The survival and clinical performance of resin-based composite restorations used to treat localised anterior tooth wear

The role of orthodontics in the management of tooth wear

Pathological tooth wear is a dental problem that affects all age groups and appears to be increasing in prevalence. A subset of these patients may benefit from a combination of orthodontic and restorative care which will be discussed in this article. Orthodontics can help to create the necessary vertical, anterior-posterior and mesio-distal space for restorative work, reducing the need for tooth reduction and lessening the biological costs of restorative care, helping to reposition the gingival margins where this impacts upon aesthetics, as well as correcting co-existing malocclusion.

Patient satisfaction following resin-bonded fixed dental prostheses cemented by using the Dahl concept

OBJECTIVE

Resin-bonded fixed dental prostheses (RBFDPs) cemented at an increased occlusal vertical dimension (OVD) (the Dahl concept) to create space for a metal retainer remains controversial because of the lack of reported clinical studies. This study analyzed the demographic (age and sex) and clinical factors (location and arch of prosthesis) affecting the patients' perception of RBFDPs cemented at an increased OVD.

MATERIAL AND METHODS

Twenty-eight participants treated with cantilevered RBFDP at an increased OVD were prospectively recruited. They were asked to answer a validated patient satisfaction questionnaire based on six parameters during the 12-week review visit.

RESULTS

71.4% of the participants were completely satisfied with the color, shape, and function. Twenty-one (75%) participants reported no complaints about the prostheses. 89.3% will recommend this treatment option to others. There was a significant difference between males and females in avoiding loading on the prostheses (p = 0.015). The level of satisfaction did not differ by age, ethnicity, location, and arch of the prostheses (p > 0.05).

CONCLUSIONS

Patient satisfaction toward RBFDP cemented by using the Dahl approach was generally high on all the parameters at the 12-week review visit.

The longevity of tooth-coloUred materials used for restoration of tooth wear: an evidence-based approach

Patients with tooth wear are commonly encountered in general dental practice. When indicated, restorative rehabilitation is often accompanied by a request from the patient for an aesthetic, tooth-coloured outcome. This article seeks to provide an evidence-based approach, focussing on the longevity of the materials which can be used for the restorative treatment of tooth wear, as well as their modes of failure and observed performance.

Interdisciplinary management of an adult patient with significant tooth wear

Adult patients may present with compromised dentitions which require extensive oral rehabilitation. This case report shows the fulfilment of both functional and aesthetic treatment objectives for a patient with significant tooth wear through carefully planned interdisciplinary management. © 2022 Australian Dental Association.

Clinical factors to consider in definitive treatment planning for patients with tooth wear

Diagnosis, disease control and prevention are the precursors to successful definitive restorative treatment of pathological tooth wear. This case series illustrates how proposed key clinical features can influence treatment complexity and provide the clinician with a logical sequence of treatment options for definitive management of tooth wear.

When (and when not) to use the Dahl Concept

The Dahl Concept describes the re-establishment of occlusal contacts after the provision of a planned localised appliance or restoration in supraocclusion. Initially developed to create space for prosthetic rehabilitation of anterior teeth suffering from localised wear, the principle has later been successfully applied to a variety of situations, including the Hall technique and resin-bonded bridges cemented in supraocclusion. Despite high levels of success seen in the relevant literature and widespread adoption in specialist care, the wider profession appears to be far more cautious in its use. This article aims to provide a brief summary of the Dahl Concept and discuss the local and general factors that influence its successful implementation in the hope of promoting its increased adoption by the broader dental profession.

How long does it take for the occlusion to re-establish following the placement of restorations at an increased occlusal vertical dimension? A literature review

Purpose This literature review aimed to investigate predictability of re-establishment of the occlusion following placement of restorations at an increased OVD, duration and to assess the quality of the available evidence.Methods An electronic search of articles using MEDLINE (1946-01/2019), EMBASE (1974-01/2019) and the Cochrane databases was undertaken. Search terms included dental restoration, vertical dimension and time. Studies involving placement of restorations at an increased OVD and recorded the time taken for the occlusion to re-establish were included. Eligibility assessments were carried out independently by two reviewers who also undertook independent extraction of predefined data fields, including study quality indicators.Results The search provided 61 results with 11 being relevant. A further 5 papers were identified for full text analysis. 4 papers used similar data from previous studies and 3 were excluded after full text assessment.. A final total of 9 papers were included in the review. It was indicated that the technique of placing restorations at an increased OVD appears to be clinically predictable in terms of re-establishment of occlusion and appears to occur most rapidly in younger patients.Conclusions The time taken for the occlusion to re-establish was between 15 days to 24 months. However, there is a need for prospective studies to evaluate the process in terms of success, predictive variables and specifically how long the process takes and this information would be helpful for both clinicians and patients, so that they know what to expect before embarking on a treatment.

Treatment of Tooth Wear Using Direct or Indirect Restorations: A Systematic Review of Clinical Studies

Tooth wear is considered a well-developed issue in daily clinical practice; however, there is no standard protocol for treatment. The aim of this manuscript was to systematically review the literature to evaluate the clinical outcomes of direct or indirect restorations for treating tooth wear. A literature search was conducted through the PubMed MedLine, Scopus, ISI Web of Science, Scielo, and EMBASE databases up to 29 April 2022. Clinical studies evaluating the clinical performance of direct or indirect restorations for treating tooth wear for a minimum follow-up of 6 months were included in the review. A total of 2776 records were obtained from the search databases. After full-text reading, 16 studies were included in the qualitative analysis. Considering the high heterogenicity of the studies included, a meta-analysis could not be performed. All studies included the rehabilitation of anterior and posterior teeth with extensive wear, using both indirect and direct restorations for a maximum follow-up of 10 years. Restoration materials included ceramo-metal crowns, full gold crowns, lithium disilicate ceramic, zirconia, polymer infiltrated ceramic networks, and resin composites. Most of the reports assessed the survival rate of the restorations and the clinical features using the United States Public Health Service (USPHS) Evaluation System criteria. Contradictory discoveries were perceived concerning the type of restoration with better clinical performance. Considering the current literature available, there is no evidence in the superiority of any restoration technique to ensure the highest clinical performance for treating tooth wear.

A Multidisciplinary Approach to Maxillary Lateral Incisor Agenesis (MLIA): A Case Report

Maxillary lateral incisor agenesis (MLIA) is a condition that significantly compromises smile esthetics and is a particular concern in younger patients. The treatment options include orthodontics for space opening with rehabilitation or space closure with canine camouflage. Currently, there is some controversy regarding the most appropriate treatment. In this case report, we propose a multidisciplinary approach through the combination of orthodontic treatment, frenectomy, and a restorative finishing stage with composite resin and dental implants. More specifically, this treatment was planned to orthodontically close the anterior space by opening the premolar area for subsequent placement of implants and enameloplasty with a composite resin. The replacement of a missing lateral incisor by an implant is a predictable treatment approach, but it might best be deferred until dental maturity and then accurately placed in a well-developed site through a multidisciplinary approach. Precluding the closure of the anterior spaces and the opening of the posterior zone for implant placement, allows for a more stable and appealing esthetic and functional rehabilitation for young patients, in whom esthetic appearance and self-esteem play a primary role.

Canine Rise Method: A Conservative Approach for Worn Teeth Rehabilitation with Different Adhesive Restorative Materials

Background

In this article, two cases with generalized dental wear and four cases with localized dental wear are reported. In some of the cases, the worn teeth were restored with direct composite techniques with no mock-up and articulator mounting according to the canine rise method. This method is used without any change in the intercuspation of posterior teeth without a muscle relaxation appliance. It introduces a stable occlusal condition that can alter neuromuscular reflex activity, leading to improvements in certain muscle pain disorders. It is also used to protect the teeth and supporting structures from abnormal forces that might create a further breakdown and/or tooth wear.

Methods

The first step of treatment in all the cases was a composite build-up for maxillary and mandibular canines to restrict and guide the horizontal and vertical jaw movements and create adequate space for restorations. The second step was the placement of direct or indirect restorations on upper and lower anterior teeth efficiently and accurately.

Results

This method enhanced the esthetic outcomes in a conservative approach with no reduction in tooth material or time-consuming treatments.

Conclusions

This technique can be suggested for the treatment of worn teeth in patients with Angle's Cl I and Cl II classifications of malocclusion based on the follow-up results. It is not applicable for the treatment of worn teeth in patients with Angle's class III because occlusion is reversed, and canine teeth do not have guidance role. Practical Implications. This method significantly reduces the overall treatment time, and additional steps are required to restore the worn-out teeth and/or occlusion using the canine rise method.

Management of Localized Anterior Tooth Wear Using a Modified Sandwich Technique and the Dahl Concept: A Case Report

This case report illustrates a minimally invasive segmental rehabilitation of localized anterior tooth wear using a modification of the sandwich technique, a combination of indirect palatal composite veneers and direct labial composite restorations, at an increased occlusal vertical dimension (the Dahl concept).

Adhesive Management of Anterior Tooth Wear in Combination with the Dahl Concept-A 27-Month Observational Case Series

Localized anterior maxillary tooth wear caused by erosion and attrition with loss of interocclusal space is difficult to manage. This observational case-series study reports six cases with worn anterior dentition treated with labial ceramic and palatal direct resin composite veneers at an increased vertical dimension of occlusion without restoration of unaffected posterior teeth. Thirty-six palatal direct veneers were made in six patients from a nanohybrid resin composite with the help of a wax-up-based template at an increased vertical dimension. After the complete re-establishment of posterior occlusion, 40 labial lithium-disilicate ceramic veneers were fabricated with a mock-up-guided method. The sandwich veneers were evaluated according to the United States Public Health Service (USPHS) criteria after a mean service time of 22.7 months. Re-establishment of posterior contacts as well as subjective patient satisfaction and function were evaluated. The overall success of the labial ceramic veneers was excellent. The quality of the palatal resin composite restorations was found to be good with predominantly "Alpha" scores. The marginal quality (11.1% and 33.3% of integrity and discoloration, respectively) and surface roughness (16.7%) showed small deteriorations indicated by "Beta" scores. The resin composite showed, in general, signs of wear facets which resulted in "Beta" scores in 44.4% of the cases. Posterior contacts re-established firmly within 4 weeks in all cases. Patient satisfaction with esthetics and function was high. The short-term outcome of this non-invasive treatment option is favorable and promising.

The Dahl Concept: Best Evidence Consensus Statement

PURPOSE

In a series of publications, Dahl and Krogstad promoted an orthodontic technique for the treatment of severe wear of the anterior teeth that reportedly could induce intrusion of the anteriors and extrusion of the posterior teeth to allow space to restore the worn anterior teeth. The purpose of this Best Evidence Consensus Statement was to evaluate the existing dental literature related to the Dahl Concept.

METHODS

A PubMed search limited to clinical studies, clinical trials, randomized controlled trials, systematic reviews, meta analyses, and journal articles, using the key words Orthodontics, Dahl appliance, Dahl concept and adult, revealed 11 citations, 9 of which were related. An additional 9 citations were culled from the reference lists in the aforementioned articles.

RESULTS

The 20 articles that met the initial search criteria were evaluated and rated. The literature largely focused on the restorative materials that are commonly used to apply the Dahl technique.

CONCLUSIONS

While there is low-level evidence from a few case series that demonstrated the ability to achieve enough space in the anterior region for the restoration of lost anterior tooth structure, there is no compelling evidence to support any theories as to how that space was achieved. In addition, there is no evidence to support the long-term stability of that position and the restorations. Negative position and restorative outcomes have been reported.

Randomized controlled trial on the performance of direct and indirect composite restorations in patients with severe tooth wear

OBJECTIVE

The study aimed to evaluate survival and failure behavior of Direct Composite Restorations (DRC) and Indirect Composite Restorations (ICR) on molars and anterior teeth, in a Randomized Controlled Trial (RCT).

METHODS

Patients with generalized severe tooth wear were included, and randomly assigned to one of 2 protocols: (1) DCR: All teeth were restored with directly applied micro-hybrid composite restorations (Clearfil AP-X, Kuraray) for load bearing areas and nano-hybrid composite restorations (IPS Empress Direct, Ivoclar Vivadent) for buccal veneers; (2) ICR: First molars were restored with indirect composite 'tabletop' restorations and maxillary anterior teeth were restored with indirect palatal veneer restorations (Clearfil Estenia C&B, cemented with Panavia F, Kuraray). Remaining teeth were restored directly. Restorations were evaluated after 3 years, focusing on clinical acceptability. Statistical analysis was performed using Kaplan Meier curves, Annual Failure Rates (AFRs), and univariate Cox regression analyses (p < 0.05).

RESULTS

41 patients (age: 36.6 ± 6.6y) were evaluated after 3 years (40.0 ± 2.2 m). 408 restorations on first molars and palatal veneers on maxillary anterior teeth were part of this RCT, with 220 DCRs and 188 ICRs. No differences in survival between treatment modality for palatal veneers for any failure criteria were found. Tabletop restorations on first molars showed a considerable higher failure rate for ICR compared to DCR (p = 0.026, HR: 3.37, 95%CI = 1.16-9.81).

SIGNIFICANCE

In this RCT, directly applied composite restorations showed superior behavior compared to the indirect composite restorations, when used in the molar region.

Measuring tooth movement with treatment using the Dahl principle: An observational study

STATEMENT OF PROBLEM

Research on the quantification of 3-dimensional tooth movements in patients undergoing treatment using the Dahl principle is lacking.

PURPOSE

The purpose of this observational clinical study was to measure the magnitude, direction, duration, and rate of tooth movement occurring in patients to reestablish tooth contact and create restorative space.

MATERIAL AND METHODS

A total of 104 paired preoperative and postoperative physical and virtual casts from 26 patients were obtained. Commencement and completion dates were recorded to calculate movement duration to reestablish occlusion. Dental casts were digitized, and the 3-dimensional digital casts obtained were superimposed via a surface matching and analysis software program by using the global registration function. Color maps were used to visualize direction, and the annotation feature quantified magnitude of tooth movement in millimeters when specific reference points were selected. Teeth within the arch were categorized as per their location to evaluate their impact on occlusal reestablishment. The average rate of movement was determined by time taken for extrusive and intrusive movements over the treatment duration. Post hoc Tukey tests were applied if a significant difference was present in the magnitude of movement between different tooth categories.

RESULTS

All participants showed evidence of tooth movement during treatment. Duration of occlusal reestablishment ranged from 3.9 to 28.2 months, with more posterior tooth extrusive movements (56.9%) than anterior tooth intrusive (43.1%) movements occurring. A comparison of magnitude of extrusive or intrusive movement between categories (molar-anterior, premolar-anterior, and premolar-molar) showed that premolar and molar extrusive movements and anterior intrusive movements were significantly different (P<.001). The amount of buccal and lingual movement for molars and premolars was similar. Anterior teeth demonstrated more buccal than lingual movements. All teeth showed more mesial than distal movements. The extrusive and intrusive movement rate was 0.13 and 0.11 mm/mo, respectively.

CONCLUSIONS

Tooth movement occurred in patients regardless of age and sex. The results of this study indicated that tooth movements have a 3-dimensional nature. Occlusal reestablishment mainly occurred via a combination of extrusive and intrusive movements. The study further highlighted the advantages of digital technology such as surface scanners and 3-dimensional software programs that can be used to quantify change in patients undergoing treatment.

Clinical performance of direct composite resin restorations in a full mouth rehabilitation for patients with severe tooth wear: 5.5-year results

OBJECTIVES

To evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation.

METHODS

A convenience sample of 34 patients were recruited to a prospective trial between December 2010 and June 2013. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the DSO-technique. Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analysed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05).

RESULTS

Annual failure rates (for all levels of failure, 'Level 3- ') of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months. The completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations.

CONCLUSIONS

At 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure.

CLINICAL SIGNIFICANCE

Direct resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance.

McNamara's Fallacies in Dentistry. 2: Tooth Surface Loss Fallacies

Given the number of perceived myths and fallacies in relation to tooth substance loss, this article seeks to address these using a wide variety of clinical cases as examples and by way of scientific references.

CPD/Clinical Relevance: The incidence of tooth wear is increasing, so an understanding of the myths and truths surrounding its treatment is valuable.

Occlusal force and occlusal contact reestablishment with resin-bonded fixed partial dental prostheses using the Dahl concept: A clinical study

STATEMENT OF PROBLEM

Space creation for a metal retainer of the resin-bonded fixed partial dental prostheses (RBFPDPs) with the Dahl concept remains controversial because of the lack of clinical studies.

PURPOSE

The purpose of this clinical study was to investigate the occlusal force and occlusal contact reestablishment of RBFPDPs cemented at an increased occlusal vertical dimension (the Dahl concept) and to evaluate the factors affecting them.

MATERIAL AND METHODS

A prospective clinical study was carried out on 28 participants receiving cantilevered RBFPDPs at an increased occlusal vertical dimension at the Faculty of Dentistry, University Teknologi MARA. Maximum occlusal forces were recorded at precementation, postcementation, and 12-week review visit by using pressure indicating film, while occlusal contact reestablishment was assessed at the precementation stage and 12-week review visit by using shim stock foils. The Wilcoxon signed-rank and chi-squared tests were used for statistical analysis (α=.05).

RESULTS

Significant differences were found for maximum occlusal force between the precementation and the postcementation and between the postcementation and the 12-week review of RBFPDPs (P<.05 for both) in all 28 participants. However, no significant difference was found between the precementation and the 12-week review (P=.085). The occlusal force reestablishment concerning sex, age, location, and arch of the prosthesis was found to be similar. Most of the participants (89.3%) achieved complete occlusal contact reestablishment and 10.7% partial occlusal reestablishment. The demographic and prosthesis factors were not significantly related to the occlusal reestablishment (P>.05).

CONCLUSIONS

Overall, occlusal force was reestablished after 12 weeks, and occlusal contact was completely reestablished in most participants after placement of RBFPDPs at an increased occlusal vertical dimension.

Occlusal re-establishment and clinical complications of resin-bonded fixed partial dental prostheses cemented at an increased occlusal vertical dimension: A retrospective study

STATEMENT OF PROBLEM

Resin-bonded fixed partial dental prostheses (RBFPDPs) cemented at an increased occlusal vertical dimension (OVD) (the Dahl concept) to create space for a metal retainer remain controversial because of the lack of reported clinical studies. This study evaluated RBFPDPs by applying the Dahl concept.

PURPOSE

The purpose of this retrospective study was to investigate the clinical factors affecting the occlusal re-establishment and short-term complications of RBFPDPs cemented at an increased OVD.

MATERIAL AND METHODS

Occlusal re-establishment and clinical complications were reviewed in 109 participants (155 RBFPDPs) treated at the Faculty of Dentistry, Universiti Teknologi MARA from January 2013 to May 2018. Types of complications and risk factors were assessed from clinical data. Demographic factors, clinical factors, and prosthesis factors were distinguished and their association with occlusal re-establishment analyzed by using multiple regression analysis.

RESULTS

A total of 155 RBFPDPs (42 anterior, 113 posterior) were placed in 109 participants. All achieved occlusal re-establishment, 89.9% complete occlusal re-establishment and 10.1% partial occlusal re-establishment, a minimum of 4 months after the RBFPDPs had been placed at an increased OVD. The design of the metal retainer coverage was found to be a significant factor affecting occlusal re-establishment and decementation (P<.05). Widening of the periodontal ligament space was the most common complication (29.2%).

CONCLUSIONS

RBFPDPs cemented at an increased OVD can be clinically recommended. The design of the retainer coverage was a significant factor influencing occlusal re-establishment and clinical complications.

Direct Composite Resin for the Management of Tooth Wear: A Systematic Review

BACKGROUND

This study systematically reviewed survival of direct composite to restore worn teeth.

MATERIALS AND METHODS

A comprehensive electronic search of databases sourced from Medline-PubMed, Embase, Cochrane Central, Scopus, Google scholar was performed on literature published between January 1990 and December 2018. Grey literature was also reviewed. Data extraction included sample size, number of composite restorations, operators, composite type, mean or total follow-up time and success rate expressed as either percent of successful restorations or median survival time (MST). Methodological quality was rated using the Joanna Briggs Institute appraisal checklist for case series. Studies on children, non-carious cervical lesions, cast and all-ceramic restorations, case reports and case series with <5 participants were excluded.

RESULTS

A total of 1563 studies were identified and 1472 were screened. Sixty-two full-text papers were assessed for eligibility which resulted in 10 studies that met inclusion criteria. These were mainly case series and assessed 3844 direct composite restorations placed in 373 patients mostly in hospital settings. Survival ranged from 50% to 99.3%. Methodological quality improved from the earlier studies and was rated low to moderate in 7 studies and good in 3. The funnel plot showed a low risk of publication bias but there was considerable heterogeneity (I²=97.7%). There was a non-significant weak negative association between age and survival (Spearman's rho=-0.12).

CONCLUSION

Qualitative evaluation of the studies proved difficult because of the nature of case series but reporting improved in the later studies. Despite the generally short duration of studies, small sample sizes in terms of patient numbers and composite restorations, the survival rates of direct hybrid composite resin in the short to medium term are acceptable and support their application for the restoration of worn teeth.

Structuring, reuse and analysis of electronic dental data using the Oral Health and Disease Ontology

Background

A key challenge for improving the quality of health care is to be able to use a common framework to work with patient information acquired in any of the health and life science disciplines. Patient information collected during dental care exposes many of the challenges that confront a wider scale approach. For example, to improve the quality of dental care, we must be able to collect and analyze data about dental procedures from multiple practices. However, a number of challenges make doing so difficult. First, dental electronic health record (EHR) information is often stored in complex relational databases that are poorly documented. Second, there is not a commonly accepted and implemented database schema for dental EHR systems. Third, integrative work that attempts to bridge dentistry and other settings in healthcare is made difficult by the disconnect between representations of medical information within dental and other disciplines’ EHR systems. As dentistry increasingly concerns itself with the general health of a patient, for example in increased efforts to monitor heart health and systemic disease, the impact of this disconnect becomes more and more severe.

To demonstrate how to address these problems, we have developed the open-source Oral Health and Disease Ontology (OHD) and our instance-based representation as a framework for dental and medical health care information. We envision a time when medical record systems use a common data back end that would make interoperating trivial and obviate the need for a dedicated messaging framework to move data between systems.

The OHD is not yet complete. It includes enough to be useful and to demonstrate how it is constructed. We demonstrate its utility in an analysis of longevity of dental restorations. Our first narrow use case provides a prototype, and is intended demonstrate a prospective design for a principled data backend that can be used consistently and encompass both dental and medical information in a single framework.

Results

The OHD contains over 1900 classes and 59 relationships. Most of the classes and relationships were imported from existing OBO Foundry ontologies. Using the LSW2 (LISP Semantic Web) software library, we translated data from a dental practice’s EHR system into a corresponding Web Ontology Language (OWL) representation based on the OHD framework. The OWL representation was then loaded into a triple store, and as a proof of concept, we addressed a question of clinical relevance – a survival analysis of the longevity of resin filling restorations. We provide queries using SPARQL and statistical analysis code in R to demonstrate how to perform clinical research using a framework such as the OHD, and we compare our results with previous studies.

Conclusions

This proof-of-concept project translated data from a single practice. By using dental practice data, we demonstrate that the OHD and the instance-based approach are sufficient to represent data generated in real-world, routine clinical settings. While the OHD is applicable to integration of data from multiple practices with different dental EHR systems, we intend our work to be understood as a prospective design for EHR data storage that would simplify medical informatics. The system has well-understood semantics because of our use of BFO-based realist ontology and its representation in OWL. The data model is a well-defined web standard.

Orthodontic-assisted one step- no prep technique: A straightforward and minimally-invasive approach for localized tooth wear treatment using polymer-infiltrated ceramic network CAD-CAM prostheses

OBJECTIVES

To introduce a minimally invasive and simple ortho-pros approach for localized tooth wear treatment.

CLINICAL CONSIDERATIONS

Four patients with localized anterior and/or posterior tooth wear were treated. Occlusal analyses were performed, and localized wax-up or digital setup were designed based on estimated tissue loss. No-prep anterior and posterior partial-coverage polymer-infiltrated ceramic network (PICN, Vita Enamic) restorations (eg, palatal and occlusal veneers) were computer-aided designed and manufactured (CAD-CAM), tried in, and bonded in supraocclusion, creating a posterior open bite. Then, brief partial (three patients) or global (one patient, for anterior teeth alignment request) orthodontic treatment was performed to extrude the posterior teeth and re-establish posterior occlusal contacts. The orthodontic treatment duration was ~2 months for extrusion. Direct composites were performed to mask the labial finish line of palatal veneers. Clinical results were successful after a follow-up of 15, 21, 23, and 47 months, with 100% success rate of PICN anterior restorations and some minor chippings of borders of thin (0.2 mm) posterior occlusal veneers. Patient-reported outcomes were positive.

CONCLUSION

Orthodontic-assisted one step-no prep technique is an advantageous and straightforward evolution of the Dahl concept. PICNs exhibit several advantages in this interdisciplinary approach.

CLINICAL SIGNIFICANCE

New hybrid-ceramic CAD-CAM materials and a collaborative interdisciplinary approach support the evolution of the Dahl concept for conservative treatment of worn dentitions. The orthodontic-assisted one step-no prep technique is predictable, efficient, and well tolerated by patients and conserves tooth structure.

Facts and Fallacies About Restorative Philosophies for the Management of the Worn Dentition

This article addresses facts and fallacies about managing worn teeth and challenges some traditional concepts and beliefs about occlusion. Whilst it is accepted that many of the historic occlusal concepts were well intended, closer examination reveals that many were unnecessarily destructive of sound tooth tissues and did not deliver all of their purported benefits. Those fallacies make them less appropriate in the litigious environment of contemporary dental practice. This paper discusses the disadvantages of 'subtractive' dental procedures for the management of tooth wear, and highlights the benefits of proven minimally destructive 'additive' techniques.

Minimally invasive rehabilitation of the worn dentition: a case report utilising adhesive additive techniques and digital technologies

The management of the worn dentition presents an increasing challenge that is encountered more frequently in daily dental practice. The consequences of tooth wear tend to be multifactorial and while they may initially only involve the loss of surface enamel it can progressively lead to significant destruction of the dentition. This paper discusses the management of a tooth wear case where a significant amount of tooth structure has been lost from both the anterior and posterior teeth. Protocols for assessment, treatment planning and restorative management of the tooth wear case are presented demonstrating the use of adhesive additive techniques and digital technologies to achieve functional and aesthetic rehabilitation of the dentition.

Conservative Management of Dental Erosion in Adolescents with Medical Conditions

The prevalence of dental erosion among children and adolescents is trending higher in recent decades and is becoming a major concern. Dental erosion can be caused by either extrinsic or intrinsic acids or both. One of the established aetiological factors for dental erosion by intrinsic acid is the gastrooesophageal reflux disease. The degree of dental erosions may be influenced by any medical conditions that cause a reduction in salivary flow such as the salivary gland excision, autoimmune disease, radiation to the head and neck regions, and medications. If left untreated, the dental erosion can cause dentine hypersensitivity, loss of occlusal vertical height, and aesthetic problems. For effective management of dental erosion, the aetiology of each case must be determined, and its detection at an early stage is of prime importance. This case report illustrates the conservative management of dental erosion in two adolescent patients presented with their medical conditions and behaviour issues. The aim of the treatments was to preserve the vitality of the affected teeth. The treatments were successfully completed using a conservative approach, with the patients' medical conditions taken into consideration.

A guide to the clinical management of attrition

Attrition is an enigmatic condition often found in older individuals and often as a result of bruxism which can take place as a result of either day bruxism, night bruxism or both. Various studies and systemic reviews clearly shown that tooth wear is an age-related phenomena and the last Adult Dental Health Survey showed that 15% of participants showed moderate wear and 3% severe wear with 80% of patients over 50 years of age showing signs of wear. This review examines current theories around the aetiological factors contributing to attrition together with the clinical management of attrition focusing on minimal intervention where possible.

The restorative management of tooth wear involving the aesthetic zone

The aim of this article is to describe a systematic approach that facilitates the establishment of a clear and appropriate diagnosis when a dentate patient presents with tooth wear involving their aesthetic zone. It will also detail the protocols that are required to allow for the development of an acceptable aesthetic prescription within the limits of the functional constraints presented by the patient (where active restorative intervention may be indicated), as well as to communicate the manner by which this information can be transferred to ultimately enable the successful and predictable rehabilitation of the affected areas. An overview will also be provided of the tooth-coloured dental materials and restorative techniques that have been commonly applied to deliver the predictable and effective dental care of worn teeth in the aesthetic zone.

Predictable prosthetic space maintenance during staged complete-mouth rehabilitation

Staged complete-mouth rehabilitation to accommodate a patient's financial constraints during the course of treatment is presented. Clear acrylic resin added to the anterior cameo surface of the maxillary fixed complete denture (FCD) served as a space maintainer. The restoration of the maxillary FCD addressed the patient's chief complaint. By adding the space maintainer, supraeruption of mandibular anterior teeth and encroachment of the prosthetic space, which could have resulted in additional treatment, was avoided. During the second stage of the complete-mouth rehabilitation, zirconia restorations were used to restore the mandibular arch to the maxillary FCD after straightforward removal of the space maintainer. This allowed a smooth transition after a delay in treatment without having to modify the previous treatment.

Direct Placement Composite: the Treatment Modality of Choice to Restore the Worn or Eroded Dentition in Primary Dental Care

Tooth wear is increasing in severity and prevalence, partly because of an ageing population and partly because of modern lifestyles. Management of the worn dentition with 'full mouth rehabilitation' is outmoded. This clinical paper aims to review the literature on composite restorations and give general dental practitioners the confidence to restore the worn dentition with dental composite. Composite is a versatile and widely available material that can be successfully applied within the existing occlusal vertical dimension (OVD) or at an increased OVD using a Dahl approach. Cases illustrate what is achievable, and clinical tips will help dentists optimise their results.

A Guided, Conservative Approach for the Management of Localized Mandibular Anterior Tooth Wear

The successful management of the worn mandibular anterior dentition may present an awkward challenge to the dental operator. The purpose of this article is to describe a case report illustrating the use of a guided, three-dimensional protocol for the ultra-conservative and predictable restoration of the worn lower anterior dentition using direct resin composite. This technique utilizes information based on established biomechanical and occlusal principles to fabricate a diagnostic wax-up, which is duplicated in dental stone. This is used to prepare a vacuum-formed modified stent, assisting the clinician to place directly bonded resin composite restorations to restore the worn lower anterior dentition. The technique, described in 2012 and referred to as 'injection moulding' has the potential to offer optimal form, function and an aesthetic outcome in an efficient manner. CPD/Clinical Relevance: This article aims to describe an alternative technique to simplify the processes involved with restoration of worn lower anterior teeth.

Survival rates of anterior composites in managing tooth wear: systematic review

The use of composite restorations for patients with tooth wear is considered as a more conservative treatment option. The aim of this study was to systematically review the literature investigating the survival rates of anterior composite restorations when used in managing tooth wear in patients. PubMed and MEDLINE (Ovid) databases were screened for studies from 1995 to 2015. Cross-referencing was used to further identify articles. Article selection and data extraction were performed in duplication. Languages were restricted to English. A quality appraisal of included studies was carried out using the Strength of Recommendation Taxonomy system. Six hundred and sixty-six articles were initially identified from which eight articles were full-text reviewed. Six articles involving five studies were selected for inclusion. Three studies were prospective and two retrospective. Included studies involved placement of 772 direct and indirect anterior composite restorations in 100 patients with follow-up periods between 5 months and 10 years. The survival rates of anterior composites were >90% and 50% at 2.5 and 5 years, respectively. Posterior occlusion was re-established in 91% of patients within 18 months. Meta-analysis could not be performed due to the heterogeneity of included studies. The systematic review's overall strength of recommendation was graded B. There is evidence to support the use of anterior composite restorations at an increased vertical dimension of occlusion in the short/medium-term management of tooth wear. Long-term reporting of outcomes remains limited. Further research is needed with standardised study design, detailed reporting of outcomes and long-term review.

Impact of lateral occlusion schemes: A systematic review

STATEMENT OF PROBLEM

Although several lateral occlusion philosophies have been proposed in the literature, there is a lack of compelling evidence supporting any scheme.

PURPOSE

The purpose of this systematic review was to investigate the clinical implications of different lateral occlusion schemes.

MATERIAL AND METHODS

A literature search was completed through PubMed (MEDLINE), Google Scholar, and Cochrane Library, up to January 2014. The literature search aimed to retrieve 2 study categories: group 1: comparative studies; group 2: clinical outcome studies. The inclusion criteria were peer-reviewed human clinical studies published in English. The search was further supplemented by manual searching through the reference lists of the selected studies.

RESULTS

The initial search revealed a total of 680 studies; however, after applying the inclusion criteria, 26 studies were found suitable for the analysis (13 for group 1 and 13 for group 2). The most commonly evaluated lateral occlusion schemes were canine-guided occlusion (CGO) and group function occlusion (GFO). Group 1 studies evaluated the impact of lateral occlusion schemes on muscular electromyographic (EMG) activity, condylar displacement, mastication, and mandibular movement. Group 2 studies evaluated the impact of restored occlusion on longevity, patient comfort, and pathologic consequences. CGO was associated with narrower mastication and less EMG activity of the masticatory muscles during clenching. GFO was associated with wider mandibular movement and quicker mastication. During mastication, there was no difference in EMG activity between the 2 lateral occlusion schemes. Furthermore, the long-term studies indicated that there is no difference between the 2 schemes in patient comfort and restoration longevity.

CONCLUSION

Although there are immediate differences between the different lateral occlusion schemes, patients have the capability to successfully adapt to CGO or GFO.

Aesthetic Treatment Related to Clinical Need--An Illustrated Case Report

Aesthetic treatment may be patient driven and usually by a 'want', rather than a 'need'. This paper describes the management of a patient who presented with aesthetic wants and clinical needs, both of which were caused as a result of unsuccessful aesthetic treatment which the patient had received previously. The diagnostic process, discussion of the treatment plan and clinical procedures, which produced a satisfactory result, are described and illustrated. Clinical Relevance: This case demonstrates that aesthetic treatment may commit the patient to future dental treatment needs, particularly if treatment provided is poorly planned and carried out to an unsatisfactory standard.

The 'slingshot' technique to align palatally impacted canines with elastomeric chain

Orthodontic alignment of palatally ectopic maxillary canines can be challenging. Treatment is usually prolonged and further complicated by the need for surgical exposure. Several methods are commonly used and have been described in the literature. This article presents two cases to describe a relatively unknown yet effective technique using the 'slingshot' method. This method is operator friendly and easily tolerated by patients.

Direct adhesive pin-retained restorations for severely worn dentition treatment: a 1.5-year follow-up report

Excessive occlusal surface wear can result in occlusal disharmony, functional and esthetic impairment. As a therapeutic approach, conventional single crowns have been proposed, but this kind of treatment is complex, highly invasive and expensive. This case report describes the clinical outcomes of an alternative minimally invasive treatment based on direct adhesive-pin retained restorations. A 64-year-old woman with severely worn dentition, eating problems related to missing teeth and generalized tooth hypersensitivity was referred for treatment. Proper treatment planning based on the diagnostic wax-up simulation was used to guide the reconstruction of maxillary anterior teeth with direct composite resin over self-threading dentin pins. As the mandibular remaining teeth were extremely worn, a tooth-supported overdenture was installed. A stabilization splint was also used to protect the restorations. This treatment was a less expensive alternative to full-mouth rehabilitation with positive esthetic and functional outcomes after 1.5 years of follow-up.

Interactive treatment planning in toothwear: are we doing it right?

Toothwear is now common, especially in younger patients, with high demand for the restoration of the damaged teeth which is likely to increase further over time. Fixed prosthodontic options range from direct composite resin to conventional tooth preparation and cemented indirect restorations. This paper summarizes the views of a variety of clinicians on a plan delivered to a patient with toothwear in secondary care and explores the possible reasons for the variation in decision-making in the treatment of toothwear.

CLINICAL RELEVANCE

With levels of toothwear increasing, the clinician needs to be aware of the different treatment modalities which are appropriate.

Information for patients undergoing treatment for toothwear with resin composite restorations placed at an increased occlusal vertical dimension

Toothwear is affecting increasing numbers of the population. In the past, treatment of patients whose teeth were affected by toothwear often involved the reduction of these teeth for crowns; a severe form of toothwear. Contemporary management of such cases is by the bonding of resin composite restorations to the worn and wearing surfaces, with these restorations being placed at an increased occlusal vertical dimension. The advantage of the technique is its minimal- or non-intervention nature and its high reported degree of patient satisfaction. There are, however, short-term disadvantages to the technique, such as the potential for lisping, pain from the teeth which will be subject to axial orthodontic tooth movement, and difficulty in chewing on the posterior teeth if these are discluded. It is therefore important, as with any treatment, that the advantages and disadvantages are fully explained to the patient. This paper therefore describes the clinical technique and presents a Patient Information Leaflet that the author has used for over five years.

CLINICAL RELEVANCE

Patients should be advised regarding the disadvantages and advantages of any technique.

Contemporary management of generalized erosive tooth surface loss

Management of generalized erosive tooth surface loss can be challenging. Careful pre-operative assessment of the patient and treatment planning is essential. The aim of any treatment provided is to prevent further tooth surface loss, restore aesthetics and function, and provide a stable occlusal relationship. Whilst attempting to fulfil these goals, it is important to protect the remaining tooth structure by using restorations which are conservative and do not cause further damage to teeth which are already compromised. This paper aims to describe a conservative approach to restoring patients with generalized tooth surface loss.

CLINICAL RELEVANCE

To highlight conservative treatment options available for the management of generalized erosive tooth surface loss and show how they contrast with other destructive irreversible conventional techniques.

Marginal adaptation of direct class II composite restorations with different cavity liners

The aim of this study was to evaluate how cavity linings with different elastic modulus can influence the marginal adaptation (MA) of Class II composite restorations before and after thermo-mechanical loading.

MATERIALS AND METHODS

Forty Class II cavities with margins extending 1 mm below the cement-enamel junction were prepared in extracted human third molars. In each group except the control group, a lining material of 1-mm thickness was applied to the bottom of the cavity and polymerized before placing the resin composite Herculite XRV Ultra (group A: control; group B: Premise Flowable lining; group C: Herculite XRV Ultra lining; and group D: Optibond FL lining). MA was evaluated (with a scanning electron microscope) before and after loading (200,000 loading cycles). Statistical analysis was done using the Shapiro-Wilks test, the analysis of variance test, and Duncan post hoc test at p<0.05.

RESULTS

Before loading, the percentages of continuous margins in dentin were superior (p<0.05) for groups C and D (71.1% and 87.2%, respectively) compared to groups A and B (55.7% and 48.3%, respectively). After loading, group D (79.8%) was statistically superior in dentin compared to all of the other groups (43.6%, 35.9%, and 54.4%, respectively). In occlusal enamel, no significant difference was found between groups. The percentage of enamel fractures and the percentage of noncontinuous margins in proximal enamel were high, with no significant difference between liners. It can be concluded that for the materials used in this study, a 1-mm-thick lining with an extremely low elastic modulus (2-3 GPa) could redistribute shrinkage stress. The use of a flowable composite did not significantly improve MA.

The management of anterior tooth wear using gold palatal veneers in canine guidance

Localised anterior tooth wear can be managed using minimally invasive techniques with conservation of tooth structure and preservation of pulp vitality. This article describes and illustrates with two clinical cases, the management of localised tooth wear, with the restoration of canine guidance by a combination of gold palatal veneers and direct composite restorations.