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Dental Tribune Middle East & Africa Edition | 6/2016 19 Figure17:Finalviewofpalatalsurfaces Figure18:Finalrestorationson thesixanterior teeth Figure19:Finalsmile palatal aspects with Empress (Ivoclar Vivadent)palatalveneers. PosteriorDahlappliance Tooth wear affecting only posterior teeth is usually part of a generalised condition affecting the whole denti- tion. Occasionally, the pattern of this tooth wear is such that individual posterior teeth may require restora- tion. More often, however, the Dahl appliance principle can be used to reverse the over eruption of poste- rior teeth due to the opposing teeth beingextracted. Where space is at a premium, the selection of a gold alloy as opposed to porcelain will be advantageous. Because of the normal arc of man- dibular closure, there will often be morespaceavailableinthepremolar regions, allowing the opportunity to use more aesthetic restorations. Aes- thetic demand is often greater for occlusal surfaces in the mandibular arch. In selected cases, it is possible to con- sider a full mouth reconstruction of the worn dentition using resin- bonded ceramic restorations. The longer-term durability, particularly of the posterior onlay restoration, remains unpredictable and charac- teristically small fracture lines can appear in time, which may eventu- allyresultincatastrophicfailure. AlternativeDahlappliances The same principles can be used in traditional crown and bridgework by leaving the prototype crowns high and waiting for over-eruption. Figures 13-19 is a typical case study of a young lady with bulimia requir- ing anterior restoration, by using the Dahl appliance theory with ‘high’ anterior prototype crowns to gain space,thepalatalaspectsoftheerod- edteethneednotbeprepared. Over-eruption, when it does occur, is seldom axial and involves tipping as well. In this scenario palatal upper cusps often appear to ‘grow’ longer and, likewise, lower buccal cusps. This increases the potential for the introductionbothRCP-ICPslidesand also non-working side interferences. Thus, every Dahl appliance treat- ment should finish with careful as- sessmentoftheocclusionandwhere appropriate occlusal adjustment in order to maintain the five principles ofocclusionintherestoredcase. Conclusion It is hoped that this article gives you an update and insight into the Dahl concept. Although there is a need for further research, the evidence to dateindicatesthatthetechniquecan be confidently and successfully used in a variety of PDclinical situations and for many patients, irrespective ofageorsex. The technique appears to be safe and avoids performing destructive restorative procedures on compro- mised teeth. The development of adverse events is very rare. If they do occur, they tend to be minor in na- tureandtransientwithnolong-term adversesequelae. The Dahl concept tends to be asso- ciated with the management of the worn dentition. However, the tech- nique could also be applied to com- promised and root filled teeth, and to correct localised distortions in the occlusalplane. Acknowledgements They author would like to thank the following for their help in preparing the articlesinthisseries: •Dr.IbrahimHussain,BDS,M.Med.Sci.Implantology–implantsurgeon •Dr.AndrewWatson,BDS,MSc,specialistinendodontics • Dr. Amit Patel, BDS, MSc, MClinDent, MFDS, RCSEd, MRD, RCSEng, specialist inperiodontics •GaryJenkinson,dentaltechnician,ARTLaboratory,Sheffield. ProfessorPaulTiptonBDS,MSc,DGDPRCS(UK) DENTALSURGEON VisitingProfessorofRestorativeandCosmeticDentistry,Cityof LondonDentalSchool | www.colds.co.uk SPECIALISTINPROSTHODONTICS | www.drpaultipton.co.uk TClinic@Manchester,London | www.tclinic.co.uk TIPTONTRAININGLtd | www.tiptontraining.co.uk www.bard.uk.com President of theBritishAcademyofRestorativeDentistry(BARD) ◊Page18 restorative Dental Tribune Middle East & Africa Edition | 6/201619