362 BIOTECHNOL. & BIOTECHNOL. EQ.

21/2007/3
ARTICLES MB
Keywords: Tooth wears, dentoalveolar compensation
Introduction
Tooth wears is an all-embracing term used to describe the
combined processes of erosion, attrition and abrasion, or when
the specic diagnosis can not be determined (Fig. 1). Erosion
is dened as the chemical dissolution of teeth by acids other
than those produced by bacteria. Attrition is the wear of tooth
against tooth, and abrasion is the wear of teeth by physical
means other than opposite teeth. The term pathologic tooth
wear has been used to describe the state when the destruction of
the teeth has reached a level at which restorations are indicated
(1, 3, 5, 8, 11).
Fig. 1.
The craniofacial complex is not a static entity in the adult,
but is subject to intrinsic and extrinsic factors, which may
inuence its morphology. It has been previously accepted that
no appreciable changes occur in this structure during adulthood,
although there is now evidence that the craniofacial complex
does, indeed, change throughout adult life, albeit at a much
slower rate than around puberty. In addition, alterations in the
dentition may well have widespread inuences, leading to
further differences in the morphology of the adult craniofacial
complex (1, 5, 12).
The developing occlusion responds to discrepancies in
the skeletal dental base by changes in the axial inclinations
of the teeth and by alterations in the supporting alveolar
bone, and this dentoalveolar compensatory mechanism assist
the establishment of the occlusion. As wear is a feature
common to all dentitions, it would not be unexpected to nd
a similar compensatory response to tooth wear in the adult.
Consequently, the effect of reduction in crown height through
wear may have a bearing on vertical facial morphology, and
there is some previous evidence to support this (13).
In this investigation, it is aimed at determining adult age-
related differences in vertical facial dimensions as a result of
dental wear.
Materials and Methods
The study sample group consisted of 20 subjects (12 males, 8
females) obtained by sequential referrals of dental practitioners
requesting an opinion on the management of vertical tooth wear.
The mean age of the sample was 52.4 years and all samples
included in the investigation showed loss by wear of incisor
crown length. The control group consisted of 20 students in the
dentistry school (14 males, 6 females) obtained from a pool
of radiographic data originally recorded as part of orthodontic
assessments (Fig. 2).
TOOTH WEARS AND DENTOALVEOLAR COMPENSATION
OF VERTICAL HEIGHT
A. Zengingul
1
, . Eskimez
1
, Y. Deer
1
, J. Kama
2

University of Dicle, Faculty of Dentistry, Department of Prosthodontics, Diyarbakr, Turkey
1
University of Dicle, Faculty of Dentistry, Department of Orthodontics, Diyarbakr, Turkey
2
Correspondence to: Ali Zengingul
Email: azengin@dicle.edu.tr
ABSTRACT
The present study aims to determine differences in vertical facial dimensions as a result of dental wear.
The study consisted of 20 subjects with vertical tooth wear. The mean age of sample was 52.4 years. The control group consisted
of 20 dental school students. The mean age of control group was 22 years (subjects with severe malocclusion or tooth wear were
not included). All subjects cephalometric and panoramic radiographs were taken from natural head posture. Dentoalveolar
height was recorded as in the maxilla and in the mandible on the both cephalometric and panoramic radiograph. Result of the
cephalometric measurements showed that signicant differences lower face height (ANS-Me), lower dentoalveolar height (Ii-
MP) between the groups (p<0,001). Upper dentoalveolar height (Is-PP) and total face height (N-Me) was greater than control
group (p<0,01).
According to the result of panoramic measurement dentoalveolar compensatory of samples was greater than control group in
mandibuler premolar area (p<0,05).
We found out that dentoalveolar structure is compensating the loss of vertical height when there is the severe occlusal tooth
wears.
363 BIOTECHNOL. & BIOTECHNOL. EQ. 21/2007/3
Fig. 2.
The mean age of the control group was 22.0 years, when
dental development was consider to be completed. No subjects
with severe malocclusion or tooth wear were included.
All subjects included in the study had standardized
panographic and cephalometric lateral radiographs which were
taken in natural head posture.
Fig. 3. Notation of cefalometric measurements
Cephalometric measurements were taken using a digitiser
from a number of locations such as anterior total face height
(N-Me), posterior total face height (S-Go), anterior lower face
height (ANS-Me), anterior upper face height (N-ANS), lower
dentoalveolar height (Ii-MP) and upper dentoalveolar height
(Is-PP). In addition SN/Go-Gn, MP-PP, Ocl-PP and Ocl MP
angles were used to evaluate vertical direction measurements
(2)

(Fig. 3).
In panographic radiographs two measurements were
recorded: the rst one was that from the inferior border of
the mandible to the lower edge of the foramen (x) while the
second was from the inferior border to the superior border
of the alveolar bone (y). According to Wical and Swoop (14)
the approximate ratio between the distance from the inferior
border to the superior border of the alveolar bone (y) and from
the inferior border of the mandible to the lower edge of the
foramen (x) was considered to be 3/1 (y/x) (15) (Fig. 4).
Fig. 4.
TABLE 1
Distribution form was assessed by calculation of differences analyzed using the Students- t test ( p<0.001= ***, p<0.01= **,
p<0.05=* ).
n=20
SAMPLE CONTROL
t p _
x
SD
_
x
SD
N-Me 144.55 7.70 135.15 8.23 3.60 **
N-ANS 60.05 3.66 58.85 4.64 0.90 ---
ANS-Me 84.45 5.80 76.30 6.90 4.01 ***
S-Go 93.30 5.63 90.00 6.92 1.65 ---
SN-GoGn 35.75 7.25 30.00 5.00 2.91 **
MP-PP 28.05 5.78 22.55 5.16 3.14 **
Ocl-PP 11.20 4.17 7.70 3.49 2.87 **
Ocl-MP 16.85 4.50 14.85 3.71 1.52 ---
Is-PP 35.55 3.44 32.40 3.45 2.88 **
Ii-MP 48.15 4.72 42.90 3.87 3.84 ***
364 BIOTECHNOL. & BIOTECHNOL. EQ. 21/2007/3
Descriptive statistics for the variables recorded and for
the differences between the control and the study sample
groups included mean values and standard deviations for each
variable. Distribution form was assessing through the analysis
of differences using the Students- t test (Table 1).
Results and Discussion
In the statistical evaluation anterior total face height (N-
Me) in the study sample was found to be greater than in the
control with an average difference of 8,1mm (p<0.01), and
the value of anterior lower face height (ANS-Me) was greater
by 7,2 mm (p<0.001). Anterior upper face height (N-ANS),
lower dentoalveolar height (Ii-MP) and upper dentoalveolar
height (Is-PP) emerged to be greater with respect to control
group (p<0.001) (p<0.01). Ocl-PP angle measurement also
established statistically signicant difference (p<0.01)
(Table 1). Measurements of the panographic radiographs,
x and y distances also showed statistically signicant
differences between the study sample and the control group
(p<0.05). The mean ratio between the inferior border of the
mandible to the lower edge of the foramen and from the inferior
border to the superior border of the alveolar bone (y/x) was
2.87:1 in the study samples and 3.01:1 in the control group,
with a standard deviation of 0.23 (Table 2, Fig. 5).
0
10
20
30
40
50
x y y/x
sample
control
Fig. 5. Results of panographic measurements
The reconstruction of a severely worn dentition is very
complex and difcult problem, representing a real challenge to
the dentist. The best treatment for any wear depends on its early
recognition, which is difcult to be achieved. It is important to
distinguish between physiologic and pathologic tooth wear and
to determine when and how to intervene. When teeth become
worn out, a serious problem is created, especially if there is
no vertical space for restoration and alteration in the vertical
dimension of necessary occlusion. Despite warnings against
increasing vertical dimension of occlusion, there is evidence
from long-term observations that supports the view that, as
a general rule, the patient adaptations to such an occlusion is
stable (7, 9, 12).
Longitudinal material is the most valuable for determining
the nature of any such changes, and Thompson and Kendrick

(14),

and Kendrick and Risinger (6) report an increase in facial
dimensions with age. An extensive study by Tallgren (13) also
indicated that an increase in facial height occurs with advancing
age beyond the point where growth is normally considered to
be completed.
Interpretation of the differences in total facial height
between the groups is required to understand presence of wear.
In this study the dimension recorded for anterior total (N-Me)
and lower face height (ANS-Me) in the wear samples showed a
signicantly greater dimension than control group. For anterior
upper face height (N-ANS) and posterior total face height,
the value was greater in the wear sample but statistically was
not signicant. Mandibuler plane (MP) palatal plane (PP),
occlusal plane (Ocl) palatal plane (PP) angles and lower and
upper dentoalveolar height in the wear sample was greater
than the control group. However, with respect to loss of
crown height, these ndings demonstrated that maxillar and
mandibuler and dentoalveolar height compensation are likely
to occur (Fig. 6).
0
20
40
60
80
100
120
140
160
N
-
M
e
N
-
A
N
S
S
-
G
o
S
N
-
G
o
G
n
M
P
-
P
P
O
c
l
-
P
P
O
c
l
-
M
P
I
s
-
P
P
I
l
-
M
P
sample
control
Fig. 6. Results of cephalometric measurements
The location of the mental foramen relative to the inferior
and superior borders of normal mandibles, as expressed by
the mean ratio of total bone height to height of the foramen
above the inferior border, appears to be consisted enough to
justify its use as a reference point in clinical studies. Since the
bone below the foramen constitutes a predictable proportion
of the total bone height in the majority of normal subjects, and
since this bone is not signicantly affected by resorption until
extreme atrophy occurs, its height may serve as the basis for
TABLE 2
Measurements of the panographic radiographs, x and y distances showed statistically signicant differences between the
study sample and control group (p<0.05=* ).
n=20
SAMPLE CONTROL
t p
_
x SD
_
x SD
x 16.60 2.76 14.50 2.80 2.38 *
y 47.25 5.43 43.75 3.74 2.37 *
y/x 2.87 3.45 3.01 3.51 3.54 ---
365 BIOTECHNOL. & BIOTECHNOL. EQ. 21/2007/3
estimating the original mandibuler height in elderly subjects
(2, 15).
Clinically, the lower edge of the mental foramen appears to
be a more useful reference mark in panographic radiographs.
Observing the distance from the inferior border of the mandible
to the lower edge of the foramen and using the approximate
ratio of 3:1 can help to estimate conveniently the original
height of the mandible before resorption (15).
According to our ndings, x and y dimensions
statistically were signicantly greater than control group,
but mean ratio of y/x was equal for both sample and control
groups. This result shows that there is an equal compensation
both in the lower and upper part of the mental foramen in the
mandible. The results presented in this study support
Kiliaridis et al.s (7) hypothesis which suggests that functional
hyperactivity of the masticatory system imposed increased
stress on the bony structures of the craniofacial complex with
possible inuences on its structure.
Ideally, changes in facial morphology associated with this
condition should be studied longitudinally, but in the case of
tooth wear this is not possible. Because all dentitions exhibit
wear as normal part of the ageing process, and it is impossible
to predict whether any individual will be severely affected.
In practice therefore, the effect of wear must be studied by
cross-sectional comparison with other samples. Again, as wear
is a normal part of the ageing process, it is extremely difcult
to nd age-matched samples, which do not themselves exhibit
wear.
Consequently, other effects of ageing on the craniofacial
skeleton are difcult to separate from the effects of wear (3,
4). In this study the mean age of the control group is such
that facial growth is complete and thus differences between
the groups may be considered to be mainly due to the wear
process, although the presence of late adult age changes must
be considered.
This study has been present in 25
th
Annual Conference EPA,
September 6-8, PRAG- 2001
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