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Tooth wear is the multifactorial process where acids and mechanical challenges either act alone or together remove enamel and then dentine. The interaction of acids and mechanical processes, attrition and abrasion, has led to increasing adoption of the term “erosive tooth wear”. This term acknowledges that most tooth wear is multifactorial, often with acids having some role in the progression. Risk assessment of tooth wear should focus on the frequency, duration and interplay of the causes. This chapter provides an overview of risk factors and discusses their individual and synergistic role in tooth wear progression. Risk characteristics are categorised by severity and existing clinical presentation. The basic erosive wear examination (BEWE) is advocated as a basic tool to screen for tooth wear. Patient health and behaviours can change which may necessitate repeating risk assessments on a regular basis when uncontrolled wear is diagnosed. Patients need to be informed not only of the risk of progression but also on the risks of restorative treatment. There is evidence that progression can be slowed to physiological levels with elimination of risk factors. Practitioners are reminded that tooth wear is a slow process and preventive approaches are encouraged.

Molars affected by molar incisor hypomineralization can represent a spectrum of severity and extension of the defect. The aim of this chapter is to review available indirect restorative treatment modalities for severe cases of MIH with cavitated structural defects. The choice of material is governed by a number of factors including severity of the condition, patient’s dental age, cooperation of the child, and child/parent’s social background and expectation.

Increase in the life expectancy and the health care has led to the rising of the elderly numbers in the populations. Beside the recent demographic changes, advances in the dental materials and clinical dentistry aided those elder individuals to retain more teeth with reduced loss rates. However, due to the ageing and the physiologic change of the dental structures and their supporting tissues, various risk factors relating to the medical conditions and pharmaceutical therapies constitute elevated caries risk status for the elderly. Regarding the gingival recession rates and decreased salivary flow and content, especially root caries occur as one of the major oral diseases with periodontal changes through the ageing years. The present chapter is dedicated to the caries destruction of the dental hard tissues including the ageing-related changes and the diagnosis, prevention and restorative treatment considerations of the root caries in the elder patients.

The traditional restorative treatment of a carious decay implies traumatic preparation. Cleaning the softened demineralized dentin using manual or mechanical methods leads to geometrical preparation of cavities displaying flat surfaces (cervical and/or pulpal), at right angles from each other. Taking advantage from the geometry of the cavity, horizontal and plane surfaces contribute to preparation of cavities according to GV. Black’s principles (1908). Ultimately, the cavity is filled with a biocompatible material. All these successive steps refer to old concepts, as they were developed in textbook or in manuals published in the previous century.

With the aim of providing dental treatment in field conditions, where no electricity or running water was available, the atraumatic restorative treatment (ART) was developed. Nowadays, numerous clinical trials and systematic reviews show its efficacy not only under those conditions but also as a treatment option for pediatric dentistry dental offices. Besides dental hygiene and sugar consumption advice, ART involves restorations using only hand instruments for carious tissue removal and also pit and fissure sealants. To ensure the restoration and sealant survival, high-viscosity glass ionomer cement must be used, followed by the finger-press technique. ART has been shown to be a less painful, effective, and child-friendly treatment, with comparable survival to conventional treatment. This chapter provides an overview of the ART technique, clinical indications, and the current scientific evidence to support its use.

Repeated epidemiological studies have been performed in the city of Jonkoping, Sweden, every 10 years since 1973. The studies were initiated in order to describe the changes in oral health in the population. Basic preventive dental care and supplementary programs were extensively performed in the population, especially among children and adolescents. In this population, the percentage of individuals with sound teeth (no caries or restorations) continuously increased each decade. The main finding regarding periodontitis is the significant increase in individuals having no or minimal periodontitis experience. In 2013, 20–60-year-olds had nearly complete dentitions (28 teeth), and the individuals in age groups 70 and 80 years had a mean number of teeth of 23 and 21, respectively. Edentulous individuals having complete dentures in the age groups 40–70 years decreased from approximately every sixth individual in 1973 to none in 2013. The continuous improvement in oral health and the reduced need for restorative treatment will have an impact on dental health-care and dental delivery systems in the near future.

This chapter aims to discuss the evidence available to date from various laboratory and clinical studies about the use of glass-ionomer cements (GICs) in the management of deep caries. The contemporary minimally invasive approach to the operative management of cavitated deep lesions approaching the pulp relies on the selective removal of infected and/or affected dentine close to the pulp, followed by the use of a suitable adhesive restorative material to seal and bond to the underlying peripheral cavity margins/walls. In order to optimize the clinical outcome, an appreciation is required as to how this physico-chemical interaction occurs between GIC and sound as well as caries-affected substrates. The ionic transfer between GIC and tooth structure is described and discussed, with a particular emphasis on its anti-caries and remineralizing potential and also any effects, deleterious or otherwise, on the dental pulp when placed in close proximity to it. The clinical techniques available to restore teeth using high-viscosity GICs are outlined, including Atraumatic Restorative Treatment (ART) and the layered/laminate/sandwich restoration with resin composite. The findings of studies assessing the clinical longevity of such restorations in comparison to other direct plastic restorative materials are analyzed, both in the primary and secondary dentition. From the evidence presented, it is clear that GIC and its derivatives, whilst not perfect, have a major role to play in the minimally invasive restorative management of deep caries lesions.

Diastema closure with direct or indirect restorative procedures, esthetic considerations, smile design, and multidisciplinary comprehensive approach should be considered for a successful restorative treatment. Closure of diastema directly with resin-based composites in restorative approach can be simple and relatively low cost compared to indirect restorations particularly porcelain laminate veneers, and also it does not impede future orthodontic treatment owing to its reversible treatment. However, change of color, leakage, and mechanical and/or chemical degradation of the material by the time despite improvements in formulations are the major drawbacks of the resin composite restorations. Indirect restorations such as porcelain laminate veneers (PLVs) are the most common indications for diastema closure and offer clinicians as well as patients the most esthetically pleasant final outcome. PLVs require minimal invasive tooth preparation and allow clinician to optimal esthetics with that of perfect mimicking tooth structures, perfect anatomical contours, correct tooth proportions, and resistance to discoloration and surface degradation compared to resin composite materials.