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Techniques for the restorative management of localized and generalized tooth wear

From Volume 50, Issue 10, November 2023 | Pages 842-856

Authors

Alex Milosevic

BDS, FDSRCS, DRDRCS, PhD, FDTF Ed

Consultant and Honorary Senior Lecturer in Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS

Articles by Alex Milosevic

Email Alex Milosevic

Abstract

This narrative review describes techniques and materials available to restore the worn dentition. Emphasis is given to application of composite resin as this material can be bonded to worn surfaces and is easily adjusted either within an existing or at an increased vertical dimension. The relevance of the differences in the composition of glass ceramics and polycrystalline ceramics for restoration in various wear scenarios are discussed. Removable dentures are still appropriate in certain circumstances, but require an understanding of their limitations.

CPD/Clinical Relevance: Young and old patients with a range of aetiologies and presentations expect dentists to know how best to restore their disordered, worn dentition.

Article

Tooth wear is a multifactorial problem that can be managed in several ways. The overriding principle for management of most dental problems is to keep it straightforward since restoration survival is finite. Planning for future failure and keeping treatment relatively simple is preferable to managing failing complex and/or extensive restorations. Furthermore, the countless different presentations in young and old, full arches or missing teeth, will require a personalized approach to restoration of the worn dentition. This article describes the application of different techniques and materials.

The rate of progress of tooth wear will depend on aetiology, the duration and the frequency of its effect on the teeth. Fortunately, age-related, or physiological, tooth wear is probably a slow process at an average steady-wear rate on occlusal contact areas of enamel of 29 microns per year for molars and approximately 15 microns per year for premolars.1 Maxillary and mandibular incisors were reported to wear by an average of 1.01 mm and 1.46 mm, respectively by 70 years of age, which is less than the wear rates for the aforementioned study on posterior teeth.2 The net result of wear progression may be a reduction in occlusal vertical height (or OVD) with an increase in free-way space or maintenance of the OVD by the process of dento-alveolar compensation. In practice, the degree of compensated wear will depend on the intra-oral presentation: the number and position of missing teeth; patient age; aetiological factors; and the duration of effect. The determinants regarding whether an increase in OVD is needed are dental aesthetics, smile line and the space required for restoration.

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