Restoration of the severely worn dentition is one of the most challenging procedures in dentistry. In order to successfully restore and maintain the teeth, one must gain insight into how the teeth arrived at this state of destruction. Tooth wear can result from abrasion, attrition, and erosion. Research has shown that these wear mechanisms rarely act alone and there is nearly always a combination of the processes. Evaluation and diagnosis should account for the patient’s diet, history of eating and/or gastric disorders, along with the present state of the occlusion. Emphasis must be placed on the evaluation of occlusal prematurities preventing condylar seating into the centric relation position. Behavioral factors that may contribute to parafunctional habits and/or nocturnal bruxism are also important to understand and manage in order to successfully restore and maintain a healthier dentition. Once a complete understanding of the etiology of the dentition’s present state is appreciated, a treatment plan can be formulated, taking into account the number of teeth to be treated, condylar position, space availability, the vertical dimension of occlusion (VDO), and the choice of restorative material.
While all occlusions wear to some degree over the lifetime of the patient, normal physiological wear usually does not require correction. Severe or excessive wear refers to tooth destruction that requires restorative intervention. Severe attritional wear can result from occlusal prematurities that prevent functional or parafunctional movements of the jaw. This wear can be seen at the site of the prematurity or on the anterior teeth as a result of the “hit and slide” forward. Restoration of the worn anterior teeth then becomes a challenge as space availability for prosthetics becomes limited. If lengthening the teeth is a goal in order to achieve a more aesthetic smile, then the question of the need to alter VDO subsequently arises.
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