RESULTS OF COMPARATIVE CLINICAL EVALUATION OF DIFFERENT METHODS OF RESTORATIVE TREATMENT OF TOOTH WEAR
DOI:
https://doi.org/10.35220/2523-420X/2025.1.22Keywords:
tooth wear, partial restorations, resin-based composites, zirconium, CAD/CAM, clinical efficiencyAbstract
Purpose of the study. To compare the clinical effectiveness of partial direct resin-based composite and indirect zirconia restorations for the treatment of tooth wear.Research methods. It was learned 30 people with generalized decompensated tooth wear, I degree, mixed form, aged up to 45 years, with men predominance (70.0 %). All patients were divided into 3 research groups of 10 persons each, equivalent in sex-age composition and clinical picture. In the first research group, worn teeth was restored with resin-based composite directly; in the second one, it was used direct resin-based composite restorations for anterior teeth and CAD/CAM zirconium overlays for lateral teeth. The results of research groups were compared with the data of control, where restorative treatment was absent according patients’ consent.Examinations were performed in 1 month and in 5 years after treatment. Restorations were checked for clinical acceptability: functionality, biological compliance, aesthetics. Failed restorations were divided into three categories: restorations with serious defects requiring total replacement (F1); restorations with localized defects requiring partial replacement (F2); restorations with small defects requiring restoration by polishing (F3).Previous and repeated digital images were superimposed using CAD/CAM software. Occlusal surfaces wear was assessed on six teeth: all first molars and upper central incisors. The interalveolar height was determined at the location of the first molars by analyzing intraoral scans of the dentitions. The results were statistically processed. Scientific novelty. The highest clinical efficacy (97.9 %) was calculated for direct resin-based composite restorations of anterior teeth in cases of lateral zirconium overlays. When direct resin-based composite restorations of lateral teeth were used, the efficacy of anterior resin-based composite restorations decreased to 93.8 %. The worst result was got for direct resin-based composite restorations of lateral teeth – 77.5 % versus 88.4 % for indirect zirconium overlays. In the absence of restorative treatment in patients of the control group, tooth wear was significantly more compared to the wear of restorations in the second group (P < 0.05 for resin- based composite and P < 0.001 for zirconium dioxide), and in the first group (P > 0.05). Wear of lateral teeth was more intense than that of anterior teeth (P > 0.05).By analogy, wear of resin-based composite restorations was more significant for lateral teeth compared to anterior ones (P < 0.05). The largest difference was found between the wear rates of resin-based composite restorations and zirconia overlays made for lateral teeth (P < 0.001).The greatest loss of interalveolar height was found in the absence of restorative treatment in the control group (1.52 ± 0.48 mm). For patients in the first group, interalveolar height loss was 1.18 ± 0.37 mm (P > 0.05).In the second group, no decrease in interalveolar height was recorded. Conclusions. Restorative treatment of tooth wear prevents progression of the disease. Direct resinbased composite restorations of anterior and lateral teeth are justified treatment method with a small numberof serious complications. The use of CAD/CAM technology for zirconia restorations of lateral teeth increases the effectiveness of treatment in the long term by means of preserving the interalveolar height.
References
Wetselaar, P., Wetselaar-Glas, M. J. M., Katzer, L. D., & Ahlers, M. O. (2020). Diagnosing tooth wear, a new taxonomy based on the revised version of the tooth wear evaluation system (TWES 2.0). J Oral Rehabil, 47(6), 703–712. https://doi.org/10.1111/joor.12972
Shellis, R. P., & Addy, M. (2025). Attrition, abrasion and erosion and their interactions in tooth wear. Monogr Oral Sci, 33, 19–31. https://doi.org/10.1159/000543571
Vailati, F., & Belser, U. (2025). Diagnosis of tooth wear – from erosion to overload. Int J Esthet Dent, 20(2), 112–122.
Dietschi D. (2025). Interceptive treatment of tooth wear. Innovative protocols in treating initial and moderate cases following a biomechanical and risk-factor-oriented strategy. Int J Esthet Dent, 20 (2), 124–139.
Dhaliwal, G., & Ouanounou, A. (2024). Tooth surface loss: causes, management, and prevention. Quintessence Int, 55 (6), 504–513. https://doi.org/ 10.3290/j.qi.b5223649
Loomans, B., Opdam, N., Attin, T., Bartlett, D., Edelhoff, D., Frankenberger, R., Benic, G., Ramseyer, S., Wetselaar, P., Sterenborg, B., Hickel, R., Pallesen, U., Mehta, S., Banerji, S., Lussi, A., & Wilson, N. (2017). Severe tooth wear: European Consensus Statement on Management Guidelines. J Adhes Dent, 19 (2), 111–119. https://doi.org/10.3290/j.jad.a38102
Hardan, L., Mancino, D., Bourgi, R., Cuevas- Suárez, C. E., Lukomska-Szymanska, M., Zarow, M., Jakubowicz, N., Zamarripa-Calderón, J. E., Kafa, L., Etienne, O., Reitzer, F., Kharouf, N., & Haïkel, Y. (2022). Treatment of tooth wear using direct or indirect restorations: a systematic review of clinical studies. Bioengineering (Basel), 9 (8), 346. https://doi.org/10.3390/bioengineering9080346
Ning, K., Bronkhorst, E., Crins, L., van der Meer, W., Pereira-Cenci, T., Yang, F., Leeuwenburgh, S., & Loomans, B. (2022). Wear behaviour of direct composite restorations in tooth wear patients: a 5-year clinical study. J Dent, 127, 104354. https://doi.org/10.1016/j.jdent.2022.104354
Mehta, S. B., Bronkhorst, E. M., Lima, V. P., Crins, L., Bronkhorst, H., Opdam, N. J. M., Huysmans, M. D. N. J. M., & Loomans, B. A. C. (2021). The effect of pre-treatment levels of tooth wear and the applied increase in the vertical dimension of occlusion (VDO) on the survival of direct resin composite restorations. J Dent, 111, 103712. https://doi.org/10.1016/j.jdent.2021.103712
Alani, A., Mehta, S., Koning, I., Loomans, B., & Pereira-Cenci, T. (2025). Restorative options for moderate and severe tooth wear: A systematic review. J Dent, 156, 105711. https://doi.org/10.1016/j.jdent.2025.105711
Crins, L. A. M. J., Opdam, N. J. M., Kreulen, C. M., Bronkhorst, E. M., Sterenborg, B. A. M. M., Huysmans, M. C. D. N. J. M., & Loomans, B. A. C. (2021). Randomized controlled trial on the performance of direct and indirect composite restorations in patients with severe tooth wear. Dent Mater, 37 (11), 1645–1654. https://doi.org/10.1016/j.dental.2021.08.018
Bronkhorst, H., Bronkhorst, E., Kalaykova, S., van der Meer, W., Huysmans, M. C., & Loomans, B. (2022). Precision of in vivo quantitative tooth wear measurement using intra-oral scans. J. Vis. Exp, 12 (185), 63680. https://doi.org/10.3791/63680
Lima, V. P., Crins, L. A. M. J., Opdam, N. J. M., Moraes, R. R., Bronkhorst, E. M., Huysmans, M. D. N. J. M., & Loomans B. A. C. (2022). Deterioration of anterior resin composite restorations in moderate to severe tooth wear patients: 3-year results. Clin Oral Investig, 26(12), 6925–6939. https://doi.org/10.1007/s00784-022-04647-y
Shah, S., Hemmings, K., Gulamali, A., Petrie, A., & Malik, J. S. (2024). The survival and clinical performance of anterior composite resin restorations and posterior indirect and cast restorations used to treat generalised tooth wear. Br Dent J, 237(3), 203–211. https://doi.org/10.1038/ s41415-024-7617-z
Alwadai, G. S., Roberts, G., Ungar, P. S., González- Cabezas, C., Lippert. F., Diefenderfer, K. E., Eckert, G. J., & Hara, A. T. (2020). Monitoring of simulated occlusal tooth wear by objective outcome measures. J Dent, 102, 103467. https://doi.org/10.1016/j.jdent.2020.103467
van Sambeek, R. M. F., Mehta, S. B., Flapper, C., Fokkinga, W. A., Loomans, B. A. C., & Pereira-Cenci, T. (2024). Changes in oral health-related ouality of life after restorative treatment of tooth wear in adult patients: A systematic review. J Dent, 151, 105428. https://doi.org/10.1016/j.jdent.2024.105428
Yar, R. (2023). Digital workflows for the management of tooth wear. Br Dent J, 234 (6), 427–431. https://doi.org/10.1038/s41415-023-5657-4
Caga, D., & Lewis, N. (2021). Treatment of tooth wear associated with reduced occlusal vertical dimension using direct composite restorations and a removable prosthesis. Prim Dent J, 10(1), 120–125. https://doi.org/ 10.1177/2050168420980978.
Attin, T., Schmidlin, P. R., & Tauböck, T.T. (2023). Direct adhesive reconstructions for restoration of posterior teeth with erosive tooth wear. Swiss Dent J, 133 (7–8), 489–495. https://doi.org/10.61872/sdj-2023-07-08-04
Burian, G., Erdelt, K., Schweiger, J., Keul, C., Edelhoff, D., & Güth, J. F. (2021). In-vivo-wear in composite and ceramic full mouth rehabilitations over 3 years. Sci Rep, 11(1), 14056. https://doi.org/10.1038/s41598-021-93425-z
