Managing Tooth Wear
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Managing Tooth Wear

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General dental practice has never been more interesting, and the field of tooth wear satisfies so many aspects of the skills we are trained to use: applying a medical diagnostic model to dentistry, design and artistry, sculpture and engineering, use of innovative technology, and the science of dental materials. It requires detective work and lateral thinking, empathy, and listening. Most of all, it’s about offering confidence and reassurance to patients who are often discovering for the first time that chemical and physical forces are damaging their teeth. But not all toothwear needs treatment. How then, does a clinician make the distinction, and what drives us to intervene? Does a patient believe they have a problem, and what is the distinction between physiologic and pathologic wear? Was it necessary when more conservative interdisciplinary solutions would be more appropriate? How can we combine interdisciplinary dentistry, such as orthodontics,to offer less aggressive alternatives to patients? This book will weigh all aspects of the treatment options and the motivation for managing tooth wear. Aboveall, it focus on biologic, functional, and ethical rationale with the goal of enamel conservation and protection at the forefront.

Andrea Shepperson


Dr. Andrea Shepperson is a highly respected dentist and educator, renowned for her expertise in managing tooth wear and interdisciplinary reconstruction of the worn dentition. Dr. Shepperson graduated from the University of Otago, New Zealand in 1984. As the owner of Shepperson Education, a dedicated teaching facility on Waiheke Island, Auckland, New Zealand she runs intensive two- and three-day events for clinicians, with a strong focus on evidence-based clinical strategies that can be implemented with clarity. With a wealth of international knowledge and networking, Dr. Shepperson engages with some of the leading dentists in the world and stays up-to-date with changing global trends and technologies in the industry. She is a mentor and alumna of the Kois Center in Seattle, USA, and a Digital Smile Design KOL. She is an Honorary Life Member of the NZ Academy of Cosmetic Dentistry and a Global Ambassador for Slow Dentistry. Dr. Shepperson’s motivation is to provide novel solutions that offer life-changing outcomes for both dentists and patients. Patients who value longevity, wellness, and a true understanding of their needs seek her services, and dentists who value evidence and authenticity value her insights. As a sought-after author and speaker, Dr. Shepperson enjoys being at the forefront of dentistry. She contributes to publications, podcasts, webinars, and expert panels, and has been a contributing author to Practical Procedures In Aesthetic Dentistry.

CHAPTER 1 Tooth Wear in General Practice

Does Tooth Wear Matter?

Early Recordings of Tooth Wear

Education and Tooth Wear for General Practitioners

Is It Just Aging? Demographic Patterns

Population Trends in Tooth Wear

Should I Treat or Refer?

CHAPTER 2 Etiology of Tooth Wear: Causes and Recognition

Recognizing Patterns of Wear

An International Grading System and Risk Assessment of Tooth Wear

Common Indices for Assessing Tooth Wear

Active Wear or Adapted Wear?

Tooth Wear Definitions and Clinical Appearance

The Role of Gastric Acid in Tooth Wear

Recreational Drug Use

Sports and Tooth Wear

Diet and Tooth Wear

Occupational Tooth Wear

Sleep-Related Breathing Disorders

The Role of Saliva

CHAPTER 3 Occlusion and Tooth Wear

Early Occlusal Concepts

Engrams and Adaptation

Key Occlusal Concepts

CHAPTER 4 Diagnosis of Tooth Wear: The Clinical Exam

Thinking Laterally

Initial Interview: Gathering a History

Medical History

Lifestyle Clues

Conditions and Medication Associated with Tooth Wear

Drug-Induced Bruxism

Diseases Associated with Hyposalivation

The Changing Medical Status of a Patient

Discussing Sensitive Issues in a Dental or Medical History

X-ray Appearance of Tooth Wear

Is It Active or Passive?

Intraoral Evaluation of Tooth Wear

Clinical Records at the New Patient Examination

CHAPTER 5 The Team and Tooth Wear: The Role of the Hygienist and Therapist


The Role of the Hygienist/Therapist

Planning a Separate Appointment for Tooth Wear Diagnosis and Prevention

Establishing Awareness of the Condition

Saliva Testing

Dietary Analysis, Frequency, and Habits

Risk Assessment Questionnaires

Tooth Wear Risk Assessment Appointment

Remineralization Strategies

Improving Saliva Quality and Quantity

Dentifrices and Prophylaxis Techniques


High pH Protective Solutions



CHAPTER 6 Developing the Blueprint for Restorative Tooth Wear Management

Facially Driven Planning

Smile Design Rules, Attractiveness, and Biology

Starting the Blueprint

An Interdisciplinary View in Planning

Tooth Wear Blueprint: Establishing the Functional Starting Point

Articulation: Analog and Virtual Assessment of Tooth Wear

Assessing the Need for an Increase in Vertical Dimension

CHAPTER 7 Testing Your Design: The Pretreatment Mock-up

The New Standard for Case Approval

New Materials for Test-Driving a Design

Starting the 3D Design: The Additive Wax-Up

How to Deliver a Mock-up

The Functional Mock-up

The Orthodontic/Restorative Mock-up

Presenting the Options

Flipping Treatment Planning on Its Head: The Emotional Mock-up

Integrating Interdisciplinary Care

The Bonded Functional and Aesthetic Mock-up

Steps to Create an Index for a Motivational Mock-up

Mock-up Delivery Steps

The Mock-up Photo Shoot

The Mock-up Presentation

Important Aesthetic and Functional Tests after the Presentation

Informed Consent

Moving to Treatment After the Mock-up

CHAPTER 8 Restorative Options: Material Selection in Tooth Wear Cases

Building a Framework for Restorative Treatment

Remaining Enamel: An Important Biomechanical Factor in Restorative Solutions

Restorative Materials

Transitional or Temporary Restorations?

CHAPTER 9 Treatment

About Treatment

Where Do I Start?

A Risk Assessment Approach to Care

A Classification of Tooth Wear

Sequencing Treatment in Complex Cases

Managing NCCLs

Composite or Porcelain?

CHAPTER 10 Longevity in Tooth Wear Cases

The Importance of Continuing Care in Case Stability

Digital Monitoring in Tooth Wear Cases

Aging of Restorations: Survival Rates of Different Materials

Imbrication of Lower Incisors and Orthodontic Relapse

Aging and Medication

Review of Temporary and Transitional Restorations

Occlusal Splints

Preventive Trays

The Patient Relationship and Continuing Care



The Author

  • Autor/es Andrea Shepperson
  • Fecha de edición abril 2023
  • Nº Páginas 536
  • Encuadernación Tapa dura
  • Tamaño 22 X 29
  • Idioma Inglés

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