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cosmetic dentistry Italian Edition Vol. 2, 2017

and ceramic inlays and onlays has not shown a major advantage of either material.33,34 I clearly favour composite in the context of tooth wear. Were ceramics to be chosen, the Empress ma- terial (Ivoclar Vivadent), which has shown limit- ed annual failure rates,35 and, of course, today’s new lithium disilicate pressed ceramic (IPS e.max Press, Ivoclar Vivadent), with improved flexur- al strength and fatigue resistance,36 would be considered the best choice. _Longevity of restorations placed to correct severe tooth wear and erosion Clinical studies have demonstrated that the performance of composite in the treatment of advanced tooth wear is adequate and that partial fractures represent the most likely complication. These can be corrected by a repair or uncom- plicated replacement of the restoration.37-39 The ten year survival rate of porcelain-fused-tometal crowns has been proved to be slightly superior to that of composite restorations, but with much more severe complications: Porcelain- fused- to-metal failures led mainly to endodontic treatments or to extractions, while composite failures or fractures could be either repaired or replaced.40 This again demonstrates the reason the conservative and adhesive approach is fa- voured for treating all kinds of mild to moderate forms of tooth wear and erosion. _Conclusion The incidence of tooth wear represents an increasing concern for the dental team and has multifactorial origins. Behavioural changes, an unbalanced diet, various medical conditions and medications inducing acid reflux or influencing salivary composition and flow rate trigger ero- sion. In addition, awake and sleep bruxism are widespread functional disorders that cause se- vere abrasion. It is then increasingly important to diagnose early signs of tooth wear so that prop- er preventive and, if necessary, restorative mea- sures are taken, with the focus on biomechanics and long-term tissue preservation. _Acknowledgments I would like to thank Serge Erpen (Oral Pro, Geneva, Switzerland) for the fabrication of the wax-ups presented in Figures 2d and f. Editorial note: This article was first published in Clinical Masters magazine 1/2016. A complete list of references is available from the publisher. case report _ aesthetic and restorative dentistry Fig. 2r Fig. 2s Figs. 2r & s_Five-year recall. The patient never did wear a night guard despite it being recommended. We can observe some additional tooth wear, mainly of an erosive nature (see, for instance, the cervical areas of the mandibular premolars). The restorations however show minimal wear or volume loss, apart from microfractures of a few margins (i.e., teeth #46 and 47). _author Dr Didier Dietschi, is a senior lecturer at the Department of Cariology and Endodontics 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, USA. Dr Dietschi also works at the Geneva Smile Center, a private practice and education centre, in Switzerland. He can be contacted at ddietschi@genevasmilecenter.ch. Geneva Smile Center – Quai Gustave-Ador 2 – 1207 Geneva (Switzerland) cosmetic dentistry 2_2017 19

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