Quantitative Percussion Diagnostics(QPD) in a 90-Year-OldPatient with Severe Wear

Identifying Structural Abnormalities Before Symptoms Appear

Determining the structural integrity of teeth in patients with severe wear is often challenging, especially in geriatric cases where treatment decisions must balance health concerns, occlusal function, and esthetics.

As teeth wear down over time, fatigue fractures become more common, yet identifying these structural abnormalities remains difficult unless the patient experiences pain on chewing. Typically, pain does not present until the final stages of the crack cycle.

With the introduction of Quantitative Percussion Diagnostics (QPD), clinicians can now assess structural abnormalities in teeth and implants before symptoms appear. QPD measures both the mobility of an entire site (Mobility Score) and localized portions (Normal Fit Error or NFE), providing objective, data-driven insights for treatment planning.

This case study highlights how InnerView was used to evaluate a 90-year-old patient with extensive occlusal wear, leading to a proactive treatment decision that prevented further structural breakdown.

InnerView Results: What Did It Show?

The patient, a 90-year-old male, had been under routine dental care for 20 years. A former runner and active property manager, he remained in good health and walked two miles daily. Despite the severe wear and discoloration of his teeth, he had long resisted treatment, stating that his condition did not bother him.

From a clinical standpoint, however, significant wear suggested the likelihood of multiple cracks. Tooth 1 had a severe lingual cusp fracture and tooth 29 and an old, inadequately repaired gold onlay, which appeared to be leaking. Tooth 29 had been monitored for years, as the patient had deferred treatment, believing there was no immediate need for intervention.

Tooth 29 had a repaired gold only which appeared to be leaking.

InnerView Assessment and Findings

An InnerView diagnostic evaluation was performed to assess the structural integrity of his teeth. Despite the patient’s age and extensive wear, the results were surprising – only two teeth showed significant issues:

Tooth 1: Severe fracture with structural instability
Tooth 29: Had an Increasing NFE scores, indicating worsening localized mobility

The patient complied with treatment, wearing her splint consistently at night and following a tailored hygiene protocol to minimize mechanical stress on her implants.

Progression Over Time: Health Monitoring Trendline

During a follow-up appointment, InnerView’s Health Monitoring Trendline revealed a notable increase in the NFE score for Tooth 29, rising from 112 to 138. This increase signified progressive micromobility, indicating a high risk of further structural breakdown.

Implant #3: NFE dropped from 59.37 to 13.55, confirming improved stability.
Implant #30: NFE reduced from 55.76 to 44.99, demonstrating a positive response to intervention.

These objective improvements provided the patient with tangible proof that her treatment—informed by InnerView insights—was working, reinforcing her commitment to long-term maintenance.

During a follow-up appointment, InnerView’s Health Monitoring Trendline revealed a notable increase in the NFE score for Tooth 29, rising from 112 to 138.

Seeing the objective data and trendline progression helped the patient understand that intervention was necessary before the situation worsened. He agreed to:

Restore Tooth 1 with a composite restoration
Proceed with a full-coverage restoration of Tooth 29During

Tooth Preparation: Structural Damage Confirmed

Upon removing the old gold onlay on Tooth 29, significant microleakage was observed on both the mesial and distal box form. Two horizontal cracks were also visible on the buccal cusp.

Upon removing the old gold onlay on Tooth 29, significant microleakage was observed on both the mesial and distal box form.

Tooth 29 after initial preparation, after initlal preparation exposed two horizontal cracks on the buccal cusp. A full-coverage ceramic restoration was placed to protect the tooth from further breakdown.

Tooth Preparation: Structural Damage Confirmed

To further educate the patient on QPD technology, he was shown the Energy ReturnGraph (ERG) for Tooth 29. This data visualization provided insight into why his toothfelt stable but was actually at risk.

The ERG showed three distinct peaks with multiple valleys, a clear sign of excessive movement due to fractures and instability.
The oscillation duration was much longer than that of a healthy tooth, demonstrating how various damaged structures were shifting.
Comparing the ERG of Tooth 29 to that of a structurally intact tooth helped the patient immediately grasp the importance of intervention.

By integrating InnerView into routine hygiene and examination appointments, clinicians can offer patients a predictive, proactive approach to implant and restorative care—backed by quantifiable data.

The ERG showed three distinct peaks with multiple valleys, indicating excessive movement due to fractures and instability.

Takeaways

Objective Data Drives Treatment Decisions  

InnerView provided quantifiable evidence that helped the patient recognize the risk andcommit to proactive treatment.

Early Intervention Prevents More Extensive Damage  

By treating Tooth 29 early, the patient avoided a potential emergency situation that could have led to fracture propagation and more complex restorative needs.

Health Monitoring Enables Long-Term Stability  

Regular InnerView assessments allow clinicians to track subtle changes over time,identifying potential risks before they become symptomatic.

The patient left the appointment grateful for the ability to monitor his dental health objectively and relieved that his other severely worn teeth remained structurally sound.

Quantitative Percussion Diagnostics(QPD) in a 90-Year-OldPatient with Severe Wear

Cherilyn Sheets, DDS

Identifying Structural Abnormalities Before Symptoms Appear

InnerView Results: What Did It Show?

InnerView Assessment and Findings

Progression Over Time: Health Monitoring Trendline

Tooth Preparation: Structural Damage Confirmed

Tooth Preparation: Structural Damage Confirmed

Takeaways

Objective Data Drives Treatment Decisions

Early Intervention Prevents More Extensive Damage

Health Monitoring Enables Long-Term Stability

More Case Studies

Beyond X-Rays: how InnerView Reveals hidden Structural Issues Before Symptoms Appear

Early Detection of Implant Instability in a 75-Year-Old Patient

Innerview in a Full-Mouth Hygiene Recall for a 75-Year-Old Patient

Final Restoration of Two Anterior Implants: A Stability-First Approach with InnerView

From Reconstruction to Routine Care: InnerView’s Role in Long-Term Dental Health

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