From Volume 46, Issue 9, October 2019 | Pages 812-816
This article will focus on the active management of localized anterior tooth wear using indirect resin composite restorations. Emphasis will be placed on minimally invasive methods of tooth preparation in order to preserve biological tooth tissue in an already compromised tooth structure. Active management commits the patient to considerable long-term maintenance and it is important, as with any treatment, that the advantages and disadvantages are fully explained to the patient.
Indirect composite resin restorations have been described since the mid-1970s, but it is only recently that they have been introduced into the marketplace with the desired mechanical and aesthetic values to provide an alternative to the use of dental ceramics.1 Their application has its advantages and disadvantages, as summarized in Table 1.2 The key advantages offered over their direct counterparts are a reduced level of polymerization shrinkage, as this takes place extra-orally, and reduced clinical chairside time, as any prescribed occlusal and aesthetic requirements will be carried out extra-orally by the dental technician.
The success and survival of indirect composite restorations in the management of tooth wear has been reported by several authors (Table 2). Overall, favourable outcomes were reported; the restorations were well tolerated, with high levels of patient satisfaction in the placement of indirect palatal composite veneers. There was a high incidence of minor wear and repair, which was treated by monitoring, repair or refinishing. Major failure requiring replacement was uncommon.3 On the other hand, Bartlett and Sundaram reported on the use of direct and indirect restorations in the management and treatment of severely worn posterior teeth and suggested that the use of direct and indirect resin composites for restoring worn posterior teeth is contra-indicated.4,5 However, these authors used a microfilled composite which are known to perform suboptimally under occlusal loading.
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