Randomised controlled trial on testing an increased vertical dimension of occlusion prior to restorative treatment of tooth wear.

Abstract

Evaluation of a new vertical dimension of occlusion (VDO) in complex restorative treatments is considered a necessary step prior to placement of restorations. This randomised controlled trial (RCT) aimed to assess the effects of using an evaluation of a VDO increase before restorative treatment in patients with moderate-to-severe tooth wear, on OHRQoL, freeway space (FWS) and interventions to restorations. Forty-two patients with tooth wear were included and randomly allocated to either a test phase with a Removable Appliance (RA) or no test phase. Restorative treatment consisted of restoration of all teeth using composite restorations in an increased VDO. OHIP-score, freeway space (FWS) and clinical acceptability of restorations were assessed at baseline and at recall appointments (1month and 1year). Intervention to restoration was scored in case of material chipping or when the abutment tooth had increased sensitivity that could be linked to occlusal overloading. ANCOVA analyses, Univariate Cox regression, t-tests and descriptive analyses were performed (p < .05). Clinical follow-up after 1year was completed for 41 patients. No significant effect of testing the VDO with a RA could be found on the OHIP-score (p=.14). Reduction of FWS in the RA group, compared to the control group, was significantly lower at 1year (p=.01, 95% CI -1.09 to -0.15). No effect on early interventions to restorations was found (p=.94). This RCT showed that a removable appliance is not indicated to functionally test the increased VDO prior to restorative treatment in patients with tooth wear.