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Petros Mylonas
CL/ST4 Restorative Dentistry, Cardiff University,
Cardiff and Vale University Health Board

An outline of developments in the management of tooth wear

There have been many advances in the diagnosis and management of tooth wear coinciding with advancements in materials, technology and improvements in our understanding of the condition. The authors of this article outline the historical, present and future trajectory of the management of tooth wear, a starting point for clinicians involved with the management of this condition.

Key advances in the management of tooth wear are based on:

 • Clinical quantification of tooth wear using an index

• Use of restorative materials to create interocclusal space to restore affected teeth without preparation (or minimal preparation)

• Use of resin-based composites and adhesive dentistry to restore teeth without preparation

• Focus on the early recognition and prevention of tooth wear using new oral therapeutic agents

• Monitoring and maintenance of tooth wear using study casts and digital technology.

The late 1970s saw a shift in understanding of tooth wear with the development of indices allowing clinicians to assess and monitor tooth wear progression. The Basic Erosive Wear Examination is now considered the most widely used index.

Tooth wear management has shifted to an additive approach with sufficient longevity data to indicate use of direct and indirect adhesive dentistry without (or with minimal) tooth preparation.

An increasing focus on the early recognition of tooth wear and introducing preventative measures to halt or slow its progression have become important tools in the dental professional’s arsenal.

Mehta SB, Banerji S. The management of tooth wear: past, present and future. Dent Update 2023; 50(5): 375–382

Factors to consider in the treatment planning for the restorative management of tooth wear

Management of tooth wear requires careful treatment planning to ensure appropriate and long-term care for these patients. The authors outline important factors to consider when treatment planning for the management of tooth wear.

Key considerations in treatment planning for tooth wear management were outlined:

• Stabilisation of primary disease and risk-factor management

• Reviewing patient compliance and expectations

 • Definitive restorative treatment

• Maintenance and recall schedule appropriate to patients’ risk assessment and treatment complexity.

The authors provide an outline of the key clinical factors to consider when restoratively managing tooth wear, which include aesthetic zone and smile line, tooth wear distribution, remaining tooth structure, tooth volume, existing restorations, root length, pulp and peri-radicular status, incisal classification and posterior occluding units.

The authors also stress the importance of disease control and risk-factor management to ensure that patient-related risk factors and habits that contributed to the aetiology of tooth wear have been controlled and eliminated.

The identification of clinical factors that contribute to the overall grading of complexity of the case as low, intermediate and advanced is important so that clinicians can manage or refer cases as appropriate.

Calvert G, Cocozza P, Elsayed Ahmed K. Clinical factors to consider in definitive treatment planning for patients with tooth wear. Br Dent J 2023; 234: 375–384

Latest advances and considerations in use of direct composite for tooth wear management

One of the cornerstones of modern restorative management of tooth wear involves the use of direct composites due to advances in adhesive technology, resin-composite material development and increasing clinical evidence for restoration longevity.

The authors provide an overview of different clinical techniques in the use of direct composites for the restorative management of tooth wear.

The key factors that were highlighted by the authors include:

• Appropriate treatment planning with articulated study models and diagnostic wax-ups

• Communication with the dental technician

• Preparing the tooth for predictable bonding and aesthetic restoration

• Moisture control

• Clinical techniques in composite placement that works for the clinician.

The authors state that a careful assessment of patients’ tooth wear with clear dialogue between patient, clinician and technician will allow for effective treatment planning.

The use of diagnostic wax-ups and provisional trial restorations enable the patient to visualise the proposed plan and the clinician to evaluate any technical considerations.

Additionally, the authors outline moisture control importance to both the ease of composite placement and its longevity, highlighting either the split-dam technique or individual tooth isolation on a quadrant/sextant basis.

The clinical techniques available to clinicians are described and include the freehand approach, putty index and freehand approach, vacuum formed matrix approach, silicone matrix ‘stamp’ approach and injection moulding technique.

The authors advise clinicians to ensure patients undergo thorough monitoring and maintenance protocol to ensure longevity of the composite restorations.

Aminian A, Leven A, Ashley M. Clinical considerations in the application of direct composite for tooth wear. Br Dent J 2023; 234: 400–405