Management of severe tooth wear with a predominantly additive, adhesive approach
- 7 days ago
- 1 min read
As seen in Oral Health
In this article, I present a conservative approach to managing severe, multifactorial tooth wear using predominantly additive, adhesive techniques. Advanced tooth wear often results from a combination of erosion, attrition, and abrasion, frequently influenced by systemic factors such as gastroesophageal reflux. Thorough diagnosis is essential, including medical and dental history, clinical examination, and dento‑facial analysis. In this case, historical photographs and objective evaluation confirmed that the patient’s anterior tooth position and facial fullness were already near ideal, making further facial reduction undesirable and guiding the decision toward an additive strategy.
The case illustrates a phased rehabilitation designed to preserve remaining tooth structure while restoring function, esthetics, and occlusal stability. Severely eroded palatal surfaces of the maxillary anterior teeth were first reconstructed using direct composite palatal shells created with an injection‑mold technique to protect exposed dentin and re‑establish anterior guidance. Minimal‑ or no‑preparation porcelain veneers were then used to refine facial esthetics without adding bulk, while thin bonded ceramic veneer‑onlays addressed occlusal erosion on the mandibular posterior teeth. Digital design, precise laboratory communication, and strict adhesive protocols were critical to achieving predictable outcomes at minimal restorative thickness.
This article discusses why an additive, adhesive “envelope” approach can be advantageous in appropriately selected patients—particularly when enamel remains available for bonding and facial tooth position must be respected. While this strategy is not universally applicable and requires ongoing risk‑factor control and maintenance, it offers a viable alternative to aggressive full‑coverage rehabilitation in select wear cases. This case demonstrates how careful diagnosis, conservative material selection, and meticulous execution can successfully restore function and esthetics while preserving valuable tooth structure.
