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Senior Lecturer/Hon Consultant in Restorative Dentistry, The University of Manchester, School of Dentistry, Higher Cambridge Street, Manchester M15 6FH
Tooth surface loss is becoming increasingly prevalent. Many cases can be managed with preventive measures, although there remain a number of patients for whom restorative intervention is indicated. Traditional treatment modalities have entailed extensive ‘full-mouth’ indirect restoration, although this approach has a number of disadvantages. Contemporary restorative techniques allow for a broader range of treatment options: this paper presents an overview of common issues and clinical techniques to overcome these.
Clinical Relevance: Treatment options and guidance for managing patients who present with tooth surface loss.
Article
Patterns of dental disease in populations are changing and the prevalence of toothwear/tooth surface loss (TSL) is increasing, both as a result of increased TSL seen in ageing populations,1 who have increased tooth retention rates compared to previous generations, and also an increase in the prevalence of TSL in younger populations.2–4 The latest UK Adult Dental Health Survey3 highlighted that 77% of dentate adults exhibited TSL extending into dentine.
The pathological loss of tooth structure may be caused by a single causative factor or, more commonly, by an interplay of factors, these being:5
In addition to the above, abfraction (the pathologic loss of hard tooth substance caused by biomechanical loading forces due to flexure and chemical fatigue degradation of enamel and/or dentine at some location distant from the actual point of loading) may cause loss of tooth structure in cervical regions. A key step in the management of patients with TSL is to determine the primary causative factor and institute an appropriate preventive regime to check further deterioration of the dentition: any treatment without prevention is likely to fail.
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