Failure of Dentition

8/3/2019 Failure of Dentition

1/19

Assignment #2

Dentition failures and principle of their

management

ID NUMBER: 1063533

DATE: 10/10/2011

WORD COUNT: 4230


2/19

Introduction:

People around the world are at risk of losing their dentition through the life for several

reasons. Specific diseases and risk factors are contributing for failure of dentition.

However, Understanding and identifying of these diseases and risk factors play an

important role in minimizing the risk dentition failure and increase the success rate ofany suggested treatment. These papers will discuss why dentitions may fail and the

principles of their management. Whether, what are the different causes of dentition

failure? Additionally, what are the risk factors that involved in initiation and progression

of disease? Furthermore, how can we prevent these diseases? What are the applicable

treatments for the conditions? Or even after extraction of the tooth or teeth. Hence the

reasons of dentition failure and their management will be discussed in these papers.

Dental caries:

Dental caries, otherwise known as tooth decay, is one of the most common chronic

diseases of people worldwide (fig. 1). Through all stages of their life, people are

susceptible to this disease. Moreover, it is the major cause of oral pain and tooth loss.

Dental caries can be defined as a destructive process causing decalcification of one or

both of tooth enamel and cementum leading to continued destruction of dentin, and

cavitation of the tooth until the tooth is destroyed. Destruction of dental hard tissues

occurs by acid production resulting from interaction over time between acid-producing

bacteria and fermentable carbohydrate. Kagihara, L., Niederhauser, V. and Stark, M.

(2009) indicated that the basic mechanism for all type of dental caries isdemineralization, or tooth mineral loss through attack by acid generated by cariogenic

bacteria. Root surface caries is similar to enamel caries in mechanism of action but

usually associated with gingival margin recession resulting from poor oral hygiene

leading to exposure of root surface. Untreated dental caries results in pain, bacteremia,

reduced growth and development premature loss of teeth with its sequelae speech

disorder, loss of self-esteem, compromised chewing and high treatment cost.

Figure 1: dental caries


3/19

Risk assessment of dental caries is essential tool to identify the people who at greatest

risk for dental caries and then initiating a preventive dental treatment as early as

possible. The new policy of American Academy of Pediatrics (2008) suggested that the

American Academy of Pediatric Dentistry, the American Dental Association, and the

American Association of Public Health Dentistry recommend that infants be scheduled

for an initial oral examination within 6 months of the eruption of the first primary tooth

but by no later than 12 months of age. Tinanoff, N. (1995) demonstrated that because

caries has multiple causes, multiple risk factors may be required to properly assess the

risk for disease. He demonstrated a model of risk assessment that was carried in

preschool children and was including a combination of social, biologic and psychological

variables. They found the strongest correlation for the dental caries risks were the

mutans streptococci levels and the prior history of caries.

Caries risk is changeable as many factors are involved in initiation of cariesdevelopment. Selwitz, R., Ismail, A. and Pitts, N. (2007) divided the risk factors intothree groups:

Physical and biological:Inadequate salivary flow and composition, high number f cariogenic bacteria,insufficient fluoride exposure, gingival recession, immunological components,need for special health care and genetic factors.

Behavioral:Poor oral hygiene, poor dietary habits including (frequent consumption of refinedcarbohydrates, frequent use of oral medications that contain sugars andinappropriate methods of feeding infants).

social:Numbers of years in education, dental insurance coverage, use of dental sealant,use of orthodontist appliances and poorly designed or ill-fitting partial dentures.

The socioeconomic of parents greatly affects the risk of dental caries in young children,despite the fact that they are covered by comprehensive public oral health program(Peterson, P. 2005).

Improving methods of caries detection, assessment and prevention will lead us to an

international trend in clinical practice towards prevention of caries instead of operative

intervention. Elderton, R. (1993) provides a decision trees to the management of

carious lesion or restored tooth indicating when to intervene as opposed to when to do

nothing and he indicating that the greater implementation of a restorative philosophy,

with all its shortcomings and inherent costs, especially in parts of the world where caries

levels are rising, would be to unreasonably ignore research findings and use precious

resources to achieve an unwanted and irrational outcome. Several methods have been


4/19

introduced to prevent early carious lesions. Fluoride is the most powerful intervention for

caries inhibition by altering bacterial metabolism and promoting mineralization.

Moreover, the reviewers recommended sealing of pit and fissures in permanent molars

to prevent dental caries. Furthermore, elimination of sucrose as can as possible and

improving of oral hygiene status play an important role in reducing dental caries.

Education of people about dental caries and the different ways for prevention may help

in reducing the prevalence of caries. If the caries lesion at stage beyond the early

carious lesion, the prevention methods will not be applicable and restorative intervention

may needed to stop dental caries extension and preserving tooth structure. A tooth

extraction might be indicated especially when the tooth have extensive decay (dental

caries)

Periodontal diseases:

Several adults around the world currently have some forms of periodontal diseases (fig.

2). Periodontal diseases are inflammatory diseases associated with bacterial infection

that affect the gingiva and other tissues supporting the tooth structure (periodontal

ligaments, alveolar bone and cementum). In their advanced forms, left untreated

periodontal diseases can lead to tooth mobility or even tooth loss. Nyman, S. and

Lindhe, J (1979) reported that frequently in cases of advanced periodontitis, the

destruction of attachment apparatus has reached a level which calls for extraction of

several teeth. Periodontal diseases always start as a mild form of gum disease

characterized by swollen, red gum and can easily bleed which called gingivitis. If

gingivitis is not treated, periodontitis can be developed leading to pocket formation, lossof attachment and destruction of the bone and connective tissue that hold teeth (fig. 3).

Johnson, N. et al (1988) suggested that the inflammatory periodontal diseases

encompass anything from the mildest gingival gingivitis to the most advanced

destructive periodontitis with loss of bone, loss of attachment and considerable tooth

mobility.

Figure 2: periodontal disease figure 3: stages of development of

periodontal disease


5/19

The role of risk assessment becomes increasingly crucial on clinical decision making

and in identifying patients and population at increased risk of periodontal diseases. Use

of formal risk assessment tool can aid dental professionals in the identification of

patients at elevated risk of periodontal disease and may help in the selections of

patients who require additional education or targeted interventions to prevent or

minimize the impact of periodontal disease (Douglass, CH. 2006). In 2002, Page and

colleagues introduced the periodontal risk calculator (PCR) which has been shown

accurate assessment for patients risk of developing periodontal disease. Information

were gathered and entered from the base line of dental research into (PCR) including

(patient age, smoking history, diabetes diagnosis, history of periodontal surgery, pocket

depth, bleeding on probing, restorations below the gingival margin, root calculus,

radiographic bone height, furcation involvement and vertical bone lesions). Then the

patients level of risk was determined on a scale from 1 (lowest risk) to 5 (highest risk)

for each subject. They found a strong association between scale score of risk and the

actual periodontal deterioration observed during a 15-year period.

It has clear that there are several risk factors associated with development of

periodontal disease. Page, R. et al (2002) showed that the risk of periodontal disease

varies greatly from one person to another and many characteristics and factors have

been identified that placed people at enhanced risk. Johnson, N . et al (1988)

demonstrated that there are many different forms of periodontal disease with different

clinical presentations, and rates of progression, reflecting important differences in

etiological factors and host susceptibility and it is no longer to talk of periodontal disease

as a single entity. Understanding the risk factors and the proper use of risk assessmenttools will maximally reduce the risk of periodontal diseases. These factors can be

summarized as the following:

Genetic:

One of the dominant determinants of periodontal disease onset and progression

is host factors and that the risk and susceptibility vary from one person to

another. Genetic susceptibility has a dominant effect on the clinical expression of

periodontitis among younger patients (Stabholz, A., Soskolne, W. and Shapira, L.

2010).

Smoking:Has a major effect on the periodontal ligaments in which the heat from smoke

increase calculus deposition and enhance attachment loss. Tanner, A. et al

(2005) show that early periodontitis was associated with gingivitis, subject age

and cigarette smoking.


6/19

Oral hygiene:

Long-term studies showing greater tooth loss (assuming periodontitis being the

major cause) in patient with poorer oral hygiene (Stabholz, A., Soskolne, W. and

Shapira, L. 2010).

Stress:

Clinical observations and epidemiologic studies suggest that periodontal disease

may be affected by depression and stress and anxiety. Stress and related body

distress, as well as inadequate coping mechanisms, are important risk indicators.

Age:

Periodontal disease prevalence and severity increases with increasing age in all

populations. Tanner, A. et al (2005) suggested that attachment loss was

associated with subject age, gingival index, and bleeding on probing.

Diabetes:

People with diabetes are at higher risk for developing oral infections, including

periodontitis. Campus, G. et al (2005) indicated that poorly controlled diabeticpatients have a worse periodontal status than control subject.

Medications:

Ciancio, s. (2005) has divided the medication and their impact on periodontal

disease into four main categories:

I. Those which affect oral hygiene.

II. Those which affect diagnosis of periodontal disease.

III. Those which affect gingival and oral mucosal tissues.

IV. Agents affecting alveolar bone.

Illnesses:

Diseases like quantitative and qualitative neutrophil deficiencies, Down

syndrome, AIDS, functional leukocyte disorders, chronic granulomatous disease,

papllon-lefevre syndrome, trisomy 21 and cancer and their treatments can also

negatively affect the health of gums.

Obesity:

Studies have indicated that the fat distributions pattern plays a crucial role in the

association with periodontitis hygiene (Stabholz, A., Soskolne, W. and Shapira,

L. 2010).

Socioeconomics level:

Socioeconomic status historically has been found to be related to gingival andpoor oral hygiene (Douglass, CH. 2006).

Hormonal changes:

Hormonal changes during pregnancy or puberty in girls/womencan make gums

more sensitive and make it easier for developing of periodontal disease.


7/19

Periodontal diseases treatment requires patient motivation and self-care to ensure the

treatment will succeed. In addition, identifying the risk factors and attempting to stop or

modify it play an important role in management of periodontal diseases. Control of

infection by doing deep scaling, root planning and elimination of pockets and other

retention factors for plaque is first choice of treatment. Some cases may require

prescription of antibiotic such as low-dose doxycycline to inhibit periodontal bone loss.

In advanced cases or if the disease is not responding to the deep cleaning, surgical

option (flap or bone and tissue graft) may take place in the treatment. When the level of

supporting bone is largely reduced and the tooth become excessively mobile tooth

extraction may be the only options.

Tooth wear:

Loss of minimal amount of tooth tissue on the occlusal, incisal and proximal is a normalphysiological process and occurs throughout the life. When the degree of tooth wear

exceeds what would be considered normal for particular age, then it may be considered

pathological and that may lead to loss of the dentition. Hemmings, K. et al (1995)

indicated that tooth wear is believed to be multifactorial in nature and in approximately

30% of cases the precise etiology is unknown. Tooth wear is often localized to anterior

teeth but some time may be generalized through dentition. Many of these patients are

teenagers or young adults and not the middle aged or elderly who are classically

associated with loss of tooth tissues (Bishop, K., Briggs, P. and Kelleher, M. 1994).

Tooth wear can be classified according to its etiology into erosion and Para functional

habits (abrasion and attrition).

Erosion:

Kelleher, M. and Bishop, k. (1999) defined erosion as the progressive loss of

hard dental tissues by chemical process not involving bacterial action (fig. 4). In

general dental practice, erosion is becoming an increasingly important problem.

Erosion make affected teeth surfaces round and destroy their surface

characteristics. The widely held believe that intrinsic (gastric) acid result in

palatally eroded site and extrinsic (dietary) acids lead to labial erosion remain

controversial (Milosevic, A. 1999).

Figure 4: dental erosion


8/19

There are several etiological factors which are associated with tooth erosion such

as:

1. Diet:

The soft drinks have acidic natures which increase the susceptibility to

erosion. In addition alcohol consumption is major risk factors.

Ph. of commonly consumed drinks

Manufacturer brand pHPepsi-cola diet 2.95Coca Cola regular

Caffeine free-dietTab clear- diet

3.153.303.20

lucozada Sport orange 3.78tango Diet orange 2.80

Orange juice 3.50

2. Acid regurgitation:Hydrochloric acid regurgitated into the mouth will cause dental erosion

(Bartlett, D. and Smith, B. 1996). Gastric contents are directed by the

tongue forward during voluntary and prepared vomiting while the lateral

spread of the tongue protects the lower teeth.

3. Salivary flow:

If reduced, may increase the potential of erosive damage.

Para functional habits:

Para functional activity may cause anterior teeth wear especially if protrusive

grinding activities exist. Continued wear may cause shortening of teeth, fracture

of enamel and may loss of teeth. It divided into two types of diseases:

Attrition Abrasion

Defined as the loss by wear of toothsubstance or a restoration caused bymastication or contact betweenoccluding or a proximal surfaces (fig.

5).

Associated with flattening ofincisal edges, cusp tips andlocalized facets on the palatal orocclusal surfaces.

Defined as the loss by wear of toothsubstance or a restoration caused byfactors other than tooth contact (fig.6).

Caused by abnormal rubbing oftooth structure by hair-grips,pipe-smoking and over vigoroustooth brushing.

Tooth wear can be acceleratedby abrasive nature of manycomponent of diet.


9/19

Figure 5: dental attrition figure 6: dental abrasion

Several factors may influencing the choice of treatment worn dentition such as amount

of remaining tooth structure, occlusal vertical dimension, patient compliance and

expectations, vitality of the affected teeth and occlusal guidance. Early diagnosis of the

problem and understanding of the properties of dental materials and different treatment

strategies and technique will help to achieve successful management of different

degree of tooth wear. Treatment plan should be as following:

Monitoring:

Monitoring of the rate of tooth wear is the first sensible step in planning of

treatment.

Prevention:

Should be including the following:

I. Correction of etiological factors.

II. Occlusal splint therapy to reduce the effect of para-functional habits.

III. Topical application of fluoride.IV. Alkaline solutions used after vomiting.

Restorative treatment:

It is advisable to use a reversible device such as a hard maxillary occlusal splint

or removable overlay denture to evaluate a patients adaptive ability to the new

occlusal scheme and protect the remaining tooth structure (Chu, F. et al. 2002).

Treatment choices are include:

I. Reduction of clinical crowns and position of complete or partial

overdenture.II. Restoration of occlusal surfaces using complete or partial onlay or overlay

dentures.

III. Restorations of anterior teeth using crowns or veneers, a removable

partial denture providing posterior support.

IV. Restoration with conventional crown.

V. Restoration with adhesive techniques:


10/19

Direct composite restorations placed at an increased occlusal vertical

dimension can provide a simple, short-term restorative solution to patient

with localized anterior tooth wear and loss of interocclusal space

(Hemmings, K., Darbar, U. and Vaughan, S. 2000).

An effective maintenance regime and recall system should be instituted. When teethare beyond restoration or patient does not wish to receive more complex treatment

extraction of teeth is the last solution.

Occlusion:

Occlusal factors may be important in the etiology of increased tooth mobility and loss of

dentition. Chu, F. et al. (2002) demonstrated that increase of OVD may lead to tooth

mobility, repeated failure of restorations, clenching and even myofacial pain. Traumatic

occlusion defined as repeated excessive force in closure of the teeth that injures the

teeth, the periodontal tissues, the residual ridge, or other oral structures. The closure

extends beyond the reparative ability of the attachment apparatus (cementum,

periodontal ligaments, and alveolar bone). Traumatic occlusion can affect an individual

tooth or group of teeth (fig. 7). Increase in mobility might happen when a new

restoration produces a premature occlusal contact or interference (direct occlusal

trauma), or as a result of an occlusal interference somewhere else in the mouth causing

a damaging deflection (indirect occlusal trauma) Wassell, R. et al (2008).

Figure 7: traumatic occlusion

Treatment of Traumatic occlusion:

Should be treated as early as possible.

Mostly treated by grinding the chewing and biting surfaces of teeth to achieve

balance and proper alignment and this procedure called occlusal equilibration.

occlusal restoration is also sometimes is needed to:

I. Correct the alignment of teeth.

II. Increase distribution of occlusal force over a large number of teeth

surfaces.

III. Prevent over eruption of any opposing teeth.


11/19

Prosthetic failure:

Prosthetic failure may lead to the need for extraction of the abutments teeth or inability

to further restore of the teeth. Downer, M. et al (1999) suggested that 50%of all

restorations last 10 to 20 years. Dental prosthesis fails for great variety of reasons such

as: Fracture of the artificial or natural crown and the tooth considered unrestorable

due to location of fracture or carious destruction of the remaining tooth. Reuter, J.

and Brose, M. (1984) indicated those abutments that were root-treated after

bridge cementation were more prone to retainer or abutment fracture than vital

abutments or those root-treated beforehand.

Fracture of the root (fig. 8).

Severe bone destruction due to improper prosthetic margin.

Figure 8: root fracture

Endodontic failures:

The success rate of endodontic treatment is directly related to reducing the number ofmicrobial population within the root canal system and to prevent reinfection by a tightseal of root canal space. Some endodontic failure make the endodontic retreatment isimpossible and the only choice of treatment is extraction. Vire, d. (1991) showed thatfailure of endodontic origin is less frequent but appears to occur faster than that ofperiodontal and prosthetic failures. Several reasons are contributing to endodonticfailure such as:

Vertical root fractures.

Instrumentations failure such as: strips, zips, and incomplete instrumentations.

Severe resorption. Loss of periradicular bone support, due to periradicular inflammation or after

apical surgery (fig. 9).

Figure 9: periradicular inflammation


12/19

Trauma:

Trauma is one of the most common causes of failing of dentition and extraction of teethespecially in the children and adolescents (fig. 10). In addition, traumatic injuries to thedentofacial part of body have a substantial impact on people daily life. Loss of one or

more teeth may have psychological effect on patient life. The most common causes ofdentofacial injuries are: falls, collision with an object, assault, bicycle accidents andvehicle accident. Trauma may lead to one or several of the following probabilities rootfracture, crown root fracture, avulsion, alveolar fracture and jaw fracture. Adekoya-sofowora, c. (2008) indicated that dental injuries could have improved outcomes ifpublic were aware of first aids measures and the need to seek immediate treatment.Dental trauma also may cause root resorption and failing of dentition so that teethshould be under observation after the trauma.

Figure 10: traumatic injury

Developmental failures:

Several dental abnormalities may occur during the development stages of dentition.

Disorders of development of teeth may be inherited or acquired causing anomalies inthe number, size, and form of teeth.

Hypodontia and anodontia:Congenital absence of one or several permanent teeth referred as hypodontia(fig. 11), while absence of all teeth referred as anodontia. These developmentalabnormalities are usually associated with:

I. Genetic disorders: Down syndrome.II. Environmental factors: radiation.III. Hormonal factors: Hypoparathyroidism.IV. Infectious factors: rubella.

Figure 11: hypodontia


13/19

Amelogenesis imperfecta:Hereditary condition affecting enamel formation causing thin, discolored and withhigh risk of dental cavities. The enamel has a similar density to dentine onradiographs Because of the deficient mineralization. Crowns are sometimesbeing indicated to protect the soft enamel. Usually stainless steel crowns are

used in children that replaced by porcelain once they reach adulthood.Sometime, the teeth may have to be extracted.

Dentinogenesis imperfecta:

Defect of the dentin that causes discoloration and translucency and weakness of

dentin.

Pathological failures:

External root resorption can be caused by pressure adjacent to the area near the

stimulation source. Larson, TH. (2007) explained that Tumor pressure caused mostly by

slow growing tumors such as cysts, ameloblastoma, giant cell tumors, and fiber-

osseous lesions, does not affect the pulpal health unless the tumors are located at the

apical foramen and disturb blood flow (fig. 12). Relieve the tumor pressure stop the root

resorption. In some cases, extraction of involved teeth is part of tumor management.

Figure 12: Ameloblastoma

Treatment of failed dentition:

There are number of reasons why your tooth or teeth might be unrestorable and the

dentist indicates that you have tooth or several teeth must be extracted. In most of

cases replacement of extracted tooth or teeth are mandatory to restore the normal

function and esthetic of dentition. Careful evaluation of the existing dental and functional

situation, benefits, risks and costs of any prosthetic management must be preceding the

decision of tooth replacement. Kayser, A. (1981) suggested that there is sufficient


14/19

adaptive capacity in shortened dental arches when at least 4 occlusal units are left,

preferably in a symmetrical position. Multiple ways of prosthetic treatment are available

for replacing of any extracted teeth. Several factors determined the best way of

treatment such as: the patients degree of cooperation, biological and technical quality

of prosthetic materials general and oral health status of the patient, economic resources

and the prosthodontists knowledge. The most common replacement procedures for

teeth are as follows:

Do nothing:

Accept the space and leave it empty. Budtz-jorgensen, E. (1993) indicated that in

patients with poor oral hygiene, the best solution with regard to the prognosis of

the remaining teeth is to abstain from any prosthetic treatment. In addition,

studies indicate that oral function can be achieved by premolars and anterior

teeth.

Implants:

Usually made of titanium and is placed within bone of the jaw leading to a

process which called osteointegration (fusion between implant surface and

surrounding bone) (fig. 13). Can be used to replace tooth or several teeth by

supporting dental prosthesis including: crowns, implant- supported dentures and

bridges. The jaw should have sufficient and strong amount of bone to hold and

support the implants. The main advantages of dental implant low marginal bone

loss around the implant, limited adjustment of the prosthesis, last longer,

perfectly safe for the teeth adjacent to the missing tooth and high success rate.

The main disadvantage is the high initial cost.

Figure 13: implants

Removable dentures:Removable dentures are divided into two main categories: partial denture

replacing one or more teeth which are missing (fig. 14). While, full dentures

replacing all teeth in the upper or lower jaw. Patient has the ability to remove and

reinsert them without professional assistance. There are several drawbacks of

removable dentures such as impaired esthetic and oral comfort, accumulation of

plaque, root caries, mechanical failure (fracture of major or minor connectors,


15/19

occlusal rests, and retentive clasps) and frequent readjustment due to bone

resorption. The positive things in the removable dentures are a non-invasive and

low cost solution.

Figure 14: removable partial denture

Fixed partial denture:

Also known as dental bridge and mostly used to fill a gap between two teeth or

tooth and implant by grinding down and creation of two crowns for the teeth on

each side of the gap and permanently joining themby a false tooth/teeth (fig. 15).

Multiple materials can used to fabricate of dental bridge such as: porcelain, gold

or porcelain fused to gold. The main weaknesses of the fixed partial denture are

the invasive and irreversible nature of the treatment, tooth fracture, caries,

technical, periodontal and endodontic complication. On the other hand, success

rate of fixed partial denture is high with better patient comfort and occlusal

stability than treatment with removable denture or a partial denture.

Figure 15: fixed partial denture

Overdenture:

Overdenture is a complete or partial denture supported by tooth abutments or

implant (fig. 16). Retention of the overdenture can be improved by using magnetsor precision attachments. Gillings, B. (1983) described that the magnetic

retention can be used on roots that would have a poor prognosis with

conventional precision attachments without transmitting significant tipping forces

to the tooth root. The main advantages of overdenture are decreased resorption

of residual ridges, easily modified if one or several abutments are lost and

psychological benefits. The main disadvantages are associated with caries and


16/19

progression of periodontal disease. Overdenture treatment should not be

considered if treatment with fixed or removable partial denture is possible (Budtz-

jorgensen, E. 1993).

Figure 16: overdenture

Conclusion:

In conclusion, it seem that dentition failure have numerous reasons. Dental health

practitioners should be able to identifying and determining the causative diseases andthe involved risk factors. Using and improving risk assessment tools may help in

reducing the incidence of dentition failure. Applying of preventive measures plays

crucial roles in preserving and maintaining the natural teeth and their function. Frequent

recall examination keep the dentist updated with the oral status of patient and minimize

the need for invasive treatment. In some cases extraction of tooth or teeth is the only

choice. Dentist should be having adequate knowledge about multiple ways of teeth

replacement and the advantages and disadvantages of each way to achieve best

results.


17/19

List of references:

Adekoya-sofowora, C., Adesina, O., Nasir, W., Oginni, A. and Ugboko, V. (2009)

Prevalence and causes of fractured permanent incisors in 12-year-old suburban

Nigerian schoolchildren. Dental traumatology25 (3), 314-317.

American academy of pediatrics (2008) policy statement: Preventive Oral HealthIntervention for Pediatricians. 122 (6) 1387-1394. USA: American academy ofpediatrics.

Bartlett, D. and Smith, B. (1996) Clinical investigations of Gastro-esophageal reflux:

Part 1. Dental update23 (5), 205-208.

Bishop, K., Briggs, P. and Kelleher, M. (1994) The aetiology and management of

localized anterior tooth wear in the young adult. Dental update21 (4), 153-160.

Campus, G., Salem, A., Uzzau, S., Baldoni, E. and Tonolo, G. (2005) Diabetes andperiodontal disease: A case-control study. Journal of periodontology76 (3), 418-425.

Chu, F., Siu, A., Newsome, P., Chow, T. and Smales, R. (2002) Restorative

management of the worn dentition:4. Generalized tooth wear. Dental update 29 (7),

318-324.

Ciancio, S. (2005) Medications: A risk factor for periodontal disease diagnosis and

treatment. Journal of periodontology76 (0), 2061-2065.

Douglass, C (2006) Risk assessment and management of periodontal disease. Journal

of American dental association137 (0), 27-32.

Downer, M., Azli, N., Bedi, R., Moles, D. and Setchell, D. (1999) How long do routine

dental restorations last? A systemic review. British dental journal187 (8), 432-439.

Elderton, R. (1993) Overtreatment with restorative dentistry: when to intervene?.

international dental journal43 (1), 17-24.

Gillings, B. (1983) Magnetic retention for overdentures. Part II. The journal of prosthetic

dentistry49 (5), 607-618.

Hemmings, K., Darbar, U. and Vaughan, S. (2000) Tooth wear treated with directcomposite restorations at an increased vertical dimension: results at 30 months. The

journal of prosthetic dentistry83 (3), 287-293.

Hemmings, K., Howlett, J., Woodley, N. and Griffiths, B. (1995) Partial dentures for

patients with advanced tooth wear. Dental update22 (2), 52-59.


18/19

Johnson, N., Griffiths, G., Wilton, J., Maiden, M., Curtis, M., Gillett, I., Wilson, D. and

Sterne, J. (1988) Detection of high-risk groups and individuals for periodontal diseases.

Journal of clinical periodontology15 (5), 276-282.

Jorgrnsen, E. (1996) Restoration of the partially edentulous mouth- a comparison of

overdentures, removable partial dentures, fixed partial dentures and implant treatment .Journal of dentistry24 (4), 237-244.

Kagihara, L., Niederhauser, V. and Stark, M. (2009) Assessment, management, and

prevention of early childhood caries. Journal of the American academy Academy of

nurse practitioners21 (1), 1-10.

Kayser, A., (1981) Shortened dental arches and oral function. Journal of oral

rehabilitation8 (5), 457-462.

Larson, T. (2007) Causes and Treatment of Root Resorption. Northwest dentistry

journal [Online] Available from:

http://www.mndental.org/features/2010/06/24/219/causes_and_treatment_of_root_resor

ption [Accessed on 09/10/2011].

Milosevic, A. (1999) Eating disorders and the dentist. British dental journal186 (3),109-

113.

Nyman, S. and Lindhe, J. (1979) A longitudinal study of combined periodontal and

prosthetic treatment of patients with advanced periodontal disease. Journal of

periodontology50 (4), 163-169.

Page, R., Krall, E., Martin, J., Mancl, L. and Garcia, R. (2002) Validity and accuracy of

a risk calculator in predicting periodontal disease. Journal of American dental

association, 133 (0), 569-576.

Petersen, P. (2005) Sociobehavioural risk factors in dental caries - international

perspectives. Community dentistry and oral epidemiology33 (0), 274-279.

Reuter, J. and Brose, M. (1984) Failures in full crown retained dental bridges . British

dental journal157 (2), 61-63.

Selwitz, R., Ismail, A. and Pitts, N. (2007) Dental caries. The lancet36 (6), 51-59.

Stabholz, A., Soskolne, W. and Shapira, L. (2010) Genetic and environmental risk

factors for chronic periodontitis and aggressive periodontitis. Periodontology 2000 53

(0), 138-153.

Tanner, A., Jr, R., Dyke, T., Sonis, S. and Murray, L. (2005) Clinical and other risk

indicators for early periodontitis in adults. Journal of periodontology76 (4), 573-581.


19/19

Tinanoff, N. (1995) Dental caries risk assessment and prevention. Dental clinics of

north America39 (4), 709-719.

Vire, D. (1991) Failure of endodontically treated teeth: classification and evaluation.

Journal of Endodontics17 (7), 338-342.

Wassell, R., Naru, A., Steele, J. and Nohl, F. (2008) Applied occlusion. London:

Quintessence publishing.

Documents

Failure of Dentition