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Minimally Invasive Direct Restoration of Worn Teeth: A Simplified Technique

From Volume 46, Issue 4, April 2019 | Pages 388-395

Authors

Dipesh Parmar

University of Birmingham School of Dentistry, St Chad's Queensway, Birmingham B4 6NN, UK

Articles by Dipesh Parmar

Abstract

Historically, patients presenting with tooth wear were commonly managed with partial or full coverage cement-retained indirect restorations according to traditional restorative protocols. Conventional rehabilitations are biologically and financially expensive, time consuming and rely heavily on precise laboratory collaboration. Recent advances in adhesive technology and materials have enabled direct composite resin to be used as a minimally invasive alternative in the management of non-carious tooth tissue loss. As extensive direct composite restorations remain technique sensitive and can be time-consuming, this paper describes an innovative, simplified placement technique that uses a progressive diagnostic wax-up, transparent silicone templates and heated composite resin.

CPD/Clinical Relevance: The predictable, conservative method of full mouth rehabilitation described in this article is cost-effective and time efficient and can deliver an excellent aesthetic outcome.

Article

The prevalence of tooth wear is increasing1 and, as a result, dental professionals are repeatedly faced with demanding diagnostic, planning and restorative challenges. When first line preventive and non-operative strategies have reached their limits, the clinical decision to intervene operatively must be taken carefully, as patients will enter a restorative cycle of restoration repair/replacement that may ultimately increase the risk of tooth loss.1 It is widely recognized that dental restorations do not last very long,2 and that the likelihood of failure is greater in patients with parafunction. Patients must be informed of the need for monitoring, maintenance requirements and that the possibility of occasional restoration replacements will incur further biological and financial costs. Since intervention will initiate the ‘restorative cycle’, it is imperative that initial operative techniques preserve as much tooth structure as possible. With improvements in adhesives and advancements in the physical and aesthetic properties of composite resins, these materials are increasingly considered to be optimal for the rehabilitation of the worn dentition.1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16

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