Background
Worn dentition has long been a significant dental burden in the elderly population and can be attributed to a combination of erosion, abrasion and attrition [1]. Several epidemiological studies have reported the prevalence of extensive tooth wear ranging from 0.6% in adolescence to more than 2% in individuals aged 65 years or more [2, 3]. Among the various features of tooth wear, shortened clinical crowns are most commonly observed, accompanied by dentoalveolar compensation. Notably, in recent times, the increasing prevalence of tooth wear has been reported among children and young adults due to rapidly changing lifestyles, including soft drink consumption [4, 5]. However, the underlying aetiology can rarely be correctly identified and successfully eliminated [6]. This has led to growing concern among the scientific community to identify various aetiological factors and develop restorations with a longer survival time.
Objective
The purpose of the present article is to evaluate the latest available literature and current evidence on direct composite resin restoration of worn teeth compared to conventional treatments such as indirect porcelain-fused-to-metal crowns and bridges, all-ceramic crowns, palatal gold with or without orthodontics. The article further summarizes the situations where direct composite restorations are more likely to fail. For instance, it has been observed that lack of posterior support is one of the main factors associated with the failure of direct composite restoration [7]. Additionally, present essay also discusses the influence of differences in the composition and physical properties of dental composites on their overall survival. And lastly, the present essay compares its finding with the available guidelines to suggest possible recommendations that could be updated in the guidelines to improve the lifespan of teeth.
Long term survival of the teeth
The advent of additive strategies for restoring worn dentition has changed the focus in the field of dentistry to increase the duration of survival of teeth rather than restorations itself. Several prospective randomized clinical trials (RCTs) have shown highly satisfactorial results when adding direct resin to worn lower anterior teeth, with no need for any root canal treatment or extraction in the follow-up years. On the contrary, pulpal and periapical problems are often seen in teeth restored with full coverage crowns.
Risk of contamination
Indirect restorations have often been blamed for contamination even before they set in, which could eventually impact its cohesive properties.
Several methods of restoration are available to a dentist, including direct composite restoration and indirect case or milled restorations. However, in the absence of consensus on guidelines, the development of treatment strategy is extremely challenging, with each method having its pros and cons, depending upon the location and severity of the wear [8]. Also, associated costs, duration of treatment, and expertise for conducting a dental procedure are always major factors before treating a patient. There has been limited research on rehabilitation of worn dentition with reliability on observational studies that are considered to be highly biased in comparison to randomized controlled trial. Although evidence is limited, modern composite resin restorations are the most favourable option to restore the worn dentition. Several reasons could be responsible for the trust, including its additive design which allows conserving the remaining worn tooth, availability of expertise, ease of conducting the procedure, reversibility and cost-effectivity [9]. On the other side, conventional methods such as fixed and removable prosthodontics are still recommended in the extensive worn dentition. However, the treatment is highly complex and invasive, adding to the treatment cost [10]. It has also been observed that many such restorations fail due to stress concentrations in the presence of heavy bruxing habits.
Limitations
Small sample size, shorter follow-up duration
In summary, present essay shows that direct composite restoration will continue to be a method of choice for rehabilitations of the worn dentition for years to come owing to its ease of implementation and low maintenance.
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