International Journal of Esthetic Dentistry (EN), 02/2025

Among all the factors responsible for pathologic tooth wear, erosion and mechanical overload are the most important. Clinicians should be capable of making a correct differential diagnosis, especially in the case of damage to the incisal edges. The present article provides pragmatic guidelines to evaluate the detrimental role of erosion and overload on the anterior teeth in order to better discuss with patients when to start the therapy and what to expect about the longevity of the restorations delivered. Anterior functional conflicts and the evolution of the affected dentition in the case of excessive masticatory muscle activation are also illustrated. Keywords: anterior functional conflicts, bruxism, erosion, explosive evolution, gnathology, implosive evolution, overload, prosthodontics, restorative dentistry, tooth wear

Tooth wear is a frequent pathology with multiple risk factors whose synergistic action can lead to severe and rapid hard tissue loss when no preventive strategy is applied. Dental erosion is triggered by an unbalanced diet and various medical conditions and medications that induce acid regurgitation or influence saliva composition and flow rate. Nowadays, widespread functional disorders (awake and sleep bruxism) induce attrition. Due to the combined biologic, functional, and also esthetic consequences of tooth wear, it has become increasingly important to diagnose its early signs so that proper preventive and, later on, interceptive–restorative measures can be taken. The use of adhesives and ultraconservative techniques is now recognized as a key approach for the treatment of moderate and even advanced tooth wear. The fundamentals of a modern treatment strategy to address erosion and attrition includes specific and detailed treatment planning based on tooth wear etiology, potential control of risk factors, and the biomechanical status of each tooth to be treated. Keywords: abrasion, attrition, erosion, interceptive treatment, minimally invasive restorations, no-prep treatment, tooth wear

Polymer-infiltrated ceramic network (PICN), commonly referred to as “hybrid ceramic,” represents a unique class of materials that integrate glass-ceramic and polymer. Vita Enamic is the only PICN material available on the market, benefiting from over a decade of clinical use and research. It offers a balance between pure ceramics and direct and CAD/CAM composites, leveraging their advantages while minimizing their disadvantages in the context of severe tooth wear (TW) treatment. PICN exhibits properties that closely mimic tooth tissue, particularly its wear behavior and stiffness, while polymer promotes the material’s ability to dampen occlusal stress. The introduction of PICN prompted the One-step No-prep technique for treating severe TW. This noninvasive and straightforward method provides a cost-effective alternative to traditional indirect approaches. The present article reviews the properties of PICN and compares them with other materials used in TW treatment. Clinical cases illustrate the One-step No-prep technique for generalized severe TW and the orthodontic-assisted One-step No-prep technique for localized cases, which is an evolution of the Dahl concept. The clinical and scientific background of PICN as used in the One-step No-prep technique are discussed and the excellent clinical outcomes from various perspectives are highlighted. The article also addresses the limitations of PICN such as the tendency for chipping at thin occlusal borders of posterior restorations and a lower gloss on occlusal surfaces compared with pure ceramics. These limitations do not affect patient satisfaction but could be improved upon. Despite these drawbacks, PICN appears to be suitable for managing TW in a noninvasive way. Keywords: CAD/CAM, composites, Dahl, minimally invasive dentistry, occlusion, orthodontics

Modern management of the full-mouth rehabilitation of worn dentition emphasizes minimally invasive and adhesive techniques, especially in treating younger patients or interceptive cases. CAD/CAM composite resins have become valuable for such treatments due to their balance between functional restoration and esthetic enhancement. These materials blend seamlessly with the natural dentition, providing satisfactory esthetic results and enhancing restoration stability and longevity, exploiting the advantages of adhesive techniques. Moreover, CAD/CAM composite resins are more economical than their ceramic counterparts, making them a sustainable option for extensive rehabilitations. The present article analyzes the rationale for using CAD/CAM composite resin materials in full-mouth minimally invasive rehabilitations. It also presents the follow-up of two previously published cases (one up to 8 years and the other up to 4 years), and a new clinical case illustrating a step-by-step, fully digital workflow. CAD/CAM composite resins offer numerous advantages such as efficient and precise fabrication, the ability to be milled into very thin layers without compromising strength, and ease of reparability. They can be considered the elective material in additive approaches, minimizing or eliminating the need for tooth preparation. However, challenges may arise with natural undercuts in worn dentition, requiring careful planning. The results of studies on CAD/CAM composite resins nowadays show them to be a viable and effective option, offering the possibility of obtaining excellent functional and esthetic results. Keywords: CAD/CAM composite resin, digital dentistry, restorative dentistry, tooth wear

Severe pathologic tooth wear is perceived internationally as an increasing problem based on growing evidence of risks associated with dental hard tissue damage due to erosion, attrition, and abrasion. The defect morphology of these wear-related lesions is different from that of caries lesions. Modern evaluation systems provide detailed quantitative assessment and classification of tooth wear. Against this background, restorative treatment concepts have become significantly more differentiated in recent decades. Direct composite restorations might be preferred for smaller defects and younger patients as they are less expensive and allow for minimally invasive procedures. Indirect restorations such as those made of glass-ceramics provide better control over the optimal form and esthetics and thus facilitate a safer and more predictable implementation of a physiologic static and dynamic occlusion. 3D treatment planning by means of a wax-up provides orientation for the subsequent tooth preparation and allows a particularly economical approach to the removal of healthy dental hard tissue. Furthermore, the introduction of new preparation designs has contributed significantly to the preservation of dental hard tissue in the teeth to be restored. The present article describes the principles of minimally invasive treatment concepts with high-strength silicate glass-ceramic restorations using anterior full veneers and posterior occlusal onlays for the rehabilitation of the worn dentition, provides up-to-date data for scientific evaluation, and presents a clinical case. Keywords: complex rehabilitation, diagnostic wax-up, full veneers, glass-ceramic, Munich splint concept, occlusal onlays, preparation technique

Tooth wear (TW) is a complex multifactorial clinical entity in which minimally invasive protocols should be considered the first choice of treatment to aid in the preservation of damaged tooth structure in the long term. Patients suffering from TW require a comprehensive evaluation and a detailed treatment plan with an occlusal enhancement focus that must be followed by all specialists involved in the therapy. The loss of tooth structure will eventually occur in all three dimensions of space and therefore the restoration will have to address these three aspects. Having a facially driven protocol, especially with the advent of facial scanning devices, brings the final outcome closer to the initial design and the patient’s expectations. It also helps to diminish the distortion that a complex multidisciplinary specialty-generated treatment might bring to the treatment schedule. The incorporation of facial scan technology into the workflow in complex multidisciplinary cases may enhance the communication process and interplay between the dentist and the dental laboratory technician as well as the decision-making within the clinical team. Keywords: digital dentistry, facial scanning, prosthodontics, restorative dentistry, tooth wear