nightguard is often recommended to protect certain restorations and prolong the need for additional treatment.
Less drilling, anesthesia, and sensitivity, which result in less anxiety. Most cases of tooth wear treatment are quite comfortable for the patient when caught early. Since these restorations are primarily in the enamel, often they can be accomplished with minimal drilling, anesthesia, and sensitivity.
Improved prognosis of the restoration and preservation of enamel. When caught early, most tooth wear restorations are primarily in the enamel, and bonding to enamel allows for high bond strength and more reliable long-term predictability.
Choosing the Best Material What is the criteria for material selection when treating Class V restorations? Universal single-shade paste and flowable composites offer an efficient and effective solution for today’s dentists. The omni-shade restoratives—which include OMNICHROMA from Tokuyama Dental America—combine the light transmission and diffusion properties of enamel and dentin, which negates the need for a multiopacity layering technique that is required by many brands. These universal restorative materials offer high strength that can be used for all restorative classes. They are durable and wear-resistant for load-bearing applications.
Case Study and Summary By leveraging advanced restorative materials and adopting a proactive treatment strategy, dentists can provide patients with comfortable, durable, and esthetically pleasing outcomes. Prioritizing early treatment enhances the longevity and health of restorations and aligns with the growing need for cost-effective solutions in today’s dental practice. Embracing new restorative solutions will ultimately lead to better patient care and more successful management of tooth wear.
The clinical photos highlight the preparation steps and the benefits of OMNICHROMA. Figures 1 and 2 are preoperative photos of the typodont. Figures 3 to 16 illustrate the preparation and the placement of the restorative. The final polish with the OptraGloss universal polisher (Ivoclar) and the completed restoration are shown in Figures 17 and 18.
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