Presentation and management of mandibular anterior tooth wear

Tooth wear in mandibular anterior teeth is a common clinical finding and may be a natural physiological process. However, excessive tooth wear can occur as a result of pathological causes. The proportion of patients suffering with premature tooth surface loss has increased over time.¹ In terms of their proportion, lower incisors are the smallest teeth and, as such, have a reduced surface area for restoration, but at the same time can be heavily involved in excursive tooth movement, particularly in protrusion. After molars, it is reported that mandibular incisors have the most extensive tooth wear with an average of 1.5 mm lost over 60 years.¹ However, a recent study of a Chinese population showed that mandibular incisors were, in fact, the most frequently worn tooth.² This is likely to be due to incisors being the first teeth to erupt, often being retained longer than posterior teeth in older patients and are, therefore, present in the mouth longer.³ Achieving both a functional and aesthetic result for lower anterior restorations can be a demanding and technique sensitive. A range of treatment options is available, from more conservative composite restorations to full coverage crowns. The choice of treatment modality must be balanced against the remaining tooth structure, removal of additional tooth structure and patient need.