N

1. Increased Abrasion of Hard
Tissues of Teeth: Orthopedic
Treatment and Complex
Rehabilitation

2. "Increased Abrasion of
Hard Tissues of Teeth."
• This condition refers to the excessive wearing down of the outer layers of the teeth, including enamel and dentin.
It is a prevalent issue that affects a significant portion of the population, leading to various dental complications
and compromising oral health.
• Importance of Addressing Increased Abrasion of Hard Dental Tissues:
• The increased abrasion of hard dental tissues is a matter of concern due to its impact on both the functionality
and aesthetics of the dentition. As the protective layers of the teeth wear away, individuals may experience
heightened sensitivity, tooth fractures, and even tooth loss. Furthermore, the compromised appearance of the
teeth can significantly affect a person's self-esteem and overall quality of life. Therefore, it is crucial to address this
condition to preserve dental health and enhance the overall well-being of affected individuals.
• Relevance of Orthopedic Treatment and Complex Rehabilitation:
• Orthopedic treatment and complex rehabilitation play a crucial role in managing the condition of increased
abrasion of hard dental tissues. Orthopedic treatment involves the use of orthodontic appliances and special
occlusal splints to correct improper tooth alignment and reduce excessive forces on the teeth during biting and
chewing. This helps to minimize further wear and tear on the dental tissues. Complex rehabilitation, on the other
hand, focuses on restoring the damaged dental structures through various restorative techniques, such as dental
crowns, veneers, and dental implants. By combining orthopedic treatment with complex rehabilitation, dentists
can provide comprehensive care and address both the functional and aesthetic aspects of the condition.

3. K03.0
• The ICD-10 code for the condition "K03.0" is used to classify the dental
condition known as "Excessive attrition of teeth."
• To explain this condition further, excessive attrition refers to the excessive
wearing down of the teeth due to various factors. Attrition can occur naturally
with age, but excessive attrition typically results from non-physiological factors
like bruxism (teeth grinding or clenching) or abrasive habits such as regularly
chewing on hard objects like pens or ice.
• The ICD-10 code system is a standardized medical classification system used
worldwide to categorize and code various diseases, disorders, and conditions.
The code "K03.0" specifically falls under the category "Diseases of hard tissues
of teeth" (K00-K14) and further classifies the condition as excessive attrition.
• It's important to note that while the ICD-10 code provides a standardized way to
classify and communicate medical conditions, it's always recommended to
consult with a healthcare professional for an accurate diagnosis and appropriate
treatment.

4. • Excessive attrition is a dental condition characterized by the excessive wearing down of tooth surfaces. This can
lead to the loss of tooth structure, exposing the underlying dentin and, in severe cases, even the pulp of the tooth.
It is often a result of chronic grinding or clenching of the teeth, a condition known as bruxism.
• Bruxism can occur during the day or at night, and many individuals may be unaware that they have this habit. It
can be caused by various factors, including stress, anxiety, malocclusion (misalignment of the teeth), or certain
medications. Bruxism can exert significant force on the teeth, leading to the wearing down of tooth enamel and
the development of attrition.
• In addition to bruxism, other factors can contribute to excessive attrition. These include abrasive habits such as
chewing on hard objects like pens, ice, or fingernails. Certain dietary factors, such as consuming highly acidic or
abrasive foods and beverages, can also contribute to accelerated tooth wear.
• Excessive attrition may present with symptoms such as tooth sensitivity, flattened or worn tooth surfaces,
shortened teeth, or even visible notches at the gum line. In severe cases, it can lead to tooth fractures, jaw pain,
headaches, and temporomandibular joint (TMJ) disorders.
• Treatment for excessive attrition depends on the underlying cause and the severity of tooth wear. In cases where
bruxism is the primary contributing factor, a custom-made nocturnal bite splint or mouthguard can be prescribed.
This appliance helps protect the teeth from further wear and may alleviate symptoms associated with bruxism.
• For cases involving malocclusion, orthodontic treatment may be recommended to correct the alignment of the
teeth and reduce excessive forces during biting and chewing.
• In situations where tooth wear has led to significant loss of tooth structure, restorative dental procedures such as
dental bonding, dental crowns, or veneers may be utilized to restore the functionality and aesthetics of the
affected teeth.

5. Slide Title
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6. • Generalized Increased Abrasion with
Decreased Height of Lower Third of the
Face

7. signs and symptoms
• - Generalized increased abrasion: This refers to the excessive wearing down of tooth
surfaces, affecting multiple teeth in the mouth. The teeth may appear flattened or have
visible signs of wear, such as notches or grooves near the gum line.
• - Decreased height of the lower third of the face
• - Jaw pain or discomfort, especially during chewing or speaking
• - Limited jaw movement or difficulty opening the mouth fully
• - Clicking, popping, or locking of the jaw joint (temporomandibular joint)
• - Headaches, earaches, or facial pain
• - Muscle tenderness in the jaw, face, neck, and shoulders
• - Neck and shoulder stiffness
• - Tinnitus (ringing in the ears)

8. Myoarticular Dysfunctional Syndrome
• Myoarticular dysfunctional syndrome refers to a complex condition involving
the dysfunction of the muscles, joints, and associated structures in the jaw. It
is often associated with temporomandibular joint disorder (TMD). The exact
causes of this syndrome are multifactorial and can include factors such as
malocclusion (misalignment of the teeth), bruxism (teeth grinding or
clenching), stress, trauma, or anatomical abnormalities.
• The syndrome involves a combination of muscular imbalances, joint
dysfunction, and pain in the temporomandibular joint region. The
malocclusion and abnormal bite alignment resulting from generalized
increased abrasion can contribute to the development or exacerbation of
myoarticular dysfunctional syndrome.
• Treatment for myoarticular dysfunctional syndrome typically involves a
multidisciplinary approach, including dental professionals, physical therapists,
and other healthcare providers. It may include interventions such as occlusal
splints or mouthguards, physical therapy exercises, stress management
techniques, and, in severe cases, orthodontic treatment or surgery.

9. Complex Treatment for Generalized Increased
Abrasion with Decreased Height of Lower Third
of the Face
• When it comes to the complex treatment of
patients with generalized increased abrasion and a
decrease in the height of the lower third of the
face, several fundamental principles guide the
approach. These principles consider the stage and
prevalence of the abrasion process and aim to
restore oral health, improve facial aesthetics, and
address the underlying causes of the condition.

11. various orthopedic treatment options
based on severity
• 1. Comprehensive Evaluation and Diagnosis
• 2. Addressing Underlying Factors
• 3. Considering the Stage and Prevalence of
Abrasion
• 4. Restorative Treatment Options
• 5. Orthopedic Treatment Options
• a) Orthognathic Surgery
• b) Vertical Dimension Restoration
• 6. Prosthodontic Treatment Options

12. different types of dentures
• 1. Partial Dentures:
• - Partial dentures, also known as removable partial dentures or simply "partials,"
are used when only a few teeth are missing or compromised.
• - They consist of a metal or acrylic framework that supports the replacement
teeth and attaches to the remaining natural teeth using clasps or precision
attachments.
• - Partial dentures not only restore the appearance and function of the missing
teeth but also help to maintain the alignment and stability of the remaining natural
teeth.
• - By filling the gaps created by missing teeth, partial dentures prevent the
adjacent teeth from shifting, which can lead to further bite problems and tooth
wear.

14. different types of dentures
• 2. Complete Dentures:
• - Complete dentures, often referred to as "full dentures," are used when all the
teeth in either the upper or lower dental arch are missing or need to be replaced.
• - They consist of a flesh-colored acrylic base that fits over the gums and supports
a set of artificial teeth.
• - Complete dentures are custom-made to fit the patient's mouth and provide
support for the lips, cheeks, and facial structures.
• - These dentures restore the ability to chew and speak properly, improve facial
aesthetics, and enhance overall oral function.
• - Complete dentures require regular maintenance and adjustments to ensure a
proper fit as the underlying bone and soft tissues change over time.

15. Complete Dentures

16. different types of dentures
• 3. Implant-Supported Dentures:
• - Implant-supported dentures are a more advanced option that combines dental
implants with dentures to provide increased stability and support.
• - Dental implants are titanium posts surgically placed into the jawbone, acting as
artificial tooth roots.
• - The dentures are then attached to the implants using connectors or
attachments, creating a secure and stable fit.
• - Implant-supported dentures offer several advantages, including improved
chewing efficiency, enhanced speech, increased comfort, and reduced bone loss in
the jaw.
• - This type of denture is particularly beneficial for patients with inadequate bone
support or those who desire a more secure and permanent solution compared to
traditional removable dentures.

18. Indications for dentures
• - Partial dentures replace missing teeth, preventing adjacent teeth
from shifting and maintaining proper alignment. They restore
function and aesthetics by filling in gaps created by missing teeth.
• - Complete dentures replace all the teeth in either the upper or
lower arch, restoring oral function, facial aesthetics, and speech.
They are designed to fit securely over the gums and provide support
to the surrounding facial structures.
• - Implant-supported dentures offer increased stability and support
by anchoring the dentures to dental implants. This type of denture
is particularly useful when there is insufficient bone support,
providing a more secure and comfortable fit.

19. Increased Abrasion without Decreased
Height of Lower Third of the Face
• Generalized increased abrasion refers to the excessive wearing down of
the tooth surfaces, typically caused by factors such as bruxism (teeth
grinding), malocclusion (improper bite relationship), or parafunctional
habits. In cases where there is no decrease in the height of the lower third
of the face, the clinical manifestations of generalized increased abrasion
can include the following signs and symptoms:
• 1. Tooth Wear
• 2. Tooth Sensitivity
• 3. Changes in Tooth Appearance
• 4. Altered Bite Relationship
• 5. Fractured Restorations

20. myostatic reflex according to Rubinov
• The myotatic reflex according to Rubinov manifests itself in functional
states associated with the stretching of the masticatory muscles
• The beginning of the myotatic reflex is given by the impulses arising in
the receptors located in the masticatory muscles and their tendons
Then, the impulses along the II and III branches of the trigeminal
nerve enter the sensory nuclei of the medulla oblongata, then into
the sensory nuclei of the optic tuber and then into the sensory zone
of the anterior hemisphere of the cerebral cortex, where they switch
from sensory to motor nuclei and return to the chewing muscles
along the centrifuga nerve pathways causing a shortening reaction
• The more the lower jaw is lowered, the more the chewing muscles
stretch Gradually, a new length of muscle fiber is produced in a state
of physiological rest

21. • Complex Treatment for
Generalized Increased
Abrasion without
Decreased Height of Lower
Third of the Face

22. 1. Preventive Measures
• - Emphasizing preventive measures is crucial in managing generalized
increased abrasion. Patients should be educated about oral hygiene
practices and encouraged to maintain good oral health habits, such as
brushing twice a day with a soft-bristled toothbrush and using fluoride
toothpaste.
• - Patients should be advised to avoid or modify habits that contribute to
tooth wear, such as chewing on hard objects, clenching or grinding the
teeth (bruxism), and using abrasive toothpaste.
• - Customized mouthguards or nightguards may be recommended for
patients with bruxism to protect the teeth from excessive forces during
sleep.

24. 2. Thorough Clinical
Examination
• - A comprehensive clinical examination is essential to assess the
extent and severity of tooth wear. This evaluation involves
examining the teeth, soft tissues, occlusion (bite relationship), and
temporomandibular joints (TMJ).
• - Diagnostic aids such as dental radiographs, study models, and
photographs may be used to aid in the evaluation and treatment
planning process.
• - The examination should also assess the underlying causes of
tooth wear, such as bruxism, malocclusion, or parafunctional habits,
to address them appropriately during treatment.

25. 3. Multidisciplinary
Approach
• - Given the complexity of the condition, a multidisciplinary
approach involving various dental specialists may be
necessary. Collaboration between prosthodontists,
orthodontists, periodontists, and other dental professionals
can provide comprehensive treatment planning and
execution.
• - The treatment plan may include a combination of
restorative procedures, orthodontic intervention, occlusal
adjustments, and behavior modification strategies to address
the underlying causes and restore oral health and function.

26. 4. Prognosis and Long-Term
Maintenance
• - Accurate assessment of the prognosis is crucial for effective treatment
planning. The prognosis depends on factors such as the severity of tooth
wear, the presence of underlying causes, and the patient's commitment to
preventive measures and treatment protocols.
• - Regular follow-up visits and maintenance appointments are necessary
to monitor the condition, evaluate the effectiveness of the treatment, and
make any necessary adjustments.
• - Long-term maintenance and preventive measures, including
professional cleanings, occlusal adjustments, and patient education, are
vital to minimize further tooth wear and maintain the results achieved
through treatment.

27. Preventive Measures
• - Good Oral Hygiene: Encourage patients to maintain proper oral hygiene
practices, including brushing twice a day with a soft-bristled toothbrush and
fluoride toothpaste. Flossing or using interdental cleaners should also be part of
their daily routine.
• - Avoiding Abrasive Substances: Advise patients to avoid using abrasive
toothpaste or excessively hard toothbrushes, as these can contribute to further
abrasion of tooth surfaces.
• - Modify Habits: Help patients identify and modify habits that contribute to
tooth wear, such as chewing on hard objects (e.g., pens, ice), clenching or
grinding the teeth (bruxism), or using teeth as tools.
• - Nightguards or Mouthguards: For patients with bruxism or parafunctional
habits, custom-fitted nightguards or mouthguards can be recommended to
protect the teeth from excessive forces during sleep or sports activities.
• - Dietary Modifications: Encourage patients to limit the consumption of acidic
foods and beverages that can contribute to enamel erosion. Additionally,
advising them to rinse their mouths with water after consuming acidic
substances can help minimize the effects.

28. Thorough Clinical Examination
• - Tooth Evaluation: Examine the teeth for signs of wear, such as flattened or
shortened incisal edges, loss of tooth surface anatomy, and exposed dentin.
• - Soft Tissue Examination: Assess the condition of the gingiva (gums) and other
soft tissues in the oral cavity to identify any signs of inflammation or trauma.
• - Occlusal Analysis: Evaluate the bite relationship and occlusal forces to determine
if malocclusion or imbalanced forces are contributing to the abrasion. This may
involve assessing the centric occlusion (the position where the teeth come
together), the excursive movements of the jaw, and potential interferences.
• - TMJ Examination: Evaluate the temporomandibular joints (TMJ) for any signs of
dysfunction or discomfort, as TMJ issues can contribute to bruxism and tooth wear.
• - Underlying Causes: Identify and address any underlying causes of increased
abrasion, such as bruxism, malocclusion, or parafunctional habits, as part of the
treatment planning process.

29. Prognosis
• - Prognosis Assessment: The prognosis of patients with increased abrasion depends
on various factors, including the stage and severity of the condition, the
effectiveness of treatment interventions, and patient compliance with preventive
measures and treatment protocols.
• - Early Intervention: Early detection and intervention generally lead to better
outcomes. Patients in the early stages of abrasion with minimal tooth structure loss
have a more favorable prognosis compared to those with advanced wear.
• - Patient Compliance: The patient's commitment to preventive measures,
behavior modification, and long-term maintenance significantly impacts the
prognosis. Regular follow-up visits and adherence to recommended treatment
protocols are essential for successful management.
• - Multidisciplinary Collaboration: In complex cases, involving multiple dental
specialists in the treatment planning and execution can improve the prognosis by
addressing the various aspects of the condition.