Vertical tooth surface loss – a narrative review

Introduction: Tooth surface loss (TSL) is a physiological process, which is multifactorial and progresses throughout life. Depending on the extent and progression of TSL, it may be necessary for the dental practitioner to initiate individualized preventive and/or therapeutic measures in cooperation with the affected patient. Methods: In the first part of this narrative review, a literature search on PubMed and in the S3 guideline on bruxism was conducted; various studies appearing up to February 2020 were evaluated. Within this framework, the second part of this article explains when pre-restorative treatments are indicated, when a bite elevation should be performed, as well as, how it can be implemented and to what extent it is limited. Moreover, the various pre- prosthetic and restorative treatment options are elucidated. Additionally, the different dental materials and their advantages and disadvantages in terms of esthetics, function and long-term results are described. Results: Although physiological, age-related TSL is an indication for treatment only in exceptional cases, extensive TSL affecting the supporting zone of the dentition or reaching far into the dentin usually must be treated. In such cases, it may be necessary to restore and secure the occlusal and vertical jaw relation by means of prosthetic rehabilitation. Most commonly, extensive TSL is treated by means of indirect restorations made of metal and ceramics. In this respect, tooth preparation for crowns and bridges can be seen as a disadvantage as it results in additional circular loss of tooth substance. Tooth- colored, minimally invasive restorations are considered a good alternative depending on the financial means of the patient. Conclusion: At present, there is no universally suitable restorative therapy concept for patients with TSL; rather, highly individualized treatment decisions must be made for each patient whereby both esthetic and functional parameters are taken into consideration in the decision-making process. Keywords: bite elevation, bridge, ceramic, composite, crown, non-cariogenic tooth surface loss (TSL), splint