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36 — issue 2016 Esthetic and Restorative Dentistry Article NO-PREP INTERCEPTIVE REHABILITATION — of tooth wear using a free-hand technique driven by a functional wax-up — Dr. Didier Dietschi, is a senior lecturer at the Depart- ment of Cariology and Endodon- tics at the University of Geneva School of Dental Medicine, Switzerland. He is also an adjunct professor at the Department of Comprehensive Care at Case Western Reserve University School of Dentistry, Cleveland, Ohio, U.S. Dr. Dietschi also works at the Geneva Smile Cen- ter, a private practice and educa- tion center, in Switzerland. He can be contacted at ddietschi@genevasmilecenter.ch. Geneva Smile Center Quai Gustave-Ador 2 1207 Geneva Switzerland Dr. Didier Dietschi, Switzerland Treatment rationale Excessive abrasion (attrition) and erosion aretwocommonconditionsaffectingden- tal hard tissue and occur in an increasing numberof patients.1, 2 Both can be consid- ered growing challenges in dentistry, be- causewithsuchpatients,especiallyincases of severe parafunction, the etiology can rarely be successfully and permanently eliminated.3–5 Therefore,continuousmon- itoringtocontrolrelatedpathologiesisre- quired. Themostfrequentcausesoferosionare unbalanced dietaryhabits with a high con- sumptionofacidicfoodorbeverages(such as fruit, carbonated drinks, fruit juices and vinegar), as well as abnormal intrinsic acid production,suchasinbulimianervosa,acid refluxandhiatalhernia.Insufficientsalivary flowrateorbuffercapacityand,ingeneral, salivary composition changes induced by variousdiseases,medicationsandagingare other etiological co-factors.6–9 As regards abrasion, awake and sleep bruxism aretwo differentformsofparafunctionalactivities that can severely affect tooth integrity.4, 5 Preventive and restorative measures are therefore mandatory to correct and limit theextentoffurthertissueandrestoration destruction. An important clinical finding is that a large number of patients affected by hard-tissue loss present combined eti- ologies,challengingthedentalteamtode- termine a multifactorial preventive and restorativeapproach.1–9 The dental consequences of abrasion and erosion are manifold and involve a loss of enamel, with progressive exposure of large dentin surfaces, which significantly affectstheocclusal,facialandlingualtooth anatomy and has biological consequences too.Objectivesymptomsorcomplaintsre- portedbypatientsareshorteningofteeth, discoloration, tooth displacement, dentin sensitivity, as well as an increased risk of formsofearlyrestorativeinterventionand their potential to restrict ongoing tissue destruction. A comprehensive treatment approach Themodernapproachtothetreatmentof toothwearaimstostopitsprogressionbe- forefullprostheticrehabilitationbecomes indicated, which would require the re- movaloflargeamountsofadditionaltooth substance with potential biological com- plications10, 11 and a rather inadequate bio- mechanical rationale. The approach in- volves three steps: (1) acomprehensiveetiologicalclinicalin- vestigation,includingdietanalysisand identification of general/medical and local risk factors; (2) treatment planning and execution, in- cluding a proper functional and es- thetic wax-up defining the new smile line and tooth anatomy, transferred then to the mouth with a combination ofdirectandindirectrestorations;and (3) a maintenance program, including a protectivenightguardand,potentially, repair or replacement of restorations over a medium- or long-term time frame. The restorative options at hand comprise direct partial composite restorations, in- direct partial composite or ceramic restorations, and indirect full-ceramic restorations. Considering the more dra- matic failure patterns observed with con- ventional prosthetic restoration,10, 11 using more conservative restorations, such as partialdirectandindirectrestorations,ap- pears to have irrefutable advantages and promising outcomes in the treatment of severe abrasion and erosion.12–14 decay and premature loss of marginal adaptation of the restoration. The signifi- cant impact of tooth wear on occlusion, function and esthetics leadsthe patientto seek advice and intervention. The biome- chanical challenge shall entail a range of treatments involving different specialties, from preventive measures to full-mouth rehabilitation. Intermediate stages (slight to moderate erosion or abrasion) require other clinical measures, such as various formsofadhesiveandpartialrestorations. The aim of this paper is to present a sound clinical concept for addressing various Article_Dietschi_00-00.qxp_Layout 1 02.03.16 20:47 Seite 1 Article_Dietschi_00-00.qxp_Layout 102.03.1620:47 Seite 1