Studio Calesini · Rome
Dental wear requires a causal diagnosis before any restoration is planned. The type and cause of wear, attrition, erosion, abrasion, determines the treatment sequence and the restorative approach.
What is dental wear
Dental wear is not a single condition. It has at least three distinct origins: attrition (tooth-to-tooth contact wear, most commonly from bruxism or parafunctional habits), erosion (chemical dissolution from gastric acid, dietary acids, or frequent vomiting), and abrasion (external agents such as abrasive toothpaste or incorrect brushing technique). In many patients, two or three forms coexist.
This distinction has direct clinical consequences. A restoration placed without identifying and controlling the causative factor is exposed to the same dynamics that produced the wear. In patients with unmanaged bruxism, restorations, however accurately executed, undergo the same fate as the natural tooth structure they replaced.
Studio Calesini applies a sequential protocol: causal diagnosis first, stabilisation where required (occlusal device, reflux management, habit modification), then restoration.
The adhesive approach
In cases of moderate to advanced wear that has not yet irreversibly compromised coronal structure, adhesive restoration with ceramic overlays or onlays can recover form, function, and aesthetics without the aggressive preparation required by a conventional crown.
A conventional crown requires the removal of a substantial proportion of healthy tooth structure to create the space the restoration needs. In patients with worn teeth, where structure loss has already occurred pathologically, an overlay uses the space already created by wear, requiring minimal or no preparation, while bonding to residual enamel to achieve mechanical resistance comparable to that of a full crown.
For many patients quoted for full-arch crown rehabilitation, an adhesive overlay approach achieves the same functional and aesthetic outcome with significantly lower biological cost to the teeth.
Clinical criteria
Not every patient with worn teeth is a candidate for adhesive restoration. The assessment must consider residual enamel volume, the occlusal situation, and whether the causative factor has been identified and managed. These are the clinical criteria that determine the indication.
Structural loss on occlusal or incisal surfaces with sufficient residual enamel for adhesive bonding. Absent enamel in specific zones does not exclude restoration, but modifies the preparation and adhesion strategy.
Bruxism managed with an occlusal device; reflux under treatment; abrasive habits modified. Restoration before stabilisation of the cause is exposed to the same forces that produced the original wear.
In cases of generalised wear with loss of vertical dimension of occlusion (VDO), restoration involves restoring it, typically progressively, using provisional composite restorations, before fabricating definitive restorations.
FAQ
Dental wear is the progressive loss of hard tooth structure from non-carious causes. The three main forms are attrition (tooth-to-tooth wear, most commonly from bruxism), erosion (chemical dissolution from gastric acid or dietary acids), and abrasion (external agents). In many patients, two or three forms coexist and require differential diagnosis before any treatment is planned.
In many cases, yes. With sufficient residual coronal structure, ceramic overlays can recover form, function, and aesthetics without the aggressive preparation required by a conventional crown. A crown removes 65-75% of healthy coronal structure; an adhesive overlay uses the space already created by wear, requiring minimal or no preparation.
Yes, it is essential. A restoration placed without identifying and controlling the causative factor is exposed to the same dynamics that produced the original wear. The correct protocol involves causal diagnosis, stabilisation where required, then restoration.
Peer-reviewed literature reports survival rates above 85% at ten years with correct clinical indication, figures comparable to crown survival data over the same period. Actual longevity depends on the accuracy of the indication, the quality of execution, and management of the causative factor.
Second opinion
Many patients with moderate or advanced dental wear are quoted for complete rehabilitation using conventional crowns. In a significant proportion of these cases, adhesive restoration with ceramic overlays achieves the same functional and aesthetic outcome with substantially lower biological cost.
A second opinion consultation at Studio Calesini includes review of available clinical documentation, a direct clinical examination, and an independent written assessment. There is no obligation to continue treatment at the practice.
Request a second opinion →First consultation
The first appointment covers causal analysis of wear, assessment of residual structure, and discussion of therapeutic options. The patient receives a written document summarising what was presented. There is no obligation to continue treatment.
Book a first appointment →