Adhesive rehabilitation of localized anterior tooth wear in combination with the Dahl concept

Abstract

Localized anterior maxillary tooth wear caused by erosion/attrition with loss of interocclusal space needs complex management. This observational case-series study reports eight cases with worn anterior dentition, treated with sandwich-veneers at an increased vertical dimension of occlusion without restoration of unaffected posterior teeth. 48 palatal direct veneers were fabricated in eight patients from nanohybrid resin composite using a wax-up based template at an increased vertical dimension. 54 labial lithium-disilicate ceramic veneers were made after the complete re-establishment of posterior occlusion. The sandwich veneers were evaluated after a mean service time of 35.1 months according to the USPHS criteria. Re-establishment of posterior contacts, subjective patient satisfaction and function were also evaluated. The overall survival of the sandwich-veneers is 100%. The success of the labial ceramic restorations was excellent. The quality of the palatal resin composite veneers was found to be good. The marginal discoloration (70.8%), wear (45.8%), surface roughness (20.8%) and marginal integrity (12.5%) showed small deteriorations. Firm posterior contacts re-established within 4 weeks. Patient satisfaction was high concerning aesthetics and function. The short-term outcome of this non-invasive sandwich-approach combined with the Dahl-concept is favorable and promising.

Keywords

• worn anterior teeth
• decreased vertical dimension
• palatal resin composite veneer
• labial ceramic veneer
• sandwich approach
• dahl-concept