A wedge-shaped defect, the reasons for which we will consider in this article, is considered not a carious damage to the teeth and is characterized by the appearance of a wedge-shaped defect in the area of the tooth neck. Often there are such problems on the fangs and premolars (located behind the fangs and in front of the molars) of the upper and lower jaw, less often this happens in the area of the remaining teeth.
What is it?
During the inspection, you can see that they have a smooth and shiny surface. It is especially interesting that defects of small sizes, located, as a rule, in the region of the enamel thickness, have a completely ordinary color. But if the lesion spreads not only to the depth of the enamel layer, but also captures the so-called dentin, then such deviations have a pigmented surface.
When a wedge-shaped defect occurs, the causes of which we will consider in the article, symptoms appear that usually act with moderate hypersensitivity to all kinds of irritants, for example, cold water or air, sweet or sour foods, reactions to mechanical irritants - pain during brushing. Although in some situations, the process can be asymptomatic.
Reasons for development
It should be noted that the very definition of a “wedge-shaped tooth defect” (a photo of the disease is presented in the article) is considered as a separate disease only in Russian medicine, it also describes only the geometric shape of severe tooth damage. Abroad, in order to classify such non-carious problems, terms are used that imply the reasons for their appearance, for example, abrasion, abrasion, erosion and so on.
In this regard, it should be noted that, unfortunately, in the treatment of such defects in our country, absolutely all fillings in patients fall out over time, and in addition, similar problems arise again, but already in other teeth. The point here is that most dentists treat wedge-shaped factors, regardless of the cause of their appearance, they just take and fill them, despite the fact that in most situations this is clearly not enough.
So, there are three main causes of a wedge-shaped tooth defect:
- erosive nature;
- abrasion type;
- abrasive nature.
Defects
Such problems are also called abrasion defects. The first reason for the appearance of this type is the incorrect relationship between the lower and upper teeth in the process of their closure, which, of course, leads to the appearance of atypical types of load on the teeth. As a result of such a process, a so-called bending stress is formed in the cervical region of the tooth, which is accompanied by a piezoelectric effect, that is, the main essence of the whole process is that the hydroxyapatite molecules squeeze out calcium ions from themselves, and this, in turn, leads to a significant the destruction of the corresponding area of enamel. What are the other causes of a wedge-shaped defect of this type?
The next significant factor in the formation of defects is the parafunction of the tongue, that is, excessive mechanical pressure on the inner region of the teeth. This occurs due to the small volume of the oral cavity, for example, against the background of narrowed jaws or a deep bite, and so on.
Another important factor is the presence of bruxism, in the framework of which a significant tonus of the masticatory muscles is observed, which leads to an increase in the duration and strength of the total pressure on the teeth during their closure. All this can also lead to the occurrence of atypical loads on the dental tissues, which, as a rule, is accompanied by enamel destruction.
It is important to note the fact that if you do not take into account the pathological occlusal interactions between the antagonist teeth, but only fill the defect, then the introduced material is guaranteed to fall out over time. This will happen because, against the background of maintaining improper contact between the teeth and the pathological load, the stress exerted on the bend in the region of the neck of the tooth will remain. Such a process will certainly lead to the destruction of the connection point between the filling and the tooth, and, consequently, the loss of the first.
Causes of a wedge-shaped tooth defect of abrasive nature
A defect of this type is formed as a response to the direct impact of abrasive materials on the teeth . First of all, it is important to talk about dental products, especially whitening, which have a very high coefficient of abrasiveness RDA. In the standard norm, each toothpaste intended for adults should have an RDA of seventy units, but most hygiene products have much larger ratios of this indicator.
Another reason is brushes with extremely hard bristles, as well as an absolutely wrong technique in the process of brushing your teeth. An ideal tool is considered to have an average degree of rigidity. It is strictly forbidden to make horizontal movements with a toothbrush on the outside of the teeth, any actions should be sweeping. The causes and treatment of a wedge-shaped tooth defect are often interrelated.
Erosive nature of defects
Considering this type, in the framework of the formation of defects, chemical factors are called, for example, acids contained in foods, juices, wine and fruits. Quite often, wedge-shaped defects appear in patients with gastritis and suffering from heartburn, since in these patients there is regular ingestion of gastric juice in the oral cavity. In addition, often these problems arise in people who work in chemical industries.
You should be aware that after drinking acidic drinks and taking the appropriate products for the first hour, it is forbidden to brush your teeth, unless you can do this with a thread. The fact is that the acid is able to leach calcium enamel from the surface layer and at the same time make it porous, and therefore less resistant to any mechanical influence. Therefore, it is imperative to wait at least an hour before the enamel is partially restored by absorption of calcium ions contained in saliva. Then a wedge-shaped defect, the photo of which can be seen in the article, does not arise.
It is important to note that most of the defects are formed precisely due to abfraction processes, that is, as a result of malocclusion, language parafunction or bruxism. Although it should be borne in mind that several factors can influence simultaneously. For example, as soon as a person damages enamel with strongly abrasive whitening pastes, his acidity factor instantly completes the process that has begun and vice versa.
In addition to the basic premises, there are also predisposing factors:
- diseases of the central nervous system;
- the formation of soft and hard deposits on the teeth;
- insufficient oral hygiene;
- thyroid disease;
- the presence of gingivitis or periodontitis.
A wedge-shaped tooth defect, the causes and treatment of which we continue to describe, is a rather unpleasant problem.
Therapeutic measures to eliminate the defect
If the patient and his dentist found a tooth defect of this kind, then any treatment process should consist, first of all, in restoring dental integrity. But, knowing the causes of such defects, you can immediately understand that not everything is so simple. To begin with, the cause of the problem, which may be associated with improper contacts in the region of the upper and lower teeth, should be excluded.
Only then proceed with the treatment of a wedge-shaped tooth defect.
If a person has several of them at once, which indicates a significant amount of the problem, it is best to visit a highly qualified orthopedic dentist, since only this category of doctors will be able to qualitatively carry out selective grinding of teeth, and also will normalize contacts between them. Among other things, it is the orthopedic dentist or also the prosthetist who will help the patient exclude other factors in the development of pathologies, for example, with phenomena such as tongue parafunction or bruxism. The causes of the wedge-shaped defect may lie in another.
In relation to the erosive and abrasive types, the patient will be selected with hygiene products and will be taught competent brushing techniques, as well as an appropriate diet will be prescribed. In case of special need, patients are sent for a consultation with a gastroenterologist and endocrinologist as well. And only after all this should we begin to restore the integrity of the teeth.
As part of the treatment, it is customary to use methods such as:
- grinding of tooth contacts;
- filling of wedge-shaped defects;
- remineralizing therapy;
- fluoridation;
- orthodontic treatment.
How to treat a wedge-shaped tooth defect? This is a common question.
Treatment of defects with small dimensions
Shallow wedge-shaped tooth problems, having a small size of up to half a millimeter, as a rule, do not require urgent filling. But in the event that the dentist feels a high risk of imminent deepening of defects, then in this situation they should be filled with liquid flowing composites, for example, Flow-It or Filtek Flow. Fluid materials are used on the grounds that they have high elasticity, but only with a small thickness of the material layer. A high degree of elasticity allows partial compensation of the pathological occlusal load from the side of antagonist teeth.
If the doctor believes that the filling process can be postponed, the emphasis in treatment should be on increasing enamel strength in relation to mechanical and chemical factors. But even before that, you should also first visit the orthopedic dentist to polish the wrong dental contacts. It is simply necessary to strengthen tooth enamel. The causes and treatment of a wedge-shaped tooth defect, a photo of which is available in the article, are closely dependent.
It is important to note that regular methods of remineralizing therapy with calcium-containing preparations, as well as fluoridation of tooth enamel - both must be done after the dentist has removed the dental plaque . It should also be said that in dental clinics more effective agents are used that contain a higher concentration of active components, although you can always come up with something at home.
Treatment of large and medium tooth defects
This type of treatment will consist in the need to fill in a wedge-shaped defect and, frankly, the process of their elimination is still some complexity in modern dentistry. The main problem is that the fillings fall out extremely quickly, and the other catch is that the introduced material very soon loses its aesthetics in the areas adjacent to the hard tissues of the teeth, that is, at the interface.
Of course, it should be said that most doctors do not see this as such a problem, but at the same time they have to redo these seals every year. Difficulties arise mainly from the fact that doctors do not remove the traumatic factor, that is, the main load on the teeth or in other words, abfraction, and this already leads to the preservation of tension on the bend in the cervical region.
Another difficulty is the wrong choice of materials for filling. As a rule, traditionally the doctor here fluctuates only between two groups of substances: a microfilm composite and glass ionomer cement.
The causes and treatment of the wedge-shaped defect are considered.
Glass ionomer cements
The advantages of this material is that its substance enters into a chemical bond with tooth tissues . The ingredient is less sensitive to moisture and has a very satisfactory aesthetics, which is still somewhat inferior to the advantages of composite materials. Among the minuses, there is a color change, an early erasure, sensitivity to overdrying and mouth breathing, which is why they are not suitable for smokers.
The studies found that as a result of the drying process, the area of the filling that adjoins the hard dental tissues is covered with a certain network of cracks, which later can be affected by various dyes. Tests have also shown that such empty areas form when traumatic stress is exerted on the teeth by antagonists. As a result, by the end of the first year of service, the installed seal practically loses its aesthetics, especially if it is located in the smile zone. Therefore, the prevention of a wedge-shaped tooth defect is very important.
Microphilic Composites
The advantages of this material are good aesthetics and wear resistance. Although, on the other hand, they are extremely sensitive to moisture and have a rather high coefficient of polymerization shrinkage. In addition, if the dentist does not eliminate the traumatic exertion of the load when closed with the antagonist, then cracks will also appear in the area of the filling of such material at the borders with the dental tissues. However, in general, this material is still considered somewhat better than glass ionomer cements.
It is important to note that dentists have a filling technique available to reduce the negative qualities of any of the above materials. It is commonly called the "sandwich technique." The meaning of this technology is that the lower part of the seal is made of glass ionomer cement, and the upper is made of composite material. At the moment, this is the only way to make high-quality seals in order to eliminate defects of large sizes.
In the article, we examined the causes of the wedge-shaped defect and methods of dealing with it.