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.


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.

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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.


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Correspondence to B. Loomans.

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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

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