Treatment Options for Abfractions

Brian Palmer, D.D.S. November, 2004

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If abnormal lateral forces are placed on a tooth, it will eventually break

down over time just as a nail or coat hanger will

bend and eventually break if they are

continually bent back and forth.

In Summary:

Bent nailC2

Forces that can be working on teeth at any time.

Green arrow - only non-destructive force.

Blue arrow - lateral force from tongue.C3

Treatment Goals:

Selectively reshape or recontour tooth so that

forces are directed down the central long axis of

the tooth (Green arrow).

Loading forces should mainly be point contacts from the buccal cusp tips of the posterior mandibular teeth (red arrow) and the lingual cusp tips of the maxillary posterior teeth. (Anterior teeth addressed later.)

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A person exerting lateral forces on the tooth because of a tongue thrust (blue arrow) should be retrained to

swallow properly by a person specially trained in myofunctional therapy or orofacial myology.

Treatment Goals continued:

A person who is a bruxer / clencher can best be helped by an occlusal splint.

Principles of occlusion will be covered in another presentation on this website.

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Treatment by equilibration only.(no decay present)

I consider abfractions, gingival recession and gingival clefts as being in the same ‘family’ of

defective lesions. I look for the same ‘causes’ in all these lesions. I believe many clefts are precursors

to abfractions.

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GV Black thought it was sometimes best not to try a put a restoration in these lesions. I agree with his position.

1st bicuspid very sensitive. Equilibrated only. See next 6 slides.C7

Bicuspid guidance – only tooth contacting (green). See next 5 slides.

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Heavy initial marks #12. See next 4 slides.C9

#12 equilibrated to a point contact – pain eliminated. See next 3 slides.

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Heavy markings on opposing tooth #21. See next 2 slides.C11

#21 equilibrated to fine point on cusp tip. See next slide.

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Guidance now only by cuspid (#12 not contacting). End of case.

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(Reflective view) Very sensitive where recession is. See next 5 slides.

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Bicuspid rise – instead of cuspid rise(Reflective). See next 4 slides.

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Heavy marking caused by bicuspid rise (Reflective). See next 3 slides.

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Heavy markings on opposing tooth. See next 2 slides.C17

Group function – equal force on all posterior teeth. See next slide.

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Bicuspid rise

Group function

End of case.

(All teeth picking up equal load during excursion.)

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#5 – Inflamed and very tender. See next 4 slides.C20

#5 – Heavy contact on incline. See next 3 slides.C21

Heavy contact on opposing #28. See next 2 slides.C22

Occlusion refined to point contacts. See next slide.C23

Original contact.

Refined contact

End of case.C24

Sensitivity resolved.

#13 – Recession / abfraction / sensitivity. (Note angulation / position of lesion.). See next 5 slides.C25

Heavy marks on inclines #13 – Slightly rotated. See next 4 slides.

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Contacts refined on #13 only. See next 3 slides.

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Heavy marks before refinement.

Pin point refined marks

See next 2 slides.C28

Heavy marks on opposing inclines on #19 & 20. See next slide.

Heavy marks

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#19 & 20 contacts refined. End of case.

Refined mark

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Recession on mal-aligned bicuspid. See next 6 slides.

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Heavy markings on mal-aligned bicuspid.See next 5 slides.

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Selective refinement of contacts. See next 4 slides.C33

Before

After

See next 3 slides.C34

Heavy contacts on opposing tooth. See next 2 slide.

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Selective refinement of opposing tooth. See next slide.

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Before

After

End of case.C37

Albert Solnit, Roger Stambaugh. Treatment of gingival clefts by occlusal therapy. March

1983:38-55. International Journal of Periodontics and Restorative Dentistry.

Drs. Solnit and Stambaugh (Univ. of Southern California) did similar occlusal adjustments as just

demonstrated on 25 cases. Their results were: “Partial to complete remission of the cleft was observed in all cases

after occlusal adjustment.” (page 41)

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Abfractions maxillary left. See next 6 slides.C39

Abfraction #19. See next 5 slides.C40

Heavy marking on lower left. See next 4 slides.

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Abfraction #30. See next 3 slides.C42

Tori and heavy anterior incisal wear. See next 2 slides.

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Splint showing central stops. See next slide.C44

Splint showing central stops and excursive marks. End of case.C45

Equilibration plus restoration.

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Abfraction #29 – 4 bi-ortho. See next 2 slides.C47

# 29 Heavy markings from excursion. See next slide.

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#29 Restored and equilibrated to point contacts. End of case.

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Single abfraction with traumatic occlusion. See next 4 slides.

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Abfraction on #20 plus marking on incline during excursion. See next 3 slides.C51

Post equilibration point contact on #20 plus restoration. See next 2 slides.

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# 20 Restored and in occlusion. See next slide.C53

Guidance post-equilibration on cuspid only. End of case.

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Single lesion #28. See next 3 slides.C55

Single lesion #28 – Heavy marking. See next 2 slides.

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#28 Restored and marking refined to tip. See next slide.

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Close-up of #28 restored. End of case..C58

#28 Single abfraction plus heavy marking. See next 5 slides.

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#28 Single abfraction – heavy marking. See next 4 slides.C60

#28 Single abfraction – heavy marking on opposing teeth. See next 3 slides.C61

#28 Contact ‘walked’ to the point of the cusp tip. See next 2 slides.

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#28 Restored and equilibrated. See next slide.C63

#28 Restored and in occlusion. End of case.C64

Tissue graft /failure.

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Old graft with new recession / abfraction. See next slide.C66

Heavy marks on tooth with graft – graft failed to solve problem. End of case.C67

Treatment with single crown

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Large abfraction with horizontal craze lines. See next 3 slides.

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Preparation with firm stain. See next 2 slides.C70

Crown cemented on first bicuspid. See next slide.C71

Abfraction on #12. Fractured porcelain on #14. End of case.

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Multiple abfractions / crowns3 cases

Case 1

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First picture taken of abfractions – 1992.

Open spaces

Open spaces

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1998 – Anterior abfractions – 6 years later.C75

1992

1998

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1998 – Anterior abfractions.C77

Lower teeth prepared for crowns.C78

Temporary crowns on lowers.C79

Crowns on model.C80

Lower crowns cemented in mouth.C81

Lower teeth in occlusion.C82

Smile with lower crowns only.C83

Upper teeth prepared for crowns.C84

Clearance needed for fabrication of crowns.C85

Temporary upper crowns.C86

Crowns on model.C87

Upper and lower crowns cemented.C88

Teeth in occlusion. Can see posterior teeth still need crowns.

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Before

After

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1998 – Posteriors still left to do.C91

1998 – Posterior abfractions and stain – left side.

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1998 – Posterior abfractions – right side.C93

1998 – Posterior abfractions – upper left.C94

1998 – Posterior abfractions – lower right.C95

1998 – Posterior abfractions – upper right.C96

1998 – Posterior abfractions right side.C97

Case #2

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Multiple abfractions. Tongue thruster.C99

Anterior abfractions and fractured central.C100

Fractured central. Looks like it is layered in sheets!!C101

Same flexing pressure on the teeth as on the cards while being shuffled ???

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Abfractions – right side.C103

Abfractions outlined on models.C104

Wax up on semi-adjustable articulator.C105

Wax up demonstrating cuspid rise.C106

Wax up – Anterior guidance following cuspid rise.

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Wax up demonstrating anterior guidance in protrusion.

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5 preps – one stop - clearance.C109

One ‘stop’ plus tongue thrust.C110

Preps plus tongue thrust more obvious.C111

Force from tongue thrust during his normal swallow.

Tongue held back

Blue arrow – tongue thrust.

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Temporary crowns in mouth.C113

Maxillary anterior crowns on model.C114

Maxillary anterior crowns in mouth.C115

Before

After

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Case #3

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A pretty lady who would smile but not

show her teeth.

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Reason she would not show her teeth - abfractions and old restorations.C119

Close-up of old restorations.C120

Maxillary (upper) right abfractions.C121

Maxillary (upper) left abfractions.C122

Abfractions outlined on study models.C123

Case waxed up before treatment started.C124

4 lower veneers and 2 crowns (cuspids) in place.

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Maxillary 6 anterior teeth prepared for crowns.C126

Strong tongue-thrust pushing tongue and saliva between teeth.C127

Multiple crowns in place.C128

Maxillary right abfractions.C129

Temporaries on teeth between appointments.C130

Crowns cemented.C131

Beaming smile upon completion.

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Before. AfterC133

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Research and presentation developed by:

Brian Palmer, DDS Kansas City, Missouri

November 2004