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We thank Mr Hassall for his interest in our work, as it is always good to get feedback. We think that we should treat our peers as intelligent individuals who should read studies and form their own conclusions.
In our view, he has not misquoted the figures, but has chosen to carefully select data to support his views. Applying the same data, there were 676 anterior restorations, of which there were 19 Level 1 (catastrophic) failures and 58 Level 2 (restorable) failures, giving a total of 77 combined Level 1 and Level 2 failures (76/676, 11.2%) over a mean observation period of 62.4 months (which is not ‘relatively short’). This would represent an annual failure rate of approximately 2.15%. We consider that most clinicians (and patients alike) would consider this quite acceptable over 5.5 years, especially given that higher-risk patients, such as severe bruxists, were not excluded in the sample.
Your correspondent has conveniently excluded the lower anterior restorations and overlooked the anterior restorations completed in one visit, which were the majority, simply showing that re-bonding was not as predictable. We think his comments are perhaps a little misleading. We didn't include polishing as a failure, as it is seen to be part of refurbishment that would be routinely required for any composite restorations, and not a cause for intervention. However, the need for maintenance with this type of restorative intervention goes without saying, and this should be discussed while seeking informed consent. In addition, there is evidence of patient satisfaction with direct resin rehabilitation for full mouth generalized tooth wear.1,2 We think this would challenge your correspondent's anecdotal observations.
As we have stated in our letter to Dental Update, good operator skill is important. Operators attaining poor outcomes may require further development of their skills etc. We are aware that any type of tooth wear rehabilitation treatment of this nature will take time. The use of our technique permits adjustment (addition and subtraction) to be performed readily in the oral environment – important given the complex occlusal and aesthetic changes being planned with the rehabilitation of generalized tooth wear. Ceramic materials cannot be adjusted in the same way in the oral environment, especially where there is the need to add material.