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References

Burke FJ. Comment. (NOT) Seeing the light. Dent Update. 2021; 48:717-718
Mehta SB, Lima VP, Bronkhorst EM Clinical performance of direct composite resin restorations in a full mouth rehabilitation for patients with severe tooth wear: 5.5-year results. J Dent. 2021; 112 https://doi.org/10.1016/j.jdent.2021.103743
Kelleher MG, Blum IR. Facts and fallacies about restorative philosophies for the management of the worn dentition. Prim Dent J. 2020; 9:27-31 https://doi.org/10.1177/2050168420911018
Hassall DC. The current status of aesthetic and restorative dentistry. Clinical Dentistry. 2021; 1:31-34

An alternative view

From Volume 48, Issue 11, December 2021 | Page 967

Authors

Dominic Hassall

BDS, MSc (Manc), FDS RCPS (Glasg), MRD RCS (Edin), FDS (Rest Dent), RCS (Eng)

Restorative, Prosthodontic and Periodontal Specialist, Director, Dominic Hassall Training Institute; Senior Clinical Lecturer School of Dentistry, Cardiff University

Articles by Dominic Hassall

Article

Professor Burke is overgenerous in his assessment of the success of traditional composite techniques in the treatment of tooth wear in his recent comments.1

Regarding the study in question, if we consider the most aesthetically demanding area, the anterior maxilla, the study results are not encouraging. If the less significant smaller Level 3 failures are excluded, then the combined Level 1 and 2 failures (those that required restoration, repair or replacement) are actually high, at 26.9% and 32.5% for one- and two-session composite veneer placements, over a relatively short study period. In addition, polishing due to extrinsic staining or roughness was not registered as failure.2

Advocates of this style of traditional style of composite rehabilitation describe the initial aesthetic outcome as ‘good enough.’3 However, the clinical experience of many of us who previously undertook this of this type of rehabilitation in private practice (where the majority of tooth wear is treated) is that many patients were not overwhelmed with the initial aesthetic outcome, and disappointed with the rapid deterioration in aesthetics due to staining, chipping or delamination, and constant replacement/repairs.

Unfortunately, the study does not assess how satisfied the patients were with the aesthetic outcome of the treatment, one of the major factors for seeking restorative treatment for tooth wear. The authors did acknowledge the high maintenance needs and the time consuming initial nature of the initial rehabilitation (up to 15 hours).

This study presents a valid option for the treatment of tooth wear, but patients should be informed of the limited initial aesthetic outcome, potentially rapid deterioration in aesthetics and high maintenance needs, and the expense involved in this.

Many of us have abandoned this approach to tooth wear rehabilitation over the last decade and embraced the significant developments in both composites and ceramics.

Many clinicians have taken advantage of the emergence of improved bonding protocols and warmed injection bulk-fill overbuild and cut-back composites techniques, encompassed by systems such as the Bioclear method and monolithic minimally invasive high-strength ceramics. These developments allow the provision of highly aesthetic, durable and minimally invasive restorations satisfying both patient and clinician demands.4