Sticking with a concept: developing the use of composite restorations to manage tooth wear

Tooth wear is a common presentation to dentists and a frequent referral to consultant clinics in hospitals. The presentation can be localized or generalized. Thirty years ago, treatment consisted of conventional crowns, which could be a full-mouth reconstruction at an increased occlusal vertical dimension (OVD). Severe tooth wear was treated with overdentures. Such treatment was time consuming and had significant financial and biological costs. The patient was also committed to onerous long-term maintenance if the work was to be successful.

At this time, I provided a diagnostic and treatment planning service to dentists on new patient consultant clinics. Approximately five to six out of 10 patients attending presented with some form of tooth wear. Health authority guidelines dictated that high priority patients (cancer, trauma and developmental defects) had to be taken on for treatment, leaving about one in 10 patients being eligible for treatment by postgraduates. So, the bulk of patients commonly presenting to dentists with severe tooth wear had to be returned with a suggested treatment plan. Feedback from dentists about these clinics was always good, but I was sceptical about whether the work was undertaken or how successful it would prove to be. The NHS contract for dentists has never been sympathetic to providing this type of work and is more difficult to work with today. A simpler approach that most dentists could provide had to be developed.