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All of the above conditions can affect older
General conservative management of attrition type TSL would be the provision of a stabilisation splint in the first instance in order to prevent further hard tissue surface loss. Parafunction against the splint would lead to favourable attrition of the acrylic splint material [6]. A upper soft bite guard could be made in acute cases as a quick urgent way of relief.


Occlusion and restoring/increasing the occlusal vertical dimension (OVD)
In cases of severe TSL due to a combination of attritive or erosive processes there may be extensive loss of the dental hard tissues, and commonly the teeth appear to look grossly shorter in clinical crown height from gingival aspect to the incisal edge or occlusal surface. It could appear that there is a loss of OVD here, however in most cases in dentate patients this buy NHS Biotin is not the case due to physiological dentoalveolar compensation that occurs [7]. The compensatory mechanism is noticeable due to the varied position of the gingival zeniths of the anterior segment (Fig. 1). If the rate of tooth destruction occurs at a faster rate than compensation, an open bite can occur.
In cases where compensation has occurred there is a loss of interocclusal space, increasing the existing OVD is a treatment strategy that may be considered. Other more drastic treatment methods have been proposed such as elective extraction, surgical crown lengthening and orthodontic intrusion. These techniques vary in their invasiveness and as such irreversible damage. Although considered invasive and damaging to sound tooth tissue and supporting structures these techniques can still be considered with appropriate care and planning. A technique routinely utilised in the UK is increasing the OVD using a method modelled on a concept first illustrated by Dahl [8]. Dahl and colleagues were the first to discover this phenomenon in the 1970s by utilising a removable cobalt chromium intrusion appliance with a bite platform anteriorly. This concept was developed further in the 1990s in the UK by utilising composite resin to restore worn teeth (Fig. 2). This involves the placement of composite restorations at an increased OVD on anterior teeth leaving posterior teeth with no occlusal contacts. A period of occlusal adaptation results with a combination of intrusion of the anterior teeth and vertical migration of posterior teeth resulting in the relinquishing of contacts over time.
This treatment modality shows good short to medium term results although the requirement for maintenance maybe high [9]. Despite this, the advent of placement of composite restorations at an increased OVD is biologically the kindest treatment modality when directly comparing to crowns, surgical crown lengthening or orthodontic intrusion.


Occlusion and the periodontium
Occlusal trauma is defined as ‘trauma to the periodontium from functional or parafunctional forces causing damage to the attachment apparatus of the periodontium by exceeding its adaptive and reparative capacities. It may be self-limiting or progressive’ [2] (Figs. 7 and 8). What seems clear within the literature and in practice is the need to distinguish between association and causation [26]. Periodontitis may be associated with a multitude of local, general or patient based factors ranging from overhanging restorations to inflammatory systematic diseases manifesting in the periodontium [26].
Few clinical studies have identified a link between trauma from occlusion and inflammatory periodontitis in man [27]. Although both processes cause destruction of the apparatus in different ways the exact mechanisms and whether there is true synergy between the two pathological processes is yet to be realised. It may be fair to say that occlusal trauma may exacerbate already present periodontal inflammation whereas orthodontic force is unlikely to exacerbate periodontal tissue loss. Where frank plaque induced periodontitis and occlusal trauma is present gradual widening of the periodontal ligament space with mobility and angular bone loss can be expected. In the absence of periodontitis occlusal trauma does not result in attachment loss but does result in tooth mobility which is reversed once the trauma is removed.
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