Abstract
Tooth wear may be described as a side-effect of occlusal forces that may be further induced by the common use of contemporary prosthetic materials in practice. The purpose of this systematic review was to appraise existing evidence on enamel wear from both in vitro and clinical research and explore whether evidence from these study designs lies on the same direction. Five databases of published and unpublished research were searched without limitations in August 2019 and study selection criteria included in vitro and clinical research on enamel tooth wear. Study selection, data extraction, and risk of bias assessment were done independently and in duplicate. Random effects meta-analyses of standardized mean differences (SMDs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were conducted while a Monte Carlo permutation test for meta-regression on the exploration of the effect of the study design on the reported outcomes was planned. A total of 27 studies (23 in vitro and 4 clinical) were eligible while 12 contributed to meta-analyses. Overall, some concerns were raised for the quality of the existing evidence and the potential for risk of bias. Enamel wear (mm) of antagonist teeth was more pronounced when opposed to conventional porcelain compared to machinable ceramics (SMD = 2.18; 95%CIs: 1.34, 3.02; p < 0.001). Polished zirconia resulted in decreased volumetric enamel wear (mm3) of opposing teeth compared to pure natural enamel (SMD = –1.06; 95%CIs: –1.73, –0.39; p = 0.002). Monolithic zirconia showed evidence of enhanced potential for antagonist wear (μm) compared to natural teeth (WMD = 107.38; 95%CIs: 30.46, 184.30; p = 0.01). Study design did not reveal an effect on the tooth wear outcome for the latter comparison when both clinical and in vitro studies were considered (three studies; Monte Carlo test, p = 0.66). In conclusion, there is an overriding need for additional evidence from clinical research to substantiate the findings from the already existing laboratory simulation studies.
Highlights
Tooth wear is a multi-faceted common dental condition, which constitutes a variable amount of tooth substance loss not related to cariogenic conditions
Eleven papers were excluded due to reasons related to our pre-defined eligibility criteria, leaving a final number of 27 studies included in the systematic review
Following the results of the formulated quantitative syntheses with at least two studies included, we recorded increased vertical tooth wear of the opposing enamel when conventional porcelain was compared to machinable ceramics (SMD = 2.18; 95%confidence intervals (CIs): 1.34, 3.02; p < 0.001)
Summary
Tooth wear is a multi-faceted common dental condition, which constitutes a variable amount of tooth substance loss not related to cariogenic conditions. Different types of ceramic materials as well as composite resins are used for prosthetic restorations after an increasing demand for nonmetallic dental prostheses. Massive use of dental restorations in clinical practice, through a range of different/ novel materials, such as a number of materials based on metal alloys, particle-reinforced polymers, and ceramics, have increased awareness regarding maintenance of antagonist natural tooth integrity [6,7]. Advances in the development of prosthetic dental materials used as crown or bridge tooth substitutes have introduced additional considerations regarding their contact interface and possible detrimental effects on sound enamel structure. Presenting unanimous advantages regarding their clinical performance, biotolerance, and aesthetic appearance, may still constitute materials of increased hardness, being resistant to fractures. Composite restorations may present antagonist tooth wear considerations as well
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