Rehabilitation of the worn dentition with glass-ceramic restorations

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