Abstract
Our aim was to evaluate the clinical performance of direct composite restorations placed in patients with severely worn dentitions at an increased vertical dimension of occlusion, after up to 11 years. One hundred and sixty-four teeth in 13 patients with severely worn dentitions had been reconstructed with either microhybrid (first cohort; n = 59) or nanofilled (second cohort; n = 105) composite restorations at increased vertical dimension of occlusion using a wax-up-based template-aided placement technique. From the dental records, information about repair and replacement of restorations was obtained. Patients were clinically examined after a mean follow-up time of 10.7 years (first cohort) or 5.2 years (second cohort) using United States Public Health Service (USPHS) criteria. Subjective patient satisfaction was also recorded using visual analogue scales (VAS). The overall quality of the restorations was good with predominantly ‘Alpha’ and ‘Bravo’ scores, respectively. Nanofilled composite showed less surface degradation and better margin qualities than microhybrid composite. Of the 59 restored teeth in the first cohort, 13 restorations showed unfavorable events after 10.7 years, of which ten could be repaired. In the second cohort, 23 of 105 restorations showed unfavorable events, which could all be repaired. VAS scores revealed high patient satisfaction with the treatment approach. In conclusion, direct composite restorations placed at an increased vertical dimension of occlusion show good clinical long-term performance in patients with severe tooth wear.
Highlights
Tooth wear represents an irreversible, multifactorial, non-carious loss of dental hard tissues based on erosive, abrasive and/or attritional effects [1,2]
Epidemiological data suggest that tooth wear is becoming increasingly common, especially in younger populations, with prevalence and extent rising with age [3,4,5]
Patients suffering from severe tooth wear require complex restorative care to compensate for the loss of tooth substance, if the occlusal vertical dimension is affected
Summary
Tooth wear represents an irreversible, multifactorial, non-carious loss of dental hard tissues based on erosive, abrasive and/or attritional effects [1,2]. Apart from epidemiological concerns, tooth wear may manifest itself in severe forms and lead to tooth hypersensitivity, loss of vertical dimension of occlusion, esthetic impairment, and compromised oral health-related quality of life at the individual patient level [6,7]. Patients suffering from severe tooth wear require complex restorative care to compensate for the loss of tooth substance, if the occlusal vertical dimension is affected. Apart from being expensive and unaffordable for many patients, this conventional approach is highly invasive due to required tooth preparations sacrificing significant amounts of sound dental hard tissue. A re-thinking in the restorative management of tooth wear toward minimum-intervention approaches has taken place, which rather focuses on conservative “additive” instead of conventional “subtractive” treatment strategies according to a dynamic restorative concept taking prophylactic and reparative considerations into account [11]
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