Composite for Managing Wear and Altering VDO

In general, the use of composite is significantly more common in Europe than the United States.  Let me clarify that by saying that although composite is a primary restorative material for posterior fillings, Class V restorations and anterior cosmetic dentistry in both Europe and the USA – I believe that we in the States under utilize composite for managing the more advanced full mouth wear patients in lieu of ceramic restorations. It has been well documented in the literature that composite can be used successfully to manage these types of patients. ^1,2

There are many advantages of using composite:

• It’s conservative
• It can restore both function and esthetics
• The reduction of overall financial cost to the patient
• It’s more easily repairable if fracture occurs

For the most predictable restorative success, case selection can be important. Given the strength differences between ceramic and composite, using composite on patients with an erosive or abrasive loss of tooth structure may be more predictable than using it on attrition patients where force management is more of an issue. This patient presented at the office holding a treatment plan from her current dentist for a full mouth reconstruction with crowns and veneers utilizing implants in all four posterior sextants. (Figs. 1-3)

Her treatment goal was to improve both the esthetics and function, as she didn’t feel she could eat normally without breaking the thin edges of her anterior teeth.  The treatment plan that I presented utilized composite resin to help restore the esthetics and function.  Given that she had been without molars for many years, she was fine with not having these teeth replaced.  The treatment plan was developed using the facially generated treatment planning process beginning with the determination of the maxillary incisal edge position. (Figs. 4-5)

The entire occlusal thought process and design was worked out on mounted models utilizing a diagnostic wax-up.  (Figs. 6-8)

The placement of the direct composite was performed in a single visit and was well tolerated by the patient. (Figs. 9-11) It not only accomplished the treatment goals, but it did so in a very conservative manner.

Greggory Kinzer, D.D.S., M.S.D., is a member of Spear Resident Faculty.

References:

1. A comprehensive and conservative approach for the restoration of of abrasion and erosion.  Part 1: concepts and clinical rationale for early intervention using adhesive techniques. Dietschi D, Argente A.  Eur J Esthet Dent  2011;6(1):20-33
2. Tooth wear treated with direct composite restorations at an increased vertical dimension: results at 30 months. Hemmings KW, Darbar UR, Vaughan S..  J Prosthet Dent 2000 Mar;83(3):287-93