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Purpose: This retrospective case series of 9 patients aimed to describe clinical outcomes and patient satisfaction following the implementation of the posterior Dahl concept to manage localized posterior tooth wear. Materials and Methods: Localized occlusal space was created in the posterior dentition. Supra-occluding direct restorations were placed bilaterally for the restoration of molars. Intraoral scans were taken at the pre-treatment stage, immediately post-restoration, and during follow-up appointments. Scans were used to undertake analysis of any occlusal changes and re-establishment of the occlusion. A questionnaire was used to assess patient satisfaction, alleviation of any pre-treatment concerns, and evaluation of post-treatment complaints. Results: Immediately post-treatment, all patients showed an increase in the vertical dimension. Opening of the bite in the untreated areas following restoration of worn posterior molars resulted either in a tendency towards or the actual reestablishment of the occlusion. One patient completely lacked compensatory vertical tooth movement in the untreated areas, culminating in the persistence of a vertical open bite. One restoration displayed cohesive fracture after 4 months. Pre-treatment problems (eg, sensitivity) were fully resolved amongst all patients after 6 months. Post-treatment complaints were minor and demonstrated resolution within a relatively short period of time. Eight patients reported being “very satisfied” with their treatment outcomes. Conclusion: Application of the posterior Dahl concept appears to offer a promising, relatively simple, minimally invasive and effective approach for the management of localized posterior tooth wear, which is well accepted by patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this prospective study was to evaluate the clinical performance of minimally invasive, CAD/CAM nano-ceramic (composite) restorations in patients with severe tooth wear, the effect of the restorative treatment on the oral health-related quality of life (OHRQoL), and the etiology of tooth wear as a risk factor for restoration failure. Materials and Methods: Patients with generalized severe tooth wear were included. Restorations (LAVA Ultimate, 3M Oral Care) were cemented (RelyX Ultimate, 3M Oral Care) on all teeth and were evaluated after 1 month and 1 year. OHRQoL was assessed via questionnaires at baseline and after 1 year. Differences were evaluated (paired t-test). Two mechanical tooth-wear lesions resulting from tooth-tooth contact, and 3 chemical tooth wear lesions resulting from intrinsic or extrinsic acids dissolving natural hard tooth substance, were evaluated to assess the etiology of tooth wear in association with restoration failure using multilevel logistic regression analyses (p < 0.05). Results: Twenty-one patients (age: 41.7 ± 10.4 years) were evaluated after 1 year (13.5 ± 1.2 months). 568 indirect CAD/CAM restorations were placed. None were replaced or lost. Twelve were repaired and 10 were refurbished. Success rates were 100% to 97.2%. Questionnaires showed a significant positive impact of the treatment on OHRQoL (p < 0.001). The presence of mechanical lesions did not pose a higher risk for restoration failure (p = 0.78). The presence of chemical lesions showed a lower risk of restoration failure (p = 0.002). Conclusion: The use of minimally invasive, CAD/CAM nano-ceramic (composite) restorations in the restorative treatment of severely worn dentitions showed satisfactory results in the short term. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the ability of two chewing simulation devices to emulate in vitro the clinical deterioration observed in anterior composite restorations in severe tooth-wear patients. Materials and Methods: Advanced tooth wear was simulated in bovine incisors, which were restored with palatal and buccal direct composite veneer restorations. The incisal edges of restorations were subjected to 960K cycles of either compressive loading (Biocycle-V2; 125 N at 2 Hz) or wear and mechanical loading (Rub&Roll; 30 N at 20 rpm). Surface degradation was rated using FDI scores to compare the chewing devices (Fisher's test, a = 0.05). Topography and deterioration of restorations was analyzed using SEM. The ability to emulate the deterioration was investigated by comparing the surface degradation observed in vitro with the clinical degradation observed in restorations placed in severe tooth-wear patients after 3.5 years. Results: Distinct degradation patterns were observed between the simulation devices: Biocycle-V2 generated deterioration that was not comparable to the clinical situation, including contact damage, minor wear, and localized roughening. The degradation caused by Rub&Roll was more similar to the in vivo situation, including wear facets, chipping, delamination, staining, and marginal ditching. The FDI scores were different between the chewing devices for surface/marginal staining, material/retention, and marginal adaptation (p = 0.003). SEM analysis showed microcracking at the interface between composite layers at the incisal edges. Conclusions: The Rub&Roll chewing device was able to emulate the clinical deterioration observed in anterior restorations in severe tooth-wear patients and thus may be used as an oral-cavity simulation method, contributing to translational research. [ABSTRACT FROM AUTHOR]

This article provides an overview of the available evidence on the performance, with particular consideration of the longevity of restorative materials used in the management of tooth wear. Different materials can be employed depending on whether a subtractive or additive strategy is used. Preference should be given to the latter to help preserve remaining tooth tissue. The use of both direct and indirect materials may yield acceptable survival results when considering data with at least 5 years of follow-up. Patients should be informed that because tooth wear is a continuous process, a certain level of maintenance of the restorations will be necessary and that this may impact on the success of the treatment. CPD/Clinical Relevance: Conservative, adhesive strategies are suitable for the restorative management of tooth wear [ABSTRACT FROM AUTHOR]

Background: Tooth wear is a multifactorial condition, leading to the irreversible loss of dental hard tissues. The availability of an unambiguous, universally applicable assessment protocol remains lacking. Objectives: The goal of the authors is to develop a set of diagnostic criteria for the assessment of tooth wear (DC‐TW). A two‐step approach will be used to achieve this objective: (1) to develop a preliminary beta version of the DC‐TW, based on the authors' clinical experience and their shared expertise and supported by a narrative review of the existing literature, and (2) to develop the final DC‐TW, with input from a larger group of experts using an international Delphi process. This paper relates to the first step. Methods: The authors outlined the components that should be incorporated into the DC‐TW. The literature search was performed to investigate if their concept was in line with the available literature. The search was conducted to identify eligible publications from inception to July 11, 2022. Two authors independently screened all publications, and differences in judgements were resolved through a consensus procedure. Results: The search yielded 5362 publications, resulting in the final inclusion of 383. These publications were divided into four main topics: (1) nomenclature/taxonomies; (2) self‐report tools; (3) clinical assessment tools; and (4) clinical decision‐making. Conclusions: The information from the publications was used and fused with the clinical experience and shared expertise of the authors to contribute to the development of a preliminary beta version of the DC‐TW. [ABSTRACT FROM AUTHOR]

Purpose: To systematically review the literature to determine whether silane combined with adhesive application improves the repair bond strength of direct methacrylate-based resin composites in comparison to the use of an adhesive alone. Materials and Methods: The literature up to December 2019 was searched through PubMed/MEDLINE, Scopus, and Lilacs databases with no publication year or language limits. From 676 potentially eligible studies, 81 were selected for full-text analysis, and 19 were included in the systematic review. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted using a random effects model to calculate pooled mean differences between adhesive- vs silane-plus-adhesive surface treatments (global meta-analysis) and considering subgroup analyses (immediate and aged repair bond strengths and type of silane - hydrolyzed or nonhydrolyzed). Statistical analyses were performed using RevMan5.3 at a significance level of 5%. Results: Global meta-analysis showed that the use of silane prior to adhesive application produced significantly higher repair bond strengths (p=0.003). A higher mean difference (effect size: 7.30, 95% CI: 2.91-17.51) between groups was found when nonhydrolyzed silanes were used. The heterogeneity was high. Studies scored between medium and high risk of bias. Conclusion: An additional silane application step could increase the repair bond strength of methacrylate-based resin composites. [ABSTRACT FROM AUTHOR]

Purpose: To investigate longevity and reasons for failure of Class II posterior composite restorations (PCRs) placed with or without a lining of glass-ionomer cement. Materials and Methods: Four hundred fifty-eight Class II PCR placed in 248 patients (110 male, 138 female, age 18 to 80) by two dentists in a general practice between 1988 and 1997 were retrospectively examined from the patient files. The restorations were placed either with a total-etch technique or with a resin-modified glass-ionomer lining placed on the dentin. Items recorded were date of placement, date of last check-up visit, tooth number, and restored surfaces. Date of replacement and reason for failure of the PCR was recorded. A restoration was clinically acceptable when still in function and acceptable at the last check-up visit. Additionally, the caries risk for each patient was estimated by the treating clinician. Life tables and Kaplan-Meier curves were used to express survival rates. A Cox regression was applied to assess the influence of variables on survival. Results: Three hundred seventy-six total-etch PCRs and 82 PCRs with a lining were investigated. After 9 years, survival percentages of 88.1% for total-etch restorations and 70.5% for restorations with a resin-modified glass-ionomer lining were found. The most important reasons for failure were fracture and caries. Predominantly, failures started occurring after 3 to 4 years of clinical service. Results of the Cox regression show that the presence of a lining and high risk for caries significantly increased the failure rate of the restorations. Conclusion: PCRs placed with a resin-modified glass-ionomer lining clinically showed more frequent fractures than PCRs placed with a total-etch technique. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the influence of composite resin consistency and placement technique on proximal contact tightness of Class II composite resin restorations. Materials and Methods: A manikin model (KaVo Dental) was used with an artificial first molar in which a standardized MO preparation was ground. This preparation was duplicated 360 times. Cavities were restored using Clearfil Photo Bond (Kuraray) combined with one of three composite resins of different consistencies: a low-viscosity (X-Flow, Dentsply), a medium-viscosity (Clearfil AP-X, Kuraray) and a high-viscosity composite (Tetric Ceram HB, Ivoclar Vivadent). Each composite was combined with 6 different matrix systems and separation techniques (n = 20). Groups 1 and 2: pre-contoured metal circumferential matrix (KerrHawe 1101-c) in a Tofflemire retainer combined either with hand instrument (OptraContact, Ivoclar Vivadent) or separation ring (Composi-Tight Gold, Garrison Dental Solutions). Group 3: pre-contoured metal sectional matrix (Lite-Flex, Danville Materials) with separation ring. Groups 4 and 5: precontoured metal circumferential dead-soft matrix (Adapt SuperCap, KerrHawe) with or without separation ring. Group 6: flat metal circumferential matrix (OptraMatrix, Ivoclar Vivadent) in a Tofflemire-retainer with hand instrument (OptraContact). Proximal contact tightness was measured using the Tooth Pressure Meter (University of Technology, Delft). To determine the effect of experimental variables on the proximal contact tightness, a multiple linear regression model was constructed. Results: Measurements in group 6 were not possible; therefore, this group was excluded. The use of medium- or high-viscosity instead of a low-viscosity composite resin resulted in statistically significantly tighter proximal contacts (p < 0.01). The use of a separation ring resulted in a large, statistically significant increase (p < 0.001) in contact tightness, while the use of a hand instrument resulted in a small, statistically significant increase of contact tightness (p = 0.017). No statistically significant differences were found when a dead-soft matrix or a sectional matrix was used instead of a Tofflemire (p = 0.159, p = 0.261, resp.). Conclusion: Use of a separation ring when restoring a Class II composite resin restoration has a greater influence on the obtained proximal contact tightness compared to the influence of the consistency of the composite resin. [ABSTRACT FROM AUTHOR]

Background/aim: The underlying mechanism of the development of cups and grooves on occlusal tooth surfaces is still unclear. The aim of this study was to evaluate factors contributing to in vitro cup formation, in order to elucidate the clinical process.Methods: A total of 48 extracted human molar teeth were exposed to acidic aqueous solutions at pH of 4.8 and 5.5 in constant motion, in combination with different loading conditions: no load (0N group, control), 30 N (30N group) or 50 N (50N group) (n = 8 per group). Before and after 3 months of exposure (1,422,000 loading cycles), the samples were scanned using a non-contact profilometer. Pre- and post-exposure scans were subtracted and height loss and volume tissue loss were calculated. Representative samples with wear and cupping lesions were imaged using scanning electron microscopy, light microscopy and micro-computed tomography.Results: Average height and volume tissue loss at pH 5.5 was 54 µm and 3.4 mm3 (0N), 52 µm and 3.4 mm3 (30N) and 58 µm and 3.7 mm3 (50N), respectively, with no statistically significant differences. Average height and volume loss at pH 4.8 were 135 µm and 8.7 mm3 (0N), 172 µm and 12.6 mm3 (30N) and 266 µm and 17.8 mm3 (50N), respectively, with a statistically significant difference between 0N and 50N (p < 0.002). Cup-shaped lesions had formed only at pH of 4.8, in the 30N and 50N groups.Conclusion: The study showed that a cup can arise fully in enamel and that mechanical loading in addition to erosive challenges are required. [ABSTRACT FROM AUTHOR]

Background: Proximal contact tightness of class II resin composite restorations is influenced by a myriad of factors. Previous studies investigated the role of matrix band type and thickness, consistency of resin composite, and technique of placement. However, the effect of volumetric shrinkage of resin and intensity of curing light has yet to be determined. Thus, the aim of this study was to identify the influence of these factors on the proximal contact tightness when restoring class II cavity preparations in vitro. Methods: Sixty artificial molars were restored with either a low-shrinkage (Filtek Silorane, 3M ESPE) or a conventional (Z100, 3M ESPE) composite and polymerized with low-intensity (Smartlite IQ2, Dentsply) or high-intensity light curing units (DemiTM, Kerr). Proximal contact tightness was measured using the Tooth Pressure Meter. Data were statistically analyzed using one-way analysis of variance and Tukey post hoc test. Results: Use of low-shrinkage composite (Filtek Silorane) resulted in significantly tighter proximal contacts compared to the use of conventional composite (Z100) when cured with the same polymerization unit (p<0.001). Moreover, the low-intensity curing unit (IQ2) resulted in significantly tighter contacts than the high-intensity unit when material is constant (p<0.001). Conclusions: Low-shrinkage resin composite and low curing light intensity is associated with tighter proximal contact values. [ABSTRACT FROM AUTHOR]

The aim was to investigate in vitro the marginal overhang in Class II composite restorations placed with various separation rings and placement techniques. A total of 180 Mesial-Occlusal [MO] preparations in artificial molar teeth were divided into nine groups (n=20). After placement of the sectional matrix, one of three ring systems was applied: Contact Matrix System (Danville Materials), Composi-Tight Gold (Garrison), and V-Ring (Triodent). In each group, rings were placed according to four different techniques (V-Ring placed with technique no. 2 only): 1) occlusally of the wedge, 2) on back end of the wedge, 3) between adjacent tooth and wedge, and 4) between treated tooth and wedge. After application of the adhesive resin, preparations were restored with composite Clearfil AP-X (Kuraray) and polymerized in increments. After matrix removal, overhang was measured on a standardized digital macroscopic image in millimeters squared. For analysis, analysis of variance and Tukey B were used (p<0.05). For the Contact Matrix System and Composi-Tight Gold ring, the different placement techniques had a statistically significant effect on the amount of marginal overhang (p<0.031). The V-Ring resulted in the least marginal overhang (p<0.001). None of the placement techniques and separation rings could completely prevent marginal overhang, and the placement technique has a significant influence on its occurrence. [ABSTRACT FROM AUTHOR]

Objective: The objective of the current study was to compare in-vitro the proximal contact tightness (PCT) of Class II resin composite restorations (RCR) placed with different established and new placement techniques. Methods: 105 ivorine lower left first molars with standardized MO cavities were randomly divided into seven groups (n=15) as follows: SRing: sectional matrix and separation ring (Garrison Dental); CRing: circumferential matrix (1101-c, KerrHawe SA) with separation ring; CWedge: circumferential matrix with a wedge only; COptra: circumferential matrix and OptraContact (Vivadent); CCerana: circumferential matrix and a Cerana insert (Nordiska Dental); CElliot: circumferential matrix and Elliot separator (PFINGST & Co) and Walser: Walser matrix O-type (Dr Walser Dental GmbH). In all the groups, the matrix band was secured using a wooden wedge except for the Walser group, following manufacturer's recommendations. A Tofflemire retainer (Kerr Corporation) was used to apply the circumferential matrix band whenever it was used. All the prepared teeth were restored with resin composite (Premise, Kerr) mounted in a manikin head to simulate the clinical environment. PCT was measured using the Tooth Pressure Meter (University of Technology, Delft). The data were analyzed using one-way ANOVA and Tukey post-hoc tests (p<0.05). Results: Compared to the control group (SRing) (6.64 ± 1.06N), all other systems resulted in significantly lower PCT values (p<0.001). Within the circumferential matrix groups, CRing (4.01 ± 0.53N) and CElliot (4.29 ± 1.08N) showed significantly tighter contacts compared to the CWedge (0.37 ± 0.22N), COptra (0.91 ± 0.49N), CCerana (2.99 ± 1.98N) and Walser (1.34 ± 0.55N) (p<0.05) group. Between CWedge and COptra, no significant difference was found (p=0.57). Conclusion: The use of separation rings with sectional matrices provides superior contacts when placing Class II RCRs. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to develop and evaluate a fully automated method for visualizing and measuring tooth wear progression using pairs of intraoral scans (IOSs) in comparison with a manual protocol., Methods: Eight patients with severe tooth wear progression were retrospectively included, with IOSs taken at baseline and 1-year, 3-year, and 5-year follow-ups. For alignment, the automated method segmented the arch into separate teeth in the IOSs. Tooth pair registration selected tooth surfaces that were likely unaffected by tooth wear and performed point set registration on the selected surfaces. Maximum tooth profile losses from baseline to each follow-up were determined based on signed distances using the manual 3D Wear Analysis (3DWA) protocol and the automated method. The automated method was evaluated against the 3DWA protocol by comparing tooth segmentations with the Dice-Sørensen coefficient (DSC) and intersection over union (IoU). The tooth profile loss measurements were compared with regression and Bland-Altman plots. Additionally, the relationship between the time interval and the measurement differences between the two methods was shown., Results: The automated method completed within two minutes. It was very effective for tooth instance segmentation (826 teeth, DSC = 0.947, IoU = 0.907), and a correlation of 0.932 was observed for agreement on tooth profile loss measurements (516 tooth pairs, mean difference = 0.021mm, 95% confidence interval = [-0.085, 0.138]). The variability in measurement differences increased for larger time intervals., Conclusions: The proposed automated method for monitoring tooth wear progression was faster and not clinically significantly different in accuracy compared to a manual protocol for full-arch IOSs., Clinical Significance: General practitioners and patients can benefit from the visualization of tooth wear, allowing quantifiable and standardized decisions concerning therapy requirements of worn teeth. The proposed method for tooth wear monitoring decreased the time required to less than two minutes compared with the manual approach, which took at least two hours., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest and that they are solely responsible for the contents of this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: Literature was systematically reviewed to identify salivary characteristics and their association with tooth wear., Data: A protocol was developed a priori (PROSPERO CRD42022338590). Established systematic review methods were used for screening, data extraction, and synthesis. Risk of bias and the certainty of evidence were assessed using the JBI tools and GRADE, respectively. Direct and indirect association between tooth wear and salivary components and characteristics were assessed., Sources: MEDLINE, Embase, SCOPUS, Web of Science, CINAHL, and additional sources were searched., Study Selection: Studies reporting salivary characteristics in patients with tooth wear or models thereof were included. Animal and in-vitro studies and case reports were excluded., Results: One-hundred eleven studies were included. Qualitative analyses showed a negative association between tooth wear and salivary pH and flow rate in many studies. The higher the study size the higher the chances that an association with pH and flow rate was found. Xerostomia, buffer capacity and salivary consistency/viscosity had also some degree of association with tooth wear in fewer studies. Associations with the 39 salivary components were scarcer. Random effects meta-analyses (7 studies) showed that pH levels in stimulated whole saliva were lower in patient with tooth wear compared to controls (-0.07 [-0.10 to -0.04]). However, there was not enough evidence to establish a quantitative association with flow rate. The general risk of bias was unclear and the certainty of evidence was low or very low. A large diversity of methodologies limited the inclusion of all studies in quantitative synthesis., Conclusion: From all potential risk factors, stimulated whole saliva pH showed a negative association, both quantitatively and qualitatively with tooth wear, indicating potential usefulness of pH monitoring in these patients. Moreover, associations between flow rate and tooth wear were observed qualitatively. However, in both cases the risk of bias was mostly unclear, and the certainty of evidence was low. No causal associations could be observed., Clinical Significance: Tooth wear is a prevalent condition that may lead to functional or esthetic impairments and pain. Knowing the potential risk factors like salivary pH or flow rate and their dynamics could be relevant during tooth wear monitoring and to intervene accordingly, especially in conditions like gastroesophageal reflux disease., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: Non-carious tooth wear often has a multifactorial etiology and may lead to functional or aesthetically related problems. The most common complaints associated with tooth wear are dissatisfaction with dental appearance and a negative impact on the experienced Oral Health Related Quality of Life (OHRQoL). The aim of this study was to investigate the change in OHRQoL and the perception of aesthetics, following restorative treatment of moderate to severe tooth wear patients, with a five-year follow-up., Methods: An explorative study, based on prospective data, was performed. OHRQoL and the perception of aesthetics were measured with the OHIP-NL and OES-NL. These questionnaires were completed before treatment, one month after treatment, and at 1-, 3- and 5-years post-treatment. Treatment involved full mouth reconstruction with composite resin restorations. The data was analysed as repeated measures by using a linear mixed-effects model., Results: One hundred and twenty-three tooth wear patients that received restorative rehabilitation were included (97 males, 26 females, 37.5 ± 8.8 years-old). Data showed a statistically significant increase in both experienced OHRQoL and orofacial appearance after restorative treatment. The OHIP-scores remained stable over time, while the OES-scores slightly decreased during the years after treatment. Regarding the seven domains of the OHIP, the largest difference in OHIP-score was found in the domain of 'Psychological Discomfort'. The mean overall OHIP-score was 1.8 at baseline and 1.3 at the 5-years recall. The mean OES score increased from 41.8 at baseline to 66.1 at the 5-years follow-up., Conclusions: Tooth wear patients reported significant improvements in their OHRQoL and their perception of orofacial aesthetics after restorative treatment. This increase remained at least five years post-treatment., Clinical Significance: The clinical impact of restorative treatment for tooth wear patients is considerable. This paper emphasizes the need to include a discussion of the patient related outcome measures when planning care., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To compare clinical performance of resin composite posterior Class-II restorations placed with etch-and-rinse adhesive or open sandwich technique using glass-ionomer cement., Methods: Data on Class II restorations placed by one dentist between 1990 and 2016 were collected from patient files, including caries risk, tooth related variables, applied materials and dates of last check-up visit and restoration placement. Open sandwich restorations were placed before 2001, while after 2001, a total-etch technique using etch-and-rinse 3-step adhesive was used when placing a Class II composite restoration. For statistical analysis, Kaplan-Meier statistics and a multilevel Cox-Regression was conducted (p < 0.05). Annual Failures Rates (AFR) were calculated., Results: 675 Class II restorations were placed in 91 patients, 491 total-etch restorations (observation time 2-18 y), and 184 open sandwich restorations (observation time 19-29 y) showing AFRs at 15 years as 2.9 % for total-etch and 9.7 % for open sandwich restorations. Secondary caries as failure was equally distributed among the 2 groups and 27 % of the failures in the open sandwich group were due to proximal deterioration of glass-ionomer cement. The Cox-regression showed a significant higher risk for failure for the open sandwich technique compared to total-etch class-II composite restorations (HR = 2.9; p < 0.001)., Significance: Application of glass-ionomer cement using the open sandwich technique cannot be recommended for class-II restorations as being more complex and showing poorer clinical performance., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Although we are increasingly recognising the need to assess patients for accelerated rates of tooth wear progression, it is often difficult to do so within a feasible diagnostic window. This paper aims to provide evidence-based timelines which a diagnosing clinician can expect to assess tooth wear progression in study models, clinical indices, clinical photographs and visually with intraoral scans. It also discusses new technologies emerging for the quantitative assessment of tooth wear, timelines for diagnosis, and caveats in the 3D scan registration and analysis process., (© 2023. The Author(s).)

Purpose: To describe the digital workflow applied for restoring a severely worn dentition with minimally invasive CAD/CAM resin nano-composite restorations., Materials and Methods: A 40-year-old male in good general health and with full-arch dentition suffered from dentin hypersensitivity and wanted to improve the esthetics of his worn anterior teeth. The dental wear can be described as general, grade 3, according to the Tooth Wear Index,27 with more wear in maxillary than in mandibular teeth. Signs and symptoms were typical for a chemical type of wear, with some mechanical wear also apparent. No functional problems, eg, impaired chewing, were present. On the OHIP-49 questionnaire, the patient expressed a reduced quality of life. The goal of the treatment was to reconstruct the anatomical form of the teeth as far as possible, thereby also improving quality of life. Due to the rather large volume of lost tooth tissue per tooth, indirect treatment using CAD/CAM resin nano-composite restorations (LAVA Ultimate, 3M Oral Care) was applied., Results: The seating of the CAD/CAM resin nano-composite restorations (LAVA Ultimate, 3M Oral Care) restorations was considered precise., Conclusion: In the treatment of severe tooth wear, the described digital workflow using CAD/CAM restorations for occluding restorations and direct composite materials in the esthetic zone is a potential treatment modality that is workable and minimally invasive.

Purpose: The aim of this prospective study was to evaluate the clinical performance of minimally invasive, CAD/CAM nano-ceramic (composite) restorations in patients with severe tooth wear, the effect of the restorative treatment on the oral health-related quality of life (OHRQoL), and the etiology of tooth wear as a risk factor for restoration failure., Materials and Methods: Patients with generalized severe tooth wear were included. Restorations (LAVA Ultimate, 3M Oral Care) were cemented (RelyX Ultimate, 3M Oral Care) on all teeth and were evaluated after 1 month and 1 year. OHRQoL was assessed via questionnaires at baseline and after 1 year. Differences were evaluated (paired t-test). Two mechanical tooth-wear lesions resulting from tooth-tooth contact, and 3 chemical tooth wear lesions resulting from intrinsic or extrinsic acids dissolving natural hard tooth substance, were evaluated to assess the etiology of tooth wear in association with restoration failure using multilevel logistic regression analyses (p < 0.05)., Results: Twenty-one patients (age: 41.7 ± 10.4 years) were evaluated after 1 year (13.5 ± 1.2 months). 568 indirect CAD/CAM restorations were placed. None were replaced or lost. Twelve were repaired and 10 were refurbished. Success rates were 100% to 97.2%. Questionnaires showed a significant positive impact of the treatment on OHRQoL (p < 0.001). The presence of mechanical lesions did not pose a higher risk for restoration failure (p = 0.78). The presence of chemical lesions showed a lower risk of restoration failure (p = 0.002)., Conclusion: The use of minimally invasive, CAD/CAM nano-ceramic (composite) restorations in the restorative treatment of severely worn dentitions showed satisfactory results in the short term.

Objectives: This study reviewed the literature to identify in vitro approaches that have been used to simulate the mechanical degradation and fatigue of resin composite restorations., Methods: A search for articles was carried out in 4 databases and included studies in which composite restorations were bonded to teeth and subject to cyclic loading. Articles were assessed for eligibility, and the following items were the extracted from the included studies: authors, country, year, materials tested, simulation device and details including load magnitude and frequency, number of cycles, type of antagonist, test medium, and temperature. Data were analyzed descriptively., Results: The 49 studies included showed a high level of heterogeneity in methods, devices, and test parameters. Nineteen different simulation devices were used, applying loads varying between 30 and 2900 N, and frequencies varying between 0.4 and 12 Hz. The load and frequency used most often were ~ 50 N (63.3%) and 1.5-1.7 Hz (32.7%). The number of cycles varied between 10 K and 2.4 M, 1.2 M was the most prevalent (40.8%). The majority of studies combined cyclic loading with at least one additional aging method: static liquid storage, thermo-mechanical cycling applied simultaneously, and thermal cycling as a discrete aging step were the three most frequent methods. The overall evidence indicated reporting problems, and suggested a lack of clinical validation of the research methods used., Significance: Validation studies, underlying clinical supporting data, and better reporting practices are needed for further improving research on the topic. Specific suggestions for future studies are provided., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation., Methods: A convenience sample of 34 patients were recruited to a prospective trial between December 2010 and June 2013. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the DSO-technique. Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analysed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05)., Results: Annual failure rates (for all levels of failure, 'Level 3- ') of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months. The completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations., Conclusions: At 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure., Clinical Significance: Direct resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To investigate the effects of the level of pre-treatment tooth wear and increasing the VDO on the performance of direct resin composite restorations for the rehabilitation of pathological tooth wear., Methods: Full-mouth (pre-treatment) grading was performed on digital greyscale scan records for 34 participants (35.3 ± 8.4 years) with signs of moderate-to-severe generalised tooth wear, using the Tooth Wear Evaluation System and the Basic Erosive Wear Examination. Each participant received full-mouth direct resin composite restorations, with increased VDO. The post-treatment increase in the VDO was determined. Recalls were planned after 1 month, and after 1, 3, and 5 years. Three 'levels' of restoration failure were described. The effects of the variables on the frequencies of restoration failure were calculated with a multivariable Cox regression, (p < 0.05)., Results: 1269 restorations were placed with a mean observation period of 62.4 months. Increasing the VDO by 1 mm significantly reduced the risks of all levels of anterior restoration failure (HR ≤ 0.62, p ≤ 0.025). A higher anterior BEWE surface score was associated with increased risks of Level 2- & 3- failures, (HR ≥ 1.29, p ≤ 0.019). Premolar restorations showed lower risks of Level 2- & 3- failure, compared to the molar restorations, (HR ≤ 0.5, p ≤ 0.005)., Conclusion: Levels of pre-treatment wear and the applied change in the VDO significantly affected failure risk., Clinical Relevance: Direct resin composite restorations for the rehabilitation of wear should be made as voluminous as possible, respecting the presenting biological, functional, and esthetic constraints., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: The aim of this study was to evaluate changes in speech characteristics and self-perceived quality of speech in tooth wear patients, after occlusal rehabilitation., Materials and Methods: Patients with tooth wear were included in this study after informed consent. The amount of tooth wear was scored with Tooth Wear Evaluation System (TWES). To assess the perspective of the patient, the Dutch Speech Handicap Index was used (SHI). Acoustic analysis was performed to evaluate changes with the use of voice recordings. These were made before treatment, T 0 ; directly after treatment, T 1 ; 1 month after treatment, T 2 . With the use of PRAAT software, the spectral characteristic centre of gravity (COG) was evaluated for the sounds /s/, /f/, /v/, /d/, /t/, /m/., Results: Recordings of 17 patients (14 men, 3 women, mean age 41.2 ± 10.4 years) were included. SHI scores did not change significantly between T 0 and T 2 (p = 0.054). A multiple regression model showed that for all sounds the intercept was negative, but statistically significant only for /s/ and /f/ between T 0 and T 1 . The effect of the initial change (between T 0 and T 1 ) on the change between T 1 and T 2 was clearly negative for all sounds (p < 0.001), showing a rebound effect ranging between 29 and 68% of the initial change., Conclusion: Tooth wear patients perceive improvement in speech function after treatment., Clinical Significance: Clinicians may explain to patients that speech is likely to alter for a short period due to treatment but that there will be a good adaption to the new situation.

Objective: To investigate the impact of an e-training resource with the consistency of tooth wear scoring using the Basic Erosive Wear Examination (BEWE)., Methods: Gold standard (GS) BEWE scores were attained from a trained examiner using the photographic and dental cast records for three conveniently selected cases representing low, medium and severe tooth wear. Four successive cohorts of first year post-graduate students, (n = 76, mean age, 35.4 years) undertook a training exercise. Each was given written guidance on using the BEWE. Following e-training, scoring was repeated, and the results expressed as mean, confidence Intervals, (95% ci) and p-values (values <0.05 were considered statistically significant)., Results: The e-training resulted in a mean improvement in the agreement with the GS score by 15.6% and 15.3%, using the records of the medium and severe tooth wear cases, (cumulative BEWE scores of 13 and 15 respectively). Post-training reductions were reported, with the mean number of disagreements with the GS and the mean change in the size of disagreement with the GS scores with records for the medium and severe cases (p = 0.001 and p < 0.001). No significant difference was revealed for the low wear case., Conclusion: e-training resulted in significant improvements in scoring BEWE, compared to the gold standard., Clinical Relevance: Online training resources can help provide training with the BEWE., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: To systematically review the literature to determine whether silane combined with adhesive application improves the repair bond strength of direct methacrylate-based resin composites in comparison to the use of an adhesive alone., Materials and Methods: The literature up to December 2019 was searched through PubMed/MEDLINE, Scopus, and Lilacs databases with no publication year or language limits. From 676 potentially eligible studies, 81 were selected for full-text analysis, and 19 were included in the systematic review. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted using a random effects model to calculate pooled mean differences between adhesive- vs silane-plus-adhesive surface treatments (global meta-analysis) and considering subgroup analyses (immediate and aged repair bond strengths and type of silane - hydrolyzed or nonhydrolyzed). Statistical analyses were performed using RevMan5.3 at a significance level of 5%., Results: Global meta-analysis showed that the use of silane prior to adhesive application produced significantly higher repair bond strengths (p=0.003). A higher mean difference (effect size: 7.30, 95% CI: 2.91-17.51) between groups was found when nonhydrolyzed silanes were used. The heterogeneity was high. Studies scored between medium and high risk of bias., Conclusion: An additional silane application step could increase the repair bond strength of methacrylate-based resin composites.

Objective: The restorative treatment of generalized tooth wear involves an increase in vertical dimension of occlusion and a comprehensive alteration of occlusal morphology. The aim of this study was to assess the impact of a direct adhesive restorative treatment on masticatory performance parameters., Materials and Methods: A sample of 23 fully dentate adult generalized tooth wear patients (17 male, 6 female, age 41.7 ± 8.3 years) undergoing direct composite restorative treatment was selected. Before and one month after restorative treatment with resin bonded composite restorations, masticatory performance was evaluated using 1) a comminution test, 2) a maximum voluntary bite force recording and 3) the sum score of five items related to eating and chewing from the Oral Health Impact Profile (OHIP-49) questionnaire. Statistical analysis was performed using a paired t-test, and analysis per OHIP item was done by a McNemar test (p < 0.05)., Results: There was no statistically significant difference in median particle size (X50) calculated before and after treatment (4.19 ± 0.97 and 4.03 ± 0.76, respectively, p = 0.327). Maximum voluntary bite force decreased significantly after treatment (baseline 389 ± 90 N, one month recall 323 ± 173 N, p = 0.028). The sum score of the five OHIP items significantly decreased after treatment (baseline 10.6 ± 4.8, one month recall 6.6 ± 2.5, p = 0.001), with the item regarding unsatisfactory diet showing the largest significance (p = 0.029)., Conclusions: This study indicates that the restorative treatment of generalized tooth wear using direct resin bonded composite has no significant short-term effect on masticatory performance as measured with a comminution test, although the self-reported ability to eat and chew, as measured by the sum score of all pertaining OHIP items, did significantly improve., Clinical Significance: On individual level, food comminution could be influenced by restorative treatment with increase of vertical dimension of occlusion, but at group level no significant effect is observed. Nevertheless, tooth wear patients do perceive improved ability to eat and chew foods, which is clinically relevant., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Masticatory performance is influenced by a number of variables such as age, gender, bite force, and occlusal units. Tooth wear may also play a role due to changes in occlusal area and in vertical dimension of occlusion. The aim of this study was to evaluate the effect of tooth wear on masticatory performance, using a communition test., Materials and Methods: Patients with different degrees of tooth wear, referred by their general dental practitioners, and included in the Radboud Tooth Wear Project, were approached for this study and included after informed consent. The amount of post canine wear was scored with the Tooth Wear Index (TWI). The number of occluding posterior units was quantified and the bite force was measured using a transducer. Masticatory performance was measured with a communition test, with the median particle size (X50) after 20 chewing cycles as outcome measure. A multiple regression model was used to assess the relation between TWI, age, gender, bite force, occlusal units and X50., Results: 52 participants (40 male, 12 female, mean age: 40 ± 8.2y) were included in the study. The post canine TWI-score was between 1.0-3.3. The average number of occlusal units per participant was 11.9 ± 1.4 and the mean bite force 369 ± 172 N. The mean X50 was 4.2 ± 1.1. The results showed no significant relation between post canine TWI-score, age, gender, bite force, and occlusal units upon the X50 (p > 0.13)., Conclusion: This study showed that the degree of tooth wear could not be observed to have an effect on masticatory performance., Clinical Significance: On individual level an effect could be present but looking at a larger group of patients, the degree of tooth wear did not have a relation with masticatory performance as measured with a communition test., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: Evaluate the effect of a full rehabilitation, including an increase of vertical dimension of occlusion (VDO), in patients with severe tooth wear on changes in facial appearance., Methods: Patients with severe tooth wear were restoratively treated using direct composite restorations, including an increase of the VDO. Before and one month after treatment 3D stereophotographs were taken and facial changes were measured with the use of 3D cephalometric landmarks. Cast models were used to determine the Tooth Wear Index (TWI) and the VDO-increase. The Orofacial Esthetic Scale-questionnaire was used to evaluate subjective happiness with appearance. Paired Student's t-tests were used to evaluate the changes after full rehabilitation. The relation between the facial changes, VDO-increment and TWI-score were analyzed using multiple regression models (p < 0.05)., Results: 44 Patients (35 men, 9 women, mean age: 38.2 ± 7.1 y) participated in this study. Mean TWI-score at baseline was 3.3 ± 0.5 and the mean increase in VDO was 1.6 ± 0.9 mm. Lower face height increased by 1.9 mm (p ≤ 0.001). Patients reported a significant improvement in orofacial appearance: OES-summary score of 34.3 ± 11.2 before and 59.9 ± 6.8 one month after treatment (p < 0.001). The increase of VDO resulted in an increase in Lower Face Height (p ≤ 0.002), whereas the TWI-score at baseline had no effect on the facial changes. The applied increase in VDO and TWI-score were not related to changes in OES-scores., Conclusions: A full rehabilitation with an increase in VDO resulted in objective differences in facial height as measured with 3D stereophotogrammetry., Clinical Significance: In patients with severe tooth wear, receiving a full rehabilitation including an increase in vertical dimension of occlusion, an objectively change will occur in the Lower facial height, but this effect will be subjectively judged as a positive change., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Chewing, drinking, and occasional tooth grinding will result in physiological tooth wear during a lifetime. Extreme challenges, such as bruxism or habitual chewing on foreign objects, may lead to excessive wear. Recently, the role of erosion in accelerating mechanical tooth wear has been recognized, but the interplay between chemical and mechanical wear processes has not been extensively studied. Our laboratory recently introduced a novel oral wear simulation device, the Rub&Roll, that enables the user to perform wear and loading studies separately or simultaneously in an erosive and/or abrasive environment. This manuscript describes an application of the device: the combined mechanical and erosive loading of extracted human (pre)molars in a simulated chewing movement, with a controlled application of force, velocity, fluid, and time, and the application of non-contact profilometry in visualizing and measuring the resulting wear pattern. The occlusal morphology that was created in the experiment with the highest loading level is very similar to the clinical presentation of erosive wear.

Objective: The purpose of this study was to evaluate the 3D-stereophotogrammetry technique to detect differences in facial appearance after a simulated rehabilitation., Materials and Methods: Eleven volunteers without tooth wear participated. A 3D-stereophotograph was taken in five different situations: resting position, teeth in occlusion, and teeth in occlusion with a 1 mm-, 3 mm- or 5 mm resin block between the first molars. Cephalometric measurements were performed on the 3D-stereophotographs using the software program Maxilim ® (Medicim NV Mechelen, Belgium). Four anatomical parameters were analyzed: (1) Subnasale-Gnathion, (2) Subnasale-Stomion, (3) Stomion-Gnathion, and (4) Masseter right-Masseter left. A paired Student's T-test was applied to detect significant differences (p < 0.05)., Results: Statistically significant changes in facial appearance of the lower facial height were detected in all measured positions, teeth in occlusion, 1 mm-, 3 mm-, and 5 mm block (p < 0.05). For the main distance (Subnasale-Gnathion) the mean measured differences were, respectively, 3.2 mm; 5.2 mm; and 6.7 mm., Conclusions: With 3D-stereophotograph imaging technology, it was possible to detect changes in facial appearance after an artificial increase of vertical dimension of occlusion. This finding implies that reconstruction of loss of tooth substance may cause a visible change in facial appearance of the patient., Clinical Significance: This study reveals a new 3D imaging technique that may be used for a better and more comprehensive treatment planning in patients with severe tooth wear. (J Esthet Restor Dent 28:397-404, 2016)., (© 2016 Wiley Periodicals, Inc.)

Unlabelled: The aim was to evaluate retrospectively the influence on restoration longevity of a repair and to evaluate longevity of repaired restorations., Materials and Methods: In a practice, 1202 amalgam and 747 composite resin restorations were placed. 407 restorations failed (amalgam 293, composite 114), 246 restorations were repaired with composite resin using an etch-and-rinse technique. Of repaired restorations reason for failure and number of surfaces of original restoration, repair date, and date of patients' last visit were recorded. Whenever a new treatment was necessary, this was considered failure. Data were analysed by Kaplan-Meier statistics and log-rank tests (p<0.05). A multi-variate Cox-regression analysis was conducted on results for variables number of surfaces, repair reason, and repaired material., Results: 133 amalgam restorations (57% due to fracture) and 113 composite restorations (62% due to caries) were repaired. 151 of 246 repaired restorations (61%) were still in service without further intervention after 4.8 years. The annual failure rates for repaired amalgam and composite restorations was 9.3% and 5.7% after 4 years (log-rank, p=0.001). Restorations that were repaired due to fracture had a lower survival than restorations that were repaired due to caries (log-rank, p=0.006). The Cox-regression showed influence of the gender but no significant influence of material or reason for repair, indicating that the findings are a consequence of joint negative influences of investigated variables., Conclusion: The present study shows that repairs can enhance the longevity of dental restorations considerably. Moreover, repairs on restorations failing due to caries have a better prognosis compared to repairs on restorations failing due to fracture., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the influence of cavity preparation (MO/DO/MOD) and type of matrix system on proximal contact tightness of direct posterior composite restorations., Materials and Methods: 85 patients in need of a two- or three surface Class II direct composite restoration were randomly divided into two treatment groups. Group 1 was treated with a sectional matrix system combined with a separation ring (Palodent); Group 2 was treated with a circumferential matrix system in combination with a retainer (Tofflemire). Proximal contact tightness was recorded before treatment and directly after finishing the restoration., Results: For the two-surface cavities use of the separation ring resulted in a statistically significantly tighter proximal contacts at both the mesial and distal site (MO: 2.51±0.81 N; DO: 2.82±1.14 N) compared to the use of the circumferential (MO: -1.08±1.04 N; DO: -0.22±0.87 N) (p=0.01). Regarding the three-surface (MOD) cavities no statistically significant differences were found between the mesial and distal site, nor was there an effect of the used matrix system. No statistically significant influence of cavity design (mesially/distally) was recorded for all cavities (MO, DO and MOD)., Conclusions: Use of the sectional matrix system in two-surface Class II cavities resulted in statistically significantly tighter proximal contacts than the use of the circumferential matrix system. For the three-surface no statistically significant differences in contact tightness were found between the different matrix systems. Location of the cavity (mesially or distally) did not show to have any statistically significant effect on the obtained proximal contact tightness., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The purpose of this study was to investigate long-term clinical effectiveness of treating painful cracked teeth with a direct bonded composite resin restoration. The hypothesis tested was that cracked teeth treated with or without cuspal coverage showed the same performance. Forty-one patients attended a dental practice with a painful cracked tooth that was restored with a direct composite resin restoration. Twenty teeth were restored without and 21 with cuspal coverage. After 7 years, 40 teeth could be evaluated. Three teeth without cuspal coverage needed an endodontic treatment, of which 2 failed as a result of fracture. No significant differences were found for tooth or pulp survival. Three more repairable restoration failures were recorded. Mean annual failure rate of restorations without cuspal coverage was 6%; no failures in restorations with cuspal coverage occurred (P = .009). A direct bonded composite resin restoration can be a successful treatment for a cracked tooth.

Objectives: The purpose of this study was to evaluate retrospectively the longevity of class I and II amalgam and composite resin restorations placed in a general practice., Methods: Patient records of a general practice were used for collecting the data for this study. From the files longevity and reasons for failure of 2867 class I and II amalgam and composite resin restorations placed in 621 patients by two operators between 1990 and 1997 were recorded in 2002., Results: 912 amalgam restorations (502 by operator 1 and 410 by operator 2) and 1955 posterior composite resin restorations (1470 by operator 1 and 485 by operator 2) were placed. One hundred and eighty-two amalgam and 259 posterior composite resin restorations failed during the observation period. The main reasons for failure of the restorations were caries (34%), endodontic treatment (12%) and fracture of the tooth (13%). Life tables calculated from the data reveal a survival for composite resin of 91.7% at 5 years and 82.2% at 10 years. For amalgam the survival is 89.6% at 5 years and 79.2% at 10 years. Cox-regression analysis resulted in a significant effect of the amount of restored surfaces on the survival of the restorations. No significant effect of operator, material as well as combination of material and operator was found., Significance: In the investigated general practice, two dentists obtained comparable longevity for amalgam and composite resin restorations.