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This in situ/ex vivo study assessed the effect of different concentrations of fluoride in dentifrices on dentin subjected to erosion or to erosion plus abrasion. Ten volunteers took part in this crossover and double-blind study performed in 3 phases (7 days). They wore acrylic palatal appliances containing 4 bovine dentin blocks divided in two rows: erosion and erosion plus abrasion. The blocks were subjected to erosion by immersion ex vivo in a cola drink (60 s, pH 2.6) 4 times daily. During this step, the volunteers brushed their teeth with one of three dentifrices D (5,000 ppm F, NaF, silica); C (1,100 ppm F, NaF, silica) and placebo (22 ppm F, silica). Then, the respective dentifrice slurry (1:3) was dripped on dentin surfaces. While no further treatment was performed in one row, the other row was brushed using an electric toothbrush for 30 s ex vivo. The appliances were replaced in the mouth and the volunteers rinsed with water. Dentin loss was determined by profilometry and analyzed by 2-way ANOVA/Bonferroni test (a = 0.05). Dentin loss after erosive-abrasive wear was significantly greater than after erosion alone. Wear was significantly higher for the placebo than for the D and C dentifrices, which were not significantly different from each other. It can be concluded that the presence of fluoride concentrations around 1,100 ppm in dentifrices is important to reduce dentin wear by erosion and erosion + abrasion, but the protective effect does not increase with fluoride concentration.

This in situ/ex vivo study assessed the effect of fluoride dentifrice on eroded enamel subjected to brushing abrasion. In a crossover study performed in 2 phases, 10 volunteers wore acrylic palatal appliances, each containing 3 human enamel blocks. Dentifrice was used to brush the volunteers’ teeth and the specimens subjected to abrasion. In phases A and B the dentifrices used had the same formulation, except for the absence or presence of fluoride, respectively. The blocks were subjected to erosion by immersion of the appliances in a cola drink for 5 min, 4 times a day. Then the blocks were brushed, and the appliance was replaced into the mouth. Enamel alterations were determined using profilometry and percentage change in surface microhardness (%SMHC) tests. The data were tested using the paired t test. The mean wear values (±SD, µm) were: group A 6.84 ± 1.72 and group B 5.38 ± 1.21 (p = 0.04). The mean %SMHC values (±SD) were: group A 54.6 ± 16.2 and group B 45.7 ± 6.8 (p = 0.04). Fluoride dentifrice had a protective effect on eroded enamel subjected to brushing abrasion.

Recent studies have shown that phytoliths are softer than dental enamel but still act as abrasive agents. Thus, phytolith content should be reflected in dental wear. Because native phytoliths show lower indentation hardness than phytoliths extracted by dry ashing, we propose that the hydration state of plant tissue will also affect dental abrasion. To assess this, we performed a controlled feeding experiment with 36 adult guinea pigs, fed exclusively with three different natural forages: lucerne, timothy grass, and bamboo with distinct phytolith/silica contents (lucerne < grass < bamboo). Each forage was fed in fresh or dried state for 3 weeks. We then performed 3D surface texture analysis (3DST) on the upper fourth premolar. Generally, enamel surface roughness increased with higher forage phytolith/silica content. Additionally, fresh and dry grass feeders displayed differences in wear patterns, with those of fresh grass feeders being similar to fresh and dry lucerne (phytolith-poor) feeders, supporting previous reports that “fresh grass grazers” show less abrasion than unspecialized grazers. Our results demonstrate that not only phytolith content but also properties such as water content can significantly affect plant abrasiveness, even to such an extent that wear patterns characteristic for dietary traits (browser–grazer differences) become indistinguishable.

Objectives This study investigated toothbrush abrasion and in vitro aging on ceramic (indirect technique) and composite veneers (direct technique). Materials and methods Identical composite and individual human incisors were restored with industrially preformed composite veneers, indirectly produced ceramic veneers, and direct composite restorations. Surface roughness was determined before and after tooth brushing. A 5-year period of oral service was simulated by thermal cycling and mechanical loading (TCML). After TCML, all specimens were examined with microscopy and scanning electron microscopy. Specimens without failures during TCML were loaded until failure. Statistics: analysis of variance; Bonferroni’s post hoc analysis, Kaplan–Meier–Log Rank test ( α  = 0.05). Results Tooth brushing yielded a non-significant increase ( p  = 0.560) in roughness in all materials (industrial veneer, 0.12+/−0.07 μm, direct restoration, 0.18+/−0.14 μm, ceramic, 0.35+/−0.16 μm). No significant differences in roughness could be determined between the materials, neither before nor after testing ( p  < 0.001). After TCML of artificial teeth, direct and preformed composite veneers on composite teeth showed no failures or damages. Two ceramic veneers showed cracking in the labial area. After TCML of human teeth, transmission microscopy indicated a facial crack in a ceramic veneer and chipping in the cervical area of a preformed veneer. Two direct composite veneers lost retention. No significantly different survival rates were found between the three veneer groups. Fracture force on human teeth varied between 527.8+/−132.4 N (ceramic), 478.3+/−165.4 N (preformed composite), and 605.0+/−263.5 N (direct composite). Conclusion All materials revealed comparable wear resistance. Indirect ceramic, direct restorative composite, and preformed composite veneers showed comparable failure rates and satisfying longevity. Clinical relevance The results indicate similar longevity of the chosen materials for veneer restorations.

Key Points Stresses the importance of a conservative approach to the treatment of erosive and abrasive lesions. Explains how to plan an initial therapeutic approach. Suggests there is no unique solution and treatment plans must be made on a case by case basis. The therapeutic management of tooth wear lesions does not require the removal of diseased tissue. Nevertheless, diverse etiological factors may be associated with the condition and they could be difficult to eliminate; this has to be considered when planning therapy. Interceptive procedures should be reserved for such situations while regular monitoring is recommended for other cases, in accordance with advice provided for using the Basic Erosive Wear Examination (BEWE). Direct and indirect adhesive procedures with composite resins allow treatment of most clinical situations, including even extensive restorations. The possibility of managing subsequent interventions should be considered when planning the initial therapeutic approach.

Key Points Highlights that non-carious tooth surface loss or tooth wear is becoming an increasingly significant factor affecting the long-term health of the dentition. Defines attrition as the wear that occurs from tooth-to-tooth contact without the presence of food. Describes abrasion as wear occurring due to the friction of exogenous material (anything foreign to the tooth) forced over the surfaces of the tooth. Non-carious tooth surface loss or tooth wear is becoming an increasingly significant factor affecting the long-term health of the dentition. The adverse effects of tooth wear are becoming increasingly apparent both in young persons and, as more people retain their teeth, into old age. This situation challenges the preventive and restorative skills of dental practitioners.

The objective of the study was to evaluate the period of remineralization needed to re–establish the resistance of eroded enamel against brushing abrasion. Enamel specimens were prepared from 84 polished bovine incisors. The samples were evenly distributed among 7 groups (A–G) and submitted to ten alternating de– and remineralization cycles which included abrasion by toothbrushing. Demineralization was accomplished by immersing the specimens in the erosive soft drink Sprite Light ® for 1 min. Remineralization was performed by storing the samples in artificial saliva for either 0 min (A), 10 min (B), 60 min (C) or 240 min (D). After each remineralization, the specimens were brushed in an automatic brushing machine. Group E (erosion and 240 min remineralization, but no brushing) group F (erosion, but no remineralization and no brushing), and group G (brushing, but no erosion and no remineralization) served as controls. After performing the cycles, loss of enamel was determined by profilometry. The following values (mean ± SD) were obtained and statistically analyzed (p<0.05): group A (5.16±1.26 μm), B (2.47±0.68 μm), C (1.72±0.75 μm), D (1.11±0.42 μm), E (0.81±0.23 μm), F (1.04±0.31 μm), G (0.22±0.15 μm). Only the differences between groups D, E, and F were statistically not significant. Under the chosen in vitro conditions, it is concluded that abrasion resistance of eroded enamel continuously increases with remineralization time. However, even after a period of 1 h of remineralization, abrasion of previously eroded enamel is increased

Key Points Recognise when tooth surface loss is pathological Determine the aetiology of tooth surface loss Help the patient to decide whether treatment is indicated Devise an orderly framework for the design of treatment plans Provide a rationale for treatment of difficult cases This part of the series is devoted to tooth surface loss (TSL) not caused by caries or trauma. The management of this form of generalised TSL is included in this series because knowledge of occlusion is needed for both the diagnosis and, when indicated, treatment. There are, however, many other factors involved in the management of generalised TSL other than those associated with 'occlusion'. These will also be discussed.

Key Points This case highlights the eating disorder pica. Pica may affect the oral tissues and should be considered as a rare cause of tooth wear. Treatment of the case emphasises the need for careful planning and close liaison with the laboratory. The case was managed by combined fixed and removable prostheses. This paper reports a case of tooth surface loss as a result of the eating disorder pica. Background to the condition is discussed and the clinical findings and treatment of the patient outlined. The case illustrates a rare cause of wear which should be considered when patients present with an unusual pattern of tooth surface loss.

Changes in tooth structure, missing teeth and decreased vertical dimension of occlusion severely deteriorate the stomatognathic system. This case report describes the treatment of a patient with loss of vertical dimension due to severe wear of maxillary and mandibular teeth. An occlusal splint was used to create an optimum maxillomandibular relationship and to provide restorative space prior to restoration of the remaining teeth. The restoration was accomplished with a hybrid composite material. This treatment has been a less-expensive alternative to full-mouth, fixed porcelain/metal-porcelain restoration while conserving the remaining tooth tissue.