Incisal tips

Contemporary operative treatment focuses on minimally invasive techniques to restore natural form, function and aesthetics, sacrificing minimal tooth substance to sustain tooth vitality. This philosophy is a popular approach for the management of toothwear,1^-4 shown to be increasing in both adolescent and adult populations.5^,6 This ‘clinical tip’ will describe techniques to achieve predictable clinical and patient outcomes using direct composite resin restorations.

A 28-year-old male presented with generalized moderate toothwear of erosive and attritive origin (Figures 1 and 2). Having identified the aetiology and completed a course of preventive treatment, review and maintenance, the maxillary anterior teeth were planned for direct composite restorations.

Study models were mounted via a facebow transfer to a semi-adjustable articulator on which a diagnostic wax-up increased the incisal length and occlusal vertical dimension (Figure 3). To assess the aesthetics, phonetics and occlusion, a vacuum-formed matrix was fabricated from the wax-up and transferred to the mouth using Bis-Acrylic resin (Figures 4–6). This provided an excellent opportunity for informed consent. Aesthetic assessment tools have been described elsewhere,7^,8^,9^,10 in this case, some minor adjustments were made to incisal length relative to the lip line, palatal contour in mandibular excursive movements and posterior occlusal contacts.