Dentaltown April 2018 - 30

show your work
case study

Treating Incisal
Edge Wear

A step-by-step
approach

by Dr. Marvin Fier
Marvin Fier, DDS, received his
DDS degree from NYU and served
as a dental officer in the U.S.
Navy. Fier, a practicing clinician
and lecturer on aesthetics,
restorative dentistry and
practice management, presents
continuing education courses
at universities and congresses
throughout the world. He is the
executive vice president of the American Society for Dental
Aesthetics. For the past 13 years, Fier has been listed as
one of the best lecturers in the "Leaders in Continuing
Education" category. Contact: docmarv@optonline.net

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30

APRIL 2018 // dentaltown.com

How often do we see incisal edge wear in
patients whose oral health and dentition are
basically healthy? I'm sure we can all recall
seeing the yellow or brown color of dentin
surrounded by borders of enamel on lower
incisal edges (Fig. 1) or perhaps even on upper
incisors. Do we leave these areas untreated
and monitor them because we don't think
they're in need of treatment ... yet?
Sometimes we also see chipping or
increased translucence of the incisal edges
due to very thin enamel. The patient might
notice a bluish translucency on upper incisors
or tell us his/her teeth are starting to chip.
When abfractions accompanied by severe
posterior wear are also present, chances are
the patient is a severe grinder and clencher
(Fig. 2). The discoloration of lower incisal
edges is easily seen by a patient, or the patient
might not be aware of what's happening.
With our aging population, people are
keeping their teeth longer. Attrition of tooth
structure accompanied by continuous eruption, is a normal phenomenon, but cratering
or cupping of incisal edges with exposed
dentin represents excessive wear. This can be
detrimental to a patient as seen in Figs. 1 and
2. Excessive wear areas are easily spotted on
lower incisors (Fig. 3). These areas can also
occur on upper incisors in the inciso-palatal
region and are often overlooked (Fig. 4).

Excessive wear
Excessive tooth wear can be caused by
abrasion, GERD (gastroesophageal reflux
disease), bruxism, clenching, acidic beverages

Fig. 1

Fig. 2

and foods, and genetic factors.1 It's important
to determine the causative factors when we
see cratered or gauged out upper or lower
incisal edges. Did the excessive wear arise
from dietary erosion due to acidic substances
contacting the teeth? Was bruxism the cause?
Interestingly, "there is no consensus about
the defi nition and diagnostic grading of
bruxism."2 If the problem is bruxism, is it
nocturnal, daytime, or both? Awake bruxism
is thought to be semi-voluntary, (i.e., genetic
and environmental), and often associated
with stress caused by family responsibilities
or work pressures.3
A detailed history including the patient's
awareness of clenching or grinding habits
must be taken. A comprehensive examination
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