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''EMuts - SR - Tooth Wear - JPD - 2014 PDF
''EMuts - SR - Tooth Wear - JPD - 2014 PDF
of treatment options
Erik-Jan Muts, MSc,a Hans van Pelt, DDS, PhD,b
Daniel Edelhoff, DMD, PhD, CDT,c Ivo Krejci, Prof Dr Med Dent,d
and Marco Cune, DDS, PhDe
Center for Dentistry and Oral Hygiene, University Medical Center
Groningen, University of Groningen, Groningen, The Netherlands;
Dental School, Ludwig-Maximilians-University, Munich, Germany;
School of Dentistry, University of Geneva, Geneva, Switzerland
Statement of problem. Treatment of tooth wear is increasing. Because no evidence-based guidelines are available, the
clinician may have difficulties deciding which treatment option to choose to resolve complex situations.
Purpose. The purpose of this systematic review was to identify similarities among treatment options for generalized tooth
wear and to develop an approach to rehabilitation based on the best evidence available.
Material and methods. A Medline and Cochrane search (for articles published from January 31, 2003, to January 31, 2013)
was conducted. Minimally invasive and fully described treatments for generalized tooth wear with esthetically satisfying results
were included. Five steps within the treatment procedures were analyzed: diagnostic waxing (DW), occlusal positioning (OP),
vertical dimension increase (VDI), restoration, and follow-up.
Results. Common threads were established within the 5 treatment steps. Nine studies used DW, and 6 performed diagnostic
tooth arrangement (DTA). Centric relation was used in 5 studies, and VDI was tested in 8 studies, 5 of which used a
removable appliance. Seven studies implemented a provisional stage, and 5 used composite resin at that time. For definitive
treatment, composite resin (6 studies) and glass ceramic (6 studies) were used. Seven studies applied a protective appliance,
and 5 scheduled regular posttreatment evaluation as means of aftercare.
Conclusions. Within the limitations of this systematic review, the present evidence is not strong enough to form conclusions,
and the presented similarities cannot be substantiated with evidence. Therefore, comprehensive clinical research into the
designated treatment of generalized tooth wear is recommended. (J Prosthet Dent 2014;112:752-759)
Clinical Implications
The available evidence advises the use of diagnostic waxing and
diagnostic tooth arrangement. The use of centric relation is advised
for the occlusal positioning for rehabilitation. Testing of the vertical
dimension increases with a removable appliance and the use of a
provisional stage before definitive treatment is recommended. Both
composite resin and glass ceramic are indicated, and a protective
appliance with regular posttreatment evaluation is advised for follow-up.
a
Assistant Professor, Department of Fixed and Removable Prosthodontics, Center for Dentistry and Oral Hygiene, University Medical
Center Groningen, University of Groningen.
b
Associate Professor, Department of Fixed and Removable Prosthodontics, Center for Dentistry and Oral Hygiene, University Medical
Center Groningen, University of Groningen.
c
Tenured Associate Professor, Department of Prosthodontics, Dental School, Ludwig-Maximilians-University.
d
Professor and Chairman, Division of Cariology and Endodontics, School of Dentistry, University of Geneva.
e
Professor and Chairman, Department of Fixed and Removable Prosthodontics, Center for Dentistry and Oral Hygiene, University
Medical Center Groningen, University of Groningen.
RESULTS
Table IV. Selection process used during data collection
Description of studies
Assessment Inclusion Criteria No. of Results
A total of 16 publications on the
Titles Relevant topic 111 treatment of generalized, complete-
Abstracts Broad inclusion criteria (Table I) 36 arch tooth wear met the inclusion
Full text Broad and detailed inclusion criteria (Table II) 16 criteria (Table IV). By merging sub-
Included studies Combining substudies 11 studies, a total of 11 studies were
included and analyzed.
Muts et al
756 Volume 112 Issue 4
Table V. Overview of included studies
No. of Follow-up
Study Year Type of Study Patients Period (mo) Journal
treatment steps. These findings could Nevertheless, the present evidence is foundations and preparation; and it
guide the clinician through the complex not strong enough to form conclusions provides better communication be-
treatment of generalized tooth wear. (low level of evidence).10 tween dentist, patient, and dental
technician.4,14,23,29,30 The disadvan-
Level of evidence Interpretation of results tages are the costs and time associated
with DW and DTA.33
All included studies were case re- DW and DTA were frequently used CR was most frequently used and
ports or case series with small numbers (in more than 5 studies) so a common was determined to be a common
of patients and short or no follow-up thread was determined. During the thread. Although the use of CR may
treatment. Assessing the included treatment of severe tooth wear, the use help the clinician during treatment,
studies on the rating of the publishing of DW and DTA may benefit the considering the molar occlusion in the
journals is not possible, and therefore clinician in the following ways: it al- decision whether to choose MI or CR is
no study quality rating was performed. lows the treatment outcome to be probably wise.29,34 Moreover, deter-
The case reports and case series should previewed while adaptations are still mining CR may be difficult, and com-
be accepted as proof of principles possible; it informs the patient; it bined with an unfavorable molar
and provide the best evidence to aids the fabrication of templates that occlusion, it may lead to an unnec-
guide the clinician during treatment. are advantageous during adhesive essary increase in the horizontal over-
lap.29 In contrast, CR is often
recommended because of its repro-
Table VI. Research questions ducibility.34 Changes in the occlusal
Treatment scheme appear not to cause temporo-
Step Research Question mandibular disorder-related problems
when absent before treatment.35
1 DW 1 Was DTA performed? The VDI was tested before treatment
2 Was DW used for treatment or treatment planning? in most studies; this step was deter-
mined to be a common thread. In most
2 DW 3 Was CR or MI used as occlusal position before treatment? patients, testing was performed with a
3 VDI 4 Was VDI tested before treatment? removable occlusal appliance. The
5 If so, how and for how long? similarity was sufficient to use this
treatment step as a useful direction.
4 Restoration 6 Which restorative materials were used, including possible provisional
According to previous studies, testing
and definitive restoration?
the VDI is only needed when the
5 Follow-up 7 How was follow-up performed? remaining interocclusal rest space
CR, centric relation; DTA, diagnostic tooth arrangement; DW, diagnostic waxing; MI, maximum after rehabilitation will be less than 2
intercuspation; VDI, vertical dimension increase. to 3 mm.6,22 Increasing the occlusal
The Journal of Prosthetic Dentistry Muts et al
October 2014 757
Table VII. Overview of analyzed treatment steps
DW VDI Restoratives
Study DW DTA OP VDI Method Wk Interim Definitive Follow-up
Edelhoff 19 Yes Yes CR Yes Occlusal device 12 High-density Lithium disilicate Clinical evaluation
PMMA and modification,
(CAD/CAM) segmented transfer
Garcia20 Yes * CR Yes Occlusal device * None Composite resin Protective device
(direct),
metal resin,
gold
Hayashi21 Yes * * Yes Acrylic resin 26 Acrylic Gold, glass Protective device,
(anterior), metal resin, metal ceramic 3 mo recall
(posterior)
Mehta22 Yes Yes CR Yes Occlusal device 4 Composite Gold, metal Protective device
resin (indirect) ceramic, (Michigan type)
composite
resin (indirect)
Mizrahi23 Yes Yes CR Yes Direct composite 8 Composite Glass ceramic, Protective device
resin (anterior), resin gold, (Michigan type)
occlusal device (direct/indirect) metal ceramic
(posterior)
CR, centric relation; DTA, diagnostic tooth arrangement; DW, diagnostic waxing; MI, maximum intercuspation; OP, occlusal positioning;
PMMA, polymethyl methacrylate; VDI, vertical dimension increase.
*No result could be established.
vertical dimension seems to be a safe testing patient acceptance or adapta- implementation of an interim stage
procedure (signs and symptoms tend to tion with a removable method is less during the treatment of generalized
be self-limiting) and well accepted up predictable than with a fixed method. tooth wear was established to be a
to 5 mm.34,36 The testing periods varied In this review, 4 studies used a fixed parallel within 7 studies and could be
in this study. If necessary, testing the method; therefore, this method was not used as guidance. The implementation
VDI for a period of at least 1 month for considered to be a common thread. of this stage is performed to evaluate
24 hours a day is probably advised.5,22 The majority used an interim treatment outcome and patient accep-
In addition, Abduo34 concluded that stage before definitive treatment. The tance.14,19 Changes in esthetics and
Muts et al
758 Volume 112 Issue 4
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Muts et al