Conservative restoration of the worn dentition - the anatomically driven direct approach (ADA)

The treatment or management of tooth wear with composite resins can be challenging because significant alterations in the patient's occlusion are usually required. Comprehensive approaches include the use of facebows, articulator-mounted casts, laboratory-made wax-ups, and silicone indexes to deliver the restorations. Even though this sequence of steps is recommended, in many cases it is not applied. The reason for this is related to the complexity and time required for these steps, which are normally applied in indirect restorations like ceramics but not properly used in direct composite resin rehabilitations. Moreover, a large portion of these patients, clinicians, and technicians in many countries may not have the resources and/or tools to undertake a full comprehensive approach. In order to aid clinicians to use an exclusively direct method to manage these patients for whatever reasons, the authors propose in this article a thought process applied to diagnosis and treatment planning that allows the restoration of extensively worn dentitions in a logical clinical sequence. The first goal is to provide a clear and organized vision of the functional, biologic, and esthetic principles of treatment planning based on the most current, evidence-based notions and clarified insights from experts. These are principles that should be applied universally in any comprehensive treatment plan. The second goal is to propose the application of these principles to direct restorations even when no individualized articulator mounting or appropriate laboratory wax-ups are available - the anatomically driven direct approach (ADA).