Vertical tooth surface loss – a narrative review

Introduction: Tooth surface loss (TSL) is etiologically the sum of cumulative, multifactorial events, which ultimately lead to irreversible loss of tooth structure. Tooth surface loss can be pathological depending on its extent and progression and it can necessitate that the dentist initiates individualized preventive or therapeutic measures in cooperation with the affected patient. Methods: A literature search for various studies published on PubMed and in the S3 guideline Bruxism up to February 2020 was conducted as part of this narrative review. The studies were evaluated based on topic-related search terms and also a manual search through their respective reference lists was performed. Standard values for TSL were defined and different methods for recording findings were compared. Results: A sound diagnosis and regular monitoring are mandatory treatment steps for the dentist when treating patients with TSL. Clinical examinations including the "Tooth Wear Index" or the "Tooth Wear Evaluation System" are available for this purpose; these help convey, depending on the index applied, the qualitative and/or quantitative loss of tooth substance. Based on the severity and extent of TSL, thorough consideration is needed for determining if a conservative or an interventional treatment is indicated. Conservative measures include protective splints, fluoridation, and regular monitoring; interventional measures constitute definitive restorations after an initial pre-restorative phase. Conclusion: A systematic decision tree for the diagnosis and therapy of patients with non-cariogenic, vertical TSL was developed based on the current recommendations found in literature. It is intended to provide dental practitioners with a guideline for the diagnosis and treatment of patients with TSL in their everyday practice. Keywords: prosthetic rehabilitation, tooth surface loss (TSL), "Tooth Wear Evaluation System", "Tooth Wear Index"