Clinical guidance and an evidence-based approach for restoration of the worn dentition by direct composite resin

Key Points

  • Reviews bonding agents and composite properties regarding which materials are better suited for restoration of the worn dentition.

  • Discusses the clinical steps and techniques, based on current evidence, required to restore worn teeth with direct composite resin.

  • Illustrates the application of direct composite from relatively moderate wear to severe wear seen in older patients.

Abstract

This paper aims to provide the dentist with practical guidance on the technique for direct composite restoration of worn teeth. It is based on current evidence and includes practical advice regarding type of composite, enamel and dentine preparation, dentine bonding and stent design. The application of direct composite has the advantage of being additive, conserving as much of the remaining worn tooth as possible, ease of placement and adjustment, low maintenance and reversibility. A pragmatic approach to management is advocated, particularly as many of the cases are older patients with advanced wear. Several cases restored by direct composite build-ups illustrate what can be achieved. The restoration of the worn dentition may be challenging for many dentists. Careful planning and simple treatment strategies, however, can prove to be highly effective and rewarding. By keeping any intervention as simple as possible, problems with high maintenance are avoided and management of future failure is made easier. An additive rather than a subtractive treatment approach is more intuitive for worn down teeth. Traditional approaches of full-mouth rehabilitation with indirect cast or milled restorations may still have their place but complex treatment modalities will inevitably be more time consuming, more costly, possibly require specialist care and still have an unpredictable outcome. Composite resin restorations are a universal restorative material familiar to dentists from early-on in the undergraduate curriculum. This review paper discusses the application of composite to restore the worn dentition.

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Figure 1
Figure 2: Case 1 showing the maxillary right first molar pre- and post-composite placement occlusally.
Figure 3: (a) Case 2 showing marked tooth wear in the lower left quadrant, probably acid erosion, but the aetiology was not identified in this 55-year old male.
Figure 4: Case 3 shows buccal erosion on the lower right canine and first premolar in a 23-year-old female.
Figure 5: Case 4 illustrates a reverse overjet with an edge-to-edge incisal relationship, lack of posterior support and wear present incisally and labially in a 67-year-old male.
Figure 6
Figure 7: Case 5 shows a typical erosion case with the incisal edge curve and loss of labial enamel.
Figure 8: Case 6 show a multi-factorial wear case with attrition and erosion.
Figure 9: Case 7 shows the problem with different degrees of wear on individual teeth in a 43-year-old male.
Figure 10: Case 8 is of an 89-year-old male who never wore dentures but functioned well despite the lack of teeth and severe upper anterior wear.
Figure 11: Case 9 shows the upper anterior eroded dentition of a female.
Figure 12: Ultrafine diamond finishing burs and the problem if insufficient care is taken with prevention of composite 'bridging' across the interdental embrasure.
Figure 13
Figure 14: Metal matrix band cut into short strips and placed through the contacts are rigid enough to be pushed through, particularly if contacts are tight.
Figure 15: Stone casts showing pre-wax up worn teeth, related in ICP, and on the right the laboratory wax-up with a Dahl approach at increased OVD.

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Milosevic, A. Clinical guidance and an evidence-based approach for restoration of the worn dentition by direct composite resin. Br Dent J 224, 301–310 (2018). https://doi.org/10.1038/sj.bdj.2018.168

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