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Identifying Tooth Instability in a Geriatric Wear Case 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.
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, significant wear suggested the likelihood of multiple cracks. Tooth #1 had a severe lingual cusp fracture, and Tooth #29 had an old, inadequately repaired gold onlay that appeared to be leaking. Tooth #29 had been monitored for years, as the patient deferred treatment, believing there was no immediate need for intervention.
An InnerView diagnostic evaluation was performed to assess the structural integrity of his teeth. Despite his age and extensive wear, only two sites showed significant issues:
Tooth #1: Severe fracture with structural instability
Tooth #29: Elevated NFE scores, indicating localized micromobility and potential risk of breakdown
These baseline findings created a starting point for ongoing monitoring and informed the decision to track Tooth #29 closely over time.
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 progression indicated increasing micromobility and a higher risk of structural breakdown.
The visual trendline helped the patient understand the urgency of intervention. Treatment included restoring Tooth #1 with a composite restoration and placing a full-coverage crown on Tooth #29 to prevent further damage.
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.
To further educate the patient on QPD technology, he was shown the Energy Return Graph (ERG) for Tooth 29. This data visualization provided insight into why his toothfelt stable but was actually at risk.
