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Conservative Treatment of
Anterior Worn Dentition with
Adhesive Composite Resin
A
s our patients are getting older and keeping their
teeth longer, wear of the incisal edges of anterior
teeth has become more pervasive. In most clinical
cases, tooth wear is not a single cause-and-effect condi-
tion. The wear may be caused by a combination of fac-
tors, including attrition, abrasion, and erosion.1 Attrition
may be due to gradual and regular loss of tooth structure
as a result of natural mastication or pathologic wear
caused by abnormal function.2 One study reported that
of 520 older adults, 84.2% had enamel attrition, 72.9%
dentin attrition, and 4.2% severe attrition.3
How does one treat anterior worn dentition when
dentin is exposed and is continuing to wear and the
amount of enamel loss barely exposes dentin? In some
cases, the patient notices and asks about the discoloration
of the incisal edges of the mandibular teeth due to exposed
dentin; other times, the patient notices a bluish translu-
cency at the incisal edges on the facial surfaces of the max-
illary incisors caused by worn dentin on the lingual
surfaces of these teeth, leaving only enamel that is translu-
cent. A conservative approach can be used to restore worn
incisal edges to the existing vertical dimension with direct
composite resin.4,5 This article describes a case report of a
conservative treatment of the worn anterior dentition
using direct bonded, wear-resistant composite resin.
thing could be done for his lower front teeth that were
chipping and discolored on the incisal edges due to ex-
posed dentin (Figure 1). The diagnosis of anterior tooth
wear through the enamel into the dentin was made. After
restorative treatment, the plan was to provide the patient
with a hard acrylic occlusal nightguard to control the pa-
tient’s parafunctional habit of bruxing. The restorative
treatment plan for these teeth was the placement of direct
bonded composite resin to restore the worn incisal edges
and cusp tips of teeth Nos. 22 to 27. Success with these
restorations depends on a fundamental approach to tooth
preparation to assure durability of the restoration.6
Tooth Preparation
In most cases, the teeth to be restored do not need to be
anesthetized. The exposed dentin is sclerotic and has little,
if any, sensation. After dam placement, a small, pear-
shaped No. 330 bur (SS White Burs, Inc) was prepared into
the dentin to a depth of 1.0 mm, leaving a shell of enamel
(Figure 2). A periodontal probe can also be used to verify
that the tooth preparation of all enamel walls has a pulpal
depth of 1.0 mm, leaving a shell of enamel (Figure 3).

Case Report: Mandibular Incisal Wear

A 53-year-old man presented for comprehensive care.
As part of the treatment review, the patient asked if any-

Howard E. Strassler, DMD, FADM, FAGD

Professor, Division of Operative Dentistry
Department of Endodontics, Prosthodontics, and
Operative Dentistry
University of Maryland Dental School
Baltimore, Maryland
Phone: 410.706.7551
E-mail: hstrassler@umaryland.edu Figure 1—Preoperative view of worn mandibular anterior teeth.

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Figure 2—Teeth prepared to a pulpal depth of 1.0 mm as evi-
denced by the cutting length of the No. 330 bur.
Figure 3—Verifying the depth of the preparation at 1.0 mm with
a periodontal probe.
Restoration Placement
The preparations were etched for 15 seconds with a
32% phosphoric acid etchant and then rinsed with an air-
water spray for 10 seconds. The tooth was lightly dried,
leaving a moist dentin surface. A single-component, fifth-
generation adhesive (SeptoBond, Septodont USA) was ap-
plied to the tooth preparation with a disposable brush (It
has been this author’s experience that self-etch adhesives
can be used successfully for the type of preparations de-
scribed). The adhesive was light cured for 20 seconds. A
dimer acid chemistry, low-shrink, wear-resistant nanohy-
brid composite resin (N’Durance Dimer Flow, Septodont
USA) was placed into the incisal preparations. The com-
posite resin was shaped to the tooth surfaces using a plas-
tic filling instrument so that there was little excess that
2 Dental Learning / November 2010
Figure 4—Care taken to shape the low-shrink nanohybrid com-
posite resin with a plastic filling instrument to minimize excess.
Figure 5—Completed restorations are both functional and esthetic.
needed to be finished (Figure 4). The composite resin was
then light cured for 20 seconds for each tooth.
Finishing and Polishing
The composite resin placement as described leaves very
little excess. The margins of the composite were finished
with abrasive disks followed by an aluminum oxide abrasive
impregnated silicone disk. The dental dam was removed and
all occlusal movements were checked using a very thin, 2-
sided occlusal film (AccuFilm II, Parkell, Inc). It should be
noted that the composite resin restores function in areas
where wear had removed needed function. A hard, acrylic,
maxillary occlusal nightguard was fabricated to protect the
dentition from parafunctional wear. The restored incisal
edges have not only made the teeth more wear resistant, but
also have created a more esthetic result (Figure 5).
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Conclusion
With the conservative technique described, placement
of a wear-resistant composite resin maintains the occlu-
sion on the anterior tooth surfaces, deferring the need for
more extensive crown and bridge procedures in the future.
Disclosure:
Dr. Strassler is affiliated with, receives research support, and/or is
a consultant for Kerr, Ribbond, DENTSPLY, and SS White Burs.
References
1. Schneider PE, Peterson J. Oral habits: considerations in
management. Ped Clin North Am. 1982;29:523-546.
2. Hand JS, Beck JD, Turner KA. The prevalence of occlusal at-
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trition and considerations for treatment in a noninstitution-
alized older populations. Special Care Dent. 1987;7:202-
206.
3. Pindborg JJ. Pathology of the Dental Hard Tissues. Phila-
delphia, PA: W.B. Saunders; 1970:294-300.
4. Strassler HE, Kihn PW, Yoon R. Conservative treatment of
the worn dentition with adhesive composite resin. Con-
temp Esthet Restor Pract. 1999;1:42-52.
5. Christensen G. A new technique for restoration of worn an-
terior teeth--1995. J Am Dent Assoc. 1995;126:1543-1545.
6. Strassler HE, Serio CL. Conservative treatment of the worn
dentition with adhesive composite resin. Dent Today.
2004;23:79-83.
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