The evaluation of direct composite restorations for the worn mandibular anterior dentition ? clinical performance and patient satisfaction

Tooth surface loss: tools and tips for management

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.

Biologically based restorative management of tooth wear

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as “The Daughter Test”, this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles.

Porcelain pornography

I write to raise some issues involved in the blatant destruction of teeth, apparently being undertaken to cure patients affected by ‘porcelain deficiency disease’ (PDD). This is a newish disease, identified by some dentists who also seem to think that teeth suffer from ‘hyperenamelosis’ (an excess of enamel). It probably goes without saying that both of these conditions are imaginary yet it does appear to me, at times, that they are perceived to exist by some ‘cosmetic’ dentists. In this article I offer comments and case studies of patients who, arguably, have had unnecessarily aggressive treatment that was probably of more benefit to the profits of the dentists concerned than to the patients’ long-term dental health.