The evaluation of direct composite restorations for the worn mandibular anterior dentition – clinical performance and patient satisfaction

Abstract

This prospective split-mouth clinical trial evaluated the performance and patient satisfaction of 168 Herculite XRV direct composite restorations bonded to the worn anterior dentition of 18 patients with localized anterior tooth surface loss. One hundred and six of these restorations were placed on the mandibular anterior teeth. The restorations increased the anterior occlusal vertical dimension between 0.5 and 5 mm and the posterior occlusal contacts were restored after a mean duration of 6.2 months (range: 3-13 months) in 14 out of the 15 'Dahl' sub-group patients. The restorations were evaluated after 2.5 years of service by five examiners. Four patients and 23 mandibular restorations were lost to follow-up. Multiple clinical and restorative variables were assessed to determine their influence on restoration performance. Complete failure occurred in 6% of the restorations. Circumferential preparation and height of the restorative addition did not influence the performance of the restorations. A Visual Analogue Scale (VAS) was used to assess the patient's opinion regarding sensitivity, aesthetics, longevity and function of the worn mandibular anterior teeth. A statistically significant difference (95% CI) was found between the pre-operative and 1-month review VAS responses for aesthetics and longevity and this was maintained at the 2.5-year review. Direct composite restorations placed at an increased occlusal vertical dimension are a simple and time-efficient method of managing the worn mandibular anterior dentition. Patient's acceptance and adaptation to the technique is good and the results are accompanied with a high level of patient satisfaction that is maintained for the medium-term.

Survival analysis of composite Dahl restorations provided to manage localised anterior tooth wear (ten year follow-up)

“…Several studies in the literature since have reported success in achieving the desired relative axial tooth movement using the Dahl principle, ranging from 93% to 100% of all cases. [7][8][9][10][11] The science and technology of composite dental restorative materials have advanced considerably over the years. Although composites have not evolved to the point of being an ideal restorative material, they have become a viable option to manage localised anterior tooth wear.…”

“…The successful use of composite resin restorations placed at an increased occlusal vertical dimension as 'Dahl' type appliances has been demonstrated over the short-term. [7][8][9][10][11][12] This simple technique offers better patient compliance compared…”

Minimum intervention dentistry and the management of tooth wear in general practice

“…[61][62][63][64][65] Long-term follow-up studies show that the main complications are repairable and retrievable with no loss of tooth vitality or need for loss of further teeth. 63 It has been reported that chipping or partial debonding may appear in teeth with no, or minimal, enamel at the margins of the worn surfaces, but the majority of problems are restorable.…”

Avaliação clínica retrospectiva de restaurações cervicais de resina composta

“…Diante do seu rápido aperfeiçoamento, combinado com o uso dos sistemas adesivos, a resina composta hoje em dia é utilizada na maioria das restaurações estéticas diretas em dentes anteriores 3,8 , solucionando um número cada vez maior de situações clínicas de alterações de função, forma e estética [8][9][10] , sob um conceito de intervenção operatória minimamente invasiva 11 . Contudo, o profissional deve conhecer os limites do material para oferecer e optar pelo melhor tratamento diante desses casos de reabilitação.…”