Anders Ekfeldt

Prevalence and severity of incisal and occlusal tooth wear in an adult Swedish population

The material consisted of 585 randomly selected dentate individuals from the community of Jönköping, Sweden, who in 1983 reached the age of 20, 30, 40, 50, 60, 70, or 80 years. The degree of incisal or occlusal wear was evaluated for each single tooth in accordance with the following criteria: 0 = no wear or negligible wear of enamel; 1 = obvious wear of enamel or wear through the enamel to dentin in single spots; 2 = wear of dentin up to one-third of the crown height; 3 = wear of dentin more than one-third of the crown height and/or excessive wear of tooth restorative material. Among the 20-year-olds 35% of the subjects had no or slight incisal or occlusal wear. The corresponding figures for the 30- to 80-year age groups were 20%, 32%, 18%, 14%, 26%, and 23%, respectively. For the age groups 20-80 years, the percentage of teeth with incisal or occlusal wear in accordance with criteria 1-3 was 13%, 20%, 16%, 24%, 23%, 23%, and 23%, respectively. Men presented more teeth with wear than women, the difference being significant for all age groups except the 20- and 60-year-olds. Among the 20-year-olds 6% had one or more teeth with wear scored 2. Among subjects aged 30 and 70 years 10% and 31%, respectively, showed tooth wear with score 2. Wear with score 3 was only found in 2% of the total population. There was an increase in the number of teeth with incisal or occlusal wear with age. With increasing age, there was also a change in distribution of wear within the dentition.

An individual tooth wear index and an analysis of factors correlated to incisal and occlusal wear in an adult Swedish population

The aim of the study was to introduce an individual tooth wear index and to use this index to investigate factors correlated to occlusal wear. The material consisted of 585 randomly selected dentate individuals from the community of Jönköping, Sweden, who in 1983 reached the age of 20, 30, 40, 50, 60, 70, or 80 years. The degree of incisal and occlusal wear was evaluated for each single tooth in accordance with criteria presented earlier. An individual tooth wear index, which made it possible to rank individuals in accordance with incisal and occlusal wear, was used as dependent variable to investigate factors related to incisal and occlusal wear. Of all factors analyzed, the following were found to correlate significantly with increased incisal and occlusal wear: number of existing teeth, age, sex, occurrence of bruxism, use of snuff, and saliva buffer capacity. Stepwise multiple regression analysis gave a total explanation factor of R2 = 0.41. It was also possible to distinguish well between groups of individuals with and without tooth wear by means of these factors.

Occlusal wear of teeth and restorative materials: A review of classification, etiology, mechanisms of wear, and some aspects of restorative procedures

This paper is a literature review of various aspects of the wear of occluding tooth surfaces. It presents classification and terminology of occlusal tooth wear, and discusses etiology and differential diagnosis. It may be difficult to differentiate among abrasion, attrition, and erosion because there is nearly always a combination of the various processes. These processes of wear are described, and the in vitro and in vivo wear of some restorative materials is discussed. Treatment of severe tooth wear is considered difficult; prophylactic measures are therefore important. Some guidelines for restorative treatment of patients with extensive occlusal tooth wear are given, with special emphasis on the type of treatment, the vertical dimension of occlusion, the space available, and choice of material for the restorations.

Occlusal contact wear of prosthodontic materials An in vivo study

The wear of gold, porcelain, and heat- and light-cured resins in occlusal contact with resin and porcelain teeth has been studied in vivo. Both weighing of removable segments of fixed partial prostheses and a replica technique allowing scanning electron microscope observations of the worn surfaces were used. The results showed that all materials had the greatest loss of substance when the opposing teeth were of porcelain. The heat-cured, unfilled resin was the least wear-resistant material, followed by light-cured resin, porcelain, and gold. The heat-cured resin showed a combined tribochemical and fatigue type of wear. The light-cured resin and porcelain showed mainly a fatigue type of wear, whereas gold showed a combined abrasive and fatigue type of wear.

Incisal and occlusal tooth wear in children and adolescents in a Swedish population

The material consisted of 527 randomly selected children and adolescents from the community of Jönköping, Sweden, who in 1983 reached the age of 3, 5, 10, 15, or 20 years. The degree of incisal or occlusal tooth wear was evaluated for each single tooth in accordance with the following criteria: score 0 = no wear or negligible wear of enamel; score 1 = obvious wear of enamel or wear through the enamel to the dentin in single spots; score 2 = wear of the dentin up to one-third of the crown height; and score 3 = wear of the dentin more than one-third of the crown height. In the age groups 3 and 5 years the primary dentition was studied, and in the age groups 10, 15, and 20 years the permanent dentition. In the 3-year-old children 63% and in the 5-year-olds 19% had no or slight incisal or occlusal wear in the primary dentition. In the permanent dentition the corresponding figures for the 10-, 15-, and 20-year-olds were 78%, 51%, and 35%, respectively. The 5-year-olds had the highest percentage of primary teeth with incisal or occlusal wear related to existing teeth in accordance with criteria 1-3 (32.2%), and the 10-year-olds had the lowest score for permanent teeth (2.5%). There were small or no differences in tooth wear between the sexes in these age groups. Eighteen children (17%) among the 5-year-olds had one or more teeth with wear scored 2 in the primary dentition, and one individual had 4 primary teeth scored 3. The corresponding figures for the 3-, 10-, 15-, and 20 year-olds were 2%, 1%, 7% and 6%, respectively. No permanent teeth with wear scored 3 were found in these age groups. The number of teeth with incisal or occlusal wear increased with age both in the primary and in the permanent dentition.

Clinical Evaluation of CAD/CAM Metal-Ceramic Posterior Crowns Fabricated from Intraoral Digital Impressions

PURPOSE The aim of this in vivo study was to evaluate the accuracy of metal-ceramic crowns fabricated using computer-aided design/computer-assisted manufacturing (CAD/CAM) in conjunction with intraoral digital impressions. MATERIALS AND METHODS Fifty patients in a general practice participated in the study. Patients were provided with crowns fabricated from digital impressions taken with an intraoral chairside scanner. Prior to crown insertion, the marginal integrity, esthetics, and occlusal and articulation contacts were evaluated using California Dental Association (CDA) criteria. The precementation space of the crowns was evaluated with the replica technique. RESULTS No adjustments were needed for any of the interproximal contact points. Adjustments of occlusion and articulation contacts were needed in 20% of the restorations. Clinical evaluation of the marginal integrity showed satisfactory results according to the CDA criteria. The 50 silicone replicas showed a median precementation space of 46 μm at the marginal measurement location, 94 μm at the midaxial location, and 185 μm at the centro-occlusal location. CONCLUSIONS The precementation spaces of the crowns were within the acceptable range for CAD/CAM restorations.

Dental status and oral function in an adult group of subjects with thalidomide embryopathy – a clinical and questionnaire study

Objective. The purpose of the study was to present the results of an oral examination of individuals with thalidomide embryopathy in relation to dental conditions and functional aspects of the masticatory system, with a special focus on tooth wear. Material and Methods. All 108 subjects with thalidomide embryopathy living in Sweden were invited to participate in a comprehensive investigation, and approximately one-third, 31 subjects (13 F and 18 M, aged 45–49years), took part. The methods included a questionnaire and clinical and radiographic examinations. Results. Most of the subjects had regular dental care, which they in general considered sufficient. All except one always brushed their teeth themselves. One subject had limited mouth opening (25mm). There were no great deviations from normal anatomy and function of the masticatory system. Caries and periodontal conditions were also normal. Regurgitation was reported by 42% of the subjects. Tooth wear was more extensive than in comparable age groups. About a third of the subjects had Class III or edge-to-edge occlusion. Conclusions. In general, subjects with thalidomide embryopathy had no great deviations in dental conditions from people of the same age in the general population except for an increased rate of tooth wear and a higher prevalence of prenormal jaw relations. Tooth wear was related less to use of the teeth as tools and more to dental erosion associated, among other things, with a high rate of regurgitation.

Treatment with implant-supported fixed dental prostheses in patients with congenital and acquired neurologic disabilities: a prospective study.

PURPOSE To study the medium- to long-term outcome of implant treatment in patients with neurologic disabilities. MATERIALS AND METHODS Twenty-seven patients with different disabilities and in need of prosthodontic treatment were treated with various implant-supported prostheses. Altogether, 88 threaded titanium implants were placed. General anesthesia was used in 21 patients and local anesthesia in 6 patients. Patients were recalled every 3 months by a dental hygienist and annually by a prosthodontist. RESULTS Five of the original 27 patients died during the 5- to 10-year follow-up period (mean, 7.2 years), but the remaining 22 patients with 70 implants could be clinically examined at the final follow-up. Twelve implants (14%) were lost, 3 before loading and 9 after insertion of the implant-supported fixed prostheses. The cumulative survival rate for placed implants was 85.8% after 10 years. Perimucositis was diagnosed in 10 patients and for 14 of the 70 implants. Three of the 15 patients with measurable radiographs and 4 implants were diagnosed with peri-implantitis. Several prosthodontic complications occurred, from minor and easily correctable to severe and requiring retreatment. CONCLUSIONS Patients with different neurologic disabilities present more problems during implant treatment and maintenance compared with healthy patients. Nevertheless, it was possible to carry out treatment, and outcomes were relatively favorable. The results indicate that implant treatment can be a valid option in oral rehabilitation of patients with neurologic disabilities.

Effect of chemical and mechanical debridement techniques on bacterial re‐growth on rough titanium surfaces: an in vitro study

OBJECTIVE The aim of this in vitro study was to compare the effect of combined chemical and mechanical debridement of titanium (Ti) surfaces inoculated with Staphylococcus epidermidis, compared with the effect of chemical debridement alone. MATERIAL AND METHODS Different Ti surfaces were characterized with respect to roughness and subsequently inoculated with S. epidermidis. NaCl (0.9 vol.%), EDTA (12 vol.%), H₂O₂ (3 vol.%) or H₂O₂ + TiO₂ nanoparticles served as chemical debridement agents, while TiBrush was used as the mechanical debridement tool. Safranin staining assessed biomass still attached to surfaces after debridement. Biofilm viability was assessed after re-incubation of the debrided samples. SEM analysis was performed before and after the cleaning process. RESULTS Surface average roughness (Sa ) of the samples was measured at 2.22 ± 0.19 μm for group A, 0.19 ± 0.02 μm for group B, and 1.99 ± 0.10 μm for group C. When chemical debridement agents were used alone, H₂O₂-containing products were most efficient in reducing the biomass load. The surface roughness did not affect the outcome of chemical debridement. However, when combining chemical and mechanical debridement, a further reduction of biofilm load and viability was observed with best effect on the smoothest surface. CONCLUSIONS Combining H₂O₂-containing chemical agents with mechanical debridement (TiBrush) provided best reduction in biofilm mass and re-growth, when studied in vitro.

Chemical debridement of contaminated titanium surfaces: An in vitro study

Abstract Objective. To compare the efficacy of different chemical solutions when used for chemical debridement of biofilm contaminated titanium surfaces in an in-vitro experimental study. Materials and methods. Commercially pure titanium discs with a diameter of 6.2 mm and height of 2 mm, mirror-polished with a measured surface amplitude value SA = 0.037 μm ± 0.009 were used as test-surfaces. A biofilm was simulated with multi-layers of Staphylococcus epidermidis ATCC359844 covering the entire titanium surface. The chemical agents tested were: 3% H2O2, 0.2% Chlorhexidine, 24% EDTA-gel, 3% H2O2 mixed with 1.6 g/L TiO2 and sterile saline solution. The decontamination effect was evaluated by optical density analysis using spectrophotometry and with scanning electron microscopy (SEM) images of the remaining biofilm. Results. The suspensions of 3% H2O2 and 1.6 g/L TiO2 or 3% H2O2 alone were the most effective in removing S. epidermidis biofilms (p < 0.05), whereas 0.2% chlorhexidine or 24% EDTA gel had no significant effects. SEM images of the remaining biofilms supported the quantitative results indicating the higher efficacy of 3% H2O2 and 1.6 g/L TiO2 or 3% H2O2 alone. It also revealed that EDTA, despite a non-significant effect on reducing the amount of established biofilms, was able to alter the biofilm architecture, as demonstrated by increased interspaced regions. Conclusions. In this in vitro study the decontamination potential of a suspension of 3% H2O2 and 1.6 g/L TiO2 or 3% H2O2 alone were encouraging. Whether such procedures would have a similar effect in vivo remains to be determined.