A guide to managing tooth wear: the Radboud philosophy

Key Points

  • Provides an overview of the philosophy and the management of the Radboud Tooth Wear Project from monitoring and counselling to a full rehabilitation.

  • Emphasises the need of counselling and monitoring to objectively evaluate the progression of tooth wear over time and determine the patients' commitment for a possible restorative rehabilitation.

  • Illustrates several minimally invasive and adhesive restorative strategies for the treatment of severe tooth wear patients.

Abstract

This paper explains a conservative, pragmatic and minimally invasive intervention concept for the treatment of severe tooth wear patients based on the Radboud Tooth Wear Project in the Netherlands. Guidelines and flowcharts for management of severe tooth wear patients and rehabilitation in increased vertical dimension of occlusion are presented. We concluded that: (a) Restorative treatment is not always indicated, even for patients with severe tooth wear. (b) If the patient has no complaints, counselling and monitoring is probably the best option. (c) Minimally invasive and adhesive restorative strategies are preferred when severe tooth wear patients are to be treated in increased vertical dimension, especially when young patients are involved. (d) Clinical evidence for a suitable restorative treatment protocol is limited to five-year follow up for direct composites. This material seems to be suitable for rehabilitation in increased vertical dimension on the middle long term. Clinical results for indirect techniques are not available yet. (e) Restorations, including those that are considered 'definitive' may prove to have a limited lifetime in patients with severe tooth wear due to bruxism and erosion. Explanation of the possible treatment options and expected complications should be included in the informed consent.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Figure 1
Figure 2: Monitoring a severe tooth wear patient (female, 33 years old).
Figure 3: Monitoring a severe tooth wear patient (female, 50 years old).
Figure 4: Male patient (52 years old) with severe erosive tooth wear in combination with heavy grinding.
Figure 5
Figure 6: Male patient (22 years old) with severe erosive tooth wear and functional problems (pain).
Figure 7: Male patient (40 years old) with severe erosive tooth wear and experiencing a lot of hypersensitivity of his teeth when drinking and eating acidic foods.
Figure 8: This series of slides shows a 22-year follow-up of a male patient (22 years old) with severe tooth wear.

References

  1. 1

    Lussi A, Carvalho T S . Erosive tooth wear: a multifactorial condition of growing concern and increasing knowledge. Monogr Oral Sci 2014; 25: 1–15.

    Article  Google Scholar 

  2. 2

    El Aidi H, Bronkhorst E M, Huysmans M C, Truin G J . Dynamics of tooth erosion in adolescents: a 3-year longitudinal study. J Dent 2010; 38: 131–137.

    Article  Google Scholar 

  3. 3

    Carvalho T S, Lussi A, Jaeggi T, Gambon D L . Erosive tooth wear in children. Monogr Oral Sci 2014; 25: 262–278.

    Article  Google Scholar 

  4. 4

    Wetselaar P, Vermaire J H, Visscher C M, Lobbezoo F, Schuller A A . The Prevalence of Tooth Wear in the Dutch Adult Population. Caries Res 2016; 50: 543–550.

    Article  Google Scholar 

  5. 5

    Bartlett D W, Lussi A, West N X, Bouchard P, Sanz M, Bourgeois D . Prevalence of tooth wear on buccal and lingual surfaces and possible risk factors in young European adults. J Dent 2013; 41: 1007–1013.

    Article  Google Scholar 

  6. 6

    Salas M M, Nascimento G G, Huysmans M C, Demarco F F . Estimated prevalence of erosive tooth wear in permanent teeth of children and adolescents: an epidemiological systematic review and meta-regression analysis. J Dent 2015; 43: 42–50.

    Article  Google Scholar 

  7. 7

    Loomans B, Opdam N, Attin T et al. Severe Tooth Wear: European Consensus Statement on Management Guidelines. J Adhes Dent 2017; 19: 111–119.

    Google Scholar 

  8. 8

    Loomans BAC, Kreulen CM, Huijs-Visser HECE, Sterenborg BAMM, Bronkhorst EM, Huysmans MCDNJM, Opdam NJM . Clinical performance of full rehabilitations with direct composite in severe tooth wear patients: 3.5 Years results. J Dent. 2018 Jan 12. pii: S0300-5712(18)30001-0. 10.1016/j.jdent.2018.01.001. [Epub ahead of print] PubMed PMID: 29339203.

    Article  Google Scholar 

  9. 9

    Johansson A, Omar R, Carlsson G E . Bruxism and prosthetic treatment: a critical review. J Prosthodont Res 2011; 55: 127–136.

    Article  Google Scholar 

  10. 10

    West N X, He T, Macdonald E L, Seong J, Hellin N, Barker M L, Eversole S L . Erosion protection benefits of stabilized SnF2 dentifrice versus an arginine-sodium monofluorophosphate dentifrice: results from in vitro and in situ clinical studies. Clin Oral Investig 2017; 21: 533–540.

    Article  Google Scholar 

  11. 11

    Wilder-Smith C H, Wilder-Smith P, Kawakami-Wong H, Voronets J, Osann K, Lussi A . Quantification of dental erosions in patients with GERD using optical coherence tomography before and after double-blind, randomized treatment with esomeprazole or placebo. Am J Gastroenterol 2009; 104: 2788–2795.

    Article  Google Scholar 

  12. 12

    Smith B G N, Knight J K . An index for measuring the wear of teeth. Br Dent J 1984; 156: 435–438.

    Article  Google Scholar 

  13. 13

    Bartlett D, Ganss C, Lussi A . Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs. Clin Oral Investig 2008; 12 (Suppl 1): S65–S68.

    Article  Google Scholar 

  14. 14

    Wetselaar P, Lobbezoo F . The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions. J Oral Rehabil 2016; 43: 69–80.

    Article  Google Scholar 

  15. 15

    Rodriguez J M, Austin R S, Bartlett DW . In vivo measurements of tooth wear over 12 months. Caries Res 2012; 46: 9–15.

    Article  Google Scholar 

  16. 16

    Bartlett D, Varma S . A retrospective audit of the outcome of composites used to restore worn teeth. Br Dent J 2017; 223: 33–36.

    Article  Google Scholar 

  17. 17

    Elderton R J . Clinical studies concerning re-restoration of teeth. Adv Dent Res 1990; 4: 4–9.

    Article  Google Scholar 

  18. 18

    Mesko M E, Sarkis-Onofre R, Cenci M S, Opdam N J, Loomans B, Pereira-Cenci T . Rehabilitation of severely worn teeth: A systematic review. J Dent 2016; 48: 9–15.

    Article  Google Scholar 

  19. 19

    Attin T, Filli T, Imfeld C, Schmidlin P R . Composite vertical bite reconstructions in eroded dentitions after 5.5 years: a case series. J Oral Rehabil 2012; 39: 73–79.

    Article  Google Scholar 

  20. 20

    Hamburger J T, Opdam N J, Bronkhorst E M, Kreulen C M, Roeters J J, Huysmans M C . Clinical performance of direct composite restorations for treatment of severe tooth wear. J Adhes Dent 2011; 13: 585–593.

    PubMed  Google Scholar 

  21. 21

    Poyser N J, Briggs P F, Chana H S, Kelleher M G, Porter R W, Patel M M . The evaluation of direct composite restorations for the worn mandibular anterior dentition – clinical performance and patient satisfaction. J Oral Rehabil 2007; 34: 361–376.

    Article  Google Scholar 

  22. 22

    Milosevic A, Burnside G . The survival of direct composite restorations in the management of severe tooth wear including attrition and erosion: A prospective 8-year study. J Dent 2016; 44: 13–19.

    Article  Google Scholar 

  23. 23

    Bartlett D, Sundaram G . An up to 3-year randomised clinical study comparing indirect and direct resin composites used to restore worn posterior teeth. Int J Prosthodont 2006; 19: 613–617.

    PubMed  Google Scholar 

  24. 24

    Morley J, Eubank J . Macroesthetic elements of smile design. J Am Dent Assoc 2001; 132: 39–45.

    Article  Google Scholar 

  25. 25

    Opdam N, Skupien J A, Kreulen C M, Roeters J, Loomans B, Huysmans M D . Case report: A predictable technique to establish occlusal contact in extensive direct composite resin restorations: The DSO-technique. Oper Dent 2016; 41 (Suppl 7): S96–S108.

    Article  Google Scholar 

  26. 26

    Hamburger J, Opdam N, Loomans B . Direct posterior esthetics: a management protocol for the treatment of severe tooth wear with resin composite (chapter 6); Direct posterior esthetics: clinical case (chapter 7). In Banerjee A (ed) Minimally invasive esthetics: essentials in esthetic dentistry series. Amsterdam: Elsevier Health Sciences, 2015.

    Google Scholar 

  27. 27

    Magne P, Spreafico R C . Deep margin elevation: A paradigm shift. Am J Esthet Dent 2012; 2: 86–96.

    Google Scholar 

  28. 28

    Opdam N, Frankenberger R, Magne P . From 'direct versus indirect' toward an integrated restorative concept in the posterior dentition. Oper Dent 2016; 41 (Suppl 7): S27–S34.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to B. Loomans.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Loomans, B., Opdam, N. A guide to managing tooth wear: the Radboud philosophy. Br Dent J 224, 348–356 (2018). https://doi.org/10.1038/sj.bdj.2018.164

Download citation

Further reading

Search