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Während die Kariesinzidenz erfreulicherweise zurückgeht, steigt die des Zahnverschleißes. Im Sinne einer präventionsorientierten Zahnheilkunde ist es wichtig, die Betroffenen früh zu erkennen, die individuellen Ursachen zu identifizieren und möglichst abzustellen. Von die hierfür vorgeschlagenen Befundschemata sieht nur das „Tooth wear evaluation system“ (TWES) 2.0 eine mehrstufige Untersuchung vor. Es beruht auf einer Basisdiagnostik in Form des Zahnverschleiß-Screenings zur Identifikation auffälliger Patienten. Bei diesen wird als erweiterte Diagnostik ein detaillierter Zahnverschleiß-Status erhoben – mit quantitativer Erfassung der Verschleißgrade aller Zähne pro Zahn. Ergänzt wird sie durch eine qualitative Suche nach Zeichen pathologischen Zahnverschleißes sowie von Hinweisen auf die Verschleißursache. Der nachfolgende Beitrag beschreibt die stufenweise Diagnostik und ihre Umsetzung in der digitalen Praxis. Manuskripteingang: 25.03.2022, Manuskriptannahme: 26.03.2022 Keywords: Zahnverschleiß, Zahnverschleiß-Screening, Zahnverschleiß-Status, „Tooth wear evaluation system“ (TWES) 2.0, Bruxismus, Erosionen

Purpose: To determine the impact of the brushing protocol on dentin wear by comparing continuous to intermittent brushing, with the same total time of brushing. Materials and Methods: Dentin specimens (n = 120) were evently distributed into six groups (A–F). The samples were brushed with slurries of different relative dentin abrasivity (RDA): Groups A+B (Sident 2480-1; RDA 85), groups C+D (Zeodent 113; RDA 67), and groups E+F (Zeodent 103; RDA 174). Groups A+C+E were brushed continuously (25 min) with one slurry preparation, while groups B+D+F were brushed intermittently (25 x 1 min) with a renewal of the slurry after each sequence. Dentin wear was determined using surface profilometry and statistically analysed with ANOVA and post-hoc tests. Results: Neither the mode of brushing (p = 0.72) nor the interaction (p = 0.18) of the brushing mode with the type of abrasive particles had a significant influence on the abrasive dentin wear. Only the type of abrasive particles had a statistically significant influence on abrasive dentin wear (p < 0.001). Conclusion: The mode of brushing (continuously or intermittently) has no influence on abrasive dentin wear. Keywords: brushing, continuously, dentin wear, intermittently

While the incidence of caries is decreasing due to good prevention, the incidence of tooth wear is increasing, especially in young adults. Over the years, a variety of diagnostic schemes have been proposed to identify tooth wear patients. Of these, only the Tooth Wear Evaluation System (TWES) provided a multi-stage examination consisting of a basic and an extended diagnostic module. An updated version, TWES 2.0, was recently released. The first module, Tooth Wear Screening, serves to identify patients with relevant findings. The second module, Tooth Wear Status, consists of a comprehensive charting procedure in patients with positive screening results, including tooth wear severity grading for each individual tooth, signs and symptoms indicative for pathological tooth wear, and the causes of the tooth wear. This article explains the practical procedure for digitally recording and interpreting the corresponding findings using special software (CMDbrux) and the resultant treatment based on an actual case example. Keywords: tooth wear, Tooth Wear Screening, Tooth Wear Status, Tooth Wear Evaluation System (TWES) 2.0, bruxism, CMDfact, CMDbrux, minimally invasive restoration

This article describes how the Tooth Wear Evaluation System (TWES) can be used to diagnose existing tooth wear in a structured manner. Since its introduction, the TWES has been used by many dental clinicians in different countries. The collected feedback has been analyzed by the developers and users, resulting in an adapted version – the TWES 2.0. The adaptations and the newly introduced taxonomy have resulted in a smoother use in daily practice, a more straightforward diagnostic system, and a structured management. Keywords: tooth wear, Tooth Wear Evaluation System, European Consensus Statement, classification, diagnosis, management, pathological tooth wear, physiological tooth wear, taxonomy

Der Beitrag fasst die europäische Konsensus-Leitlinie zur zahnärztlichen Therapie bei fortgeschrittenem Zahnhartsubstanzverlust zusammen. Er fokussiert auf die Definition von physiologischem versus pathologischem Zahnhartsubstanzverlust und empfiehlt, die Diagnostik, Prävention, Aufklärung und Überwachung auf die Ätiologie, die Art und das Ausmaß des pathologischen Zahnhartsubstanzverlustes sowie Mittel zu seiner Kontrolle auszurichten. Therapieentscheidungen werden von vielen Faktoren beeinflusst und sind sowohl vom Schweregrad und von den klinischen Auswirkungen des Zahnhartsubstanzverlustes als auch von den Wünschen des Patienten abhängig. Idealerweise werden restaurative Maßnahmen so lange wie möglich hinausgezögert. Wenn eine solche Intervention indiziert ist und der betroffene Patient zustimmt, wird ein konservierender minimalinvasiver Ansatz mit ergänzenden Präventionsmaßnahmen empfohlen. Beispielhaft werden adhäsive minimalinvasive Therapiekonzepte vorgestellt. Keywords: Zahnhartsubstanzverlust, Entscheidungsfindung, restaurative Behandlung, direkte Restauration, indirekte Restauration

This paper presents European expert consensus guidelines on the management of severe tooth wear. It focuses on the definition of physiological vs pathological tooth wear and recommends diagnosis, prevention, counseling, and monitoring aimed at elucidating the etiology, nature, rate and means of controlling pathological tooth wear. Management decisions are multifactorial, depending principally on the severity and effects of the wear and the wishes of the patient. Restorative intervention is typically best delayed as long as possible. When such intervention is indicated and agreed upon with the patient, a conservative, minimally invasive approach is recommended, complemented by supportive preventive measures. Examples of adhesive, minimum-intervention management protocols are presented. Keywords: tooth wear, decision making, restorative treatment, direct, indirect

Tooth wear is a multifactorial condition leading to the loss of dental hard tissue, ie, enamel and dentin. Tooth wear can be divided into the subtypes mechanical wear (attrition and abrasion), and chemical wear (erosion). Due to its multifactorial etiology, tooth wear can manifest in many different ways. The condition can therefore be difficult to diagnose and manage. A systematic approach is a sine qua non. In the Tooth Wear Evaluation System (TWES) described in this article (the second in a series of two), all the necessary tools for a clinical guideline are presented in various modules. This allows the clinician to perform a state-of-the-art diagnosis, in both a general practitioner and a referral setting. To avoid the risk of cumbersome usage, the clinician can select only those modules appropriate in a given setting. The modules of the TWES match each other, which is indispensable and essential when different modules are being compared. With the TWES it is possible to recognize the problem (qualification), grade its severity (quantification), diagnose the likely causes, and monitor (the progress of) the condition. In addition, a proposal for the classification of tooth wear is made. Further, it is possible to decide when to start a restorative treatment and which kind of treatment to apply, as well as to estimate the level of difficulty of the treatment. In this second article of the two-part series1, the management modules are described. Keywords: clinical guideline, management planning, tooth wear

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissue, ie, enamel and dentin. Tooth wear can be divided into the subtypes mechanical wear (attrition and abrasion), and chemical wear (erosion). Due to its multifactorial etiology, tooth wear can manifest in many different ways. The condition can therefore be difficult to diagnose and manage. A systematic approach is a sine qua non. In the Tooth Wear Evaluation System (TWES) described in this article (the first in a series of two), all the necessary tools for a clinical guideline are presented in various modules. This allows the clinician to perform a state-of-the-art diagnosis, in both a general practitioner and a referral setting. To avoid the risk of cumbersome usage, the clinician can select only those modules appropriate in a given setting. The modules of the TWES match each other, which is indispensable and essential when different modules are being compared. With the TWES, it is possible to recognize the problem (qualification), grade its severity (quantification), diagnose the likely causes, and monitor (the progress of) the condition. In addition, a proposal for the classification of tooth wear is made. Further, it is possible to determine when to start a treatment, decide which kind of treatment to apply, and estimate the level of difficulty of a restorative treatment. In this first article, the diagnostic modules and proposed classification system are described. Keywords: clinical guideline, diagnosis, qualifying, quantifying, classification, tooth wear

This case report describes a patient who is referred by his home physician to a centre for special dental care because of the presence of severe oral pain with an existing dental phobia. The patient has Asperger's Syndrome. Besides his extreme fear for dental treatment and several deep carious lesions, the most important clinical finding is generalized tooth wear of the dentition. In this case report, the diagnostic process is described from a multidisciplinary perspective. Keywords: Asperger's Syndrome, tooth wear, multidisciplinary treatment, dental anxiety, treatment planning

The reliability of a newly developed tooth wear grading system was assessed both clinically and on dental casts by two observers using 20 participants. The reliability of clinical occlusal/incisal tooth wear grading was fair-to-good to excellent, while that of most of the clinical nonocclusal/nonincisal grades was at least fair-to-good. Dental cast assessment frequently yielded poor reliabilities, especially for nonocclusal/nonincisal surfaces. Hence, occlusal/incisal wear could be graded more reliably than nonocclusal/nonincisal wear, while the clinical assessment of tooth wear was more reliable than the grading of dental casts.