A Randomized Controlled Trial On Restorative Treatment Of Tooth Wear

Objectives: Restorative treatment of severe tooth wear often includes full rehabilitation in increased Vertical Dimension of Occlusion (VDO). The aim of this study was to evaluate survival and failure behavior of direct and indirect resin composite restorations in the treatment of severe tooth wear in patients requiring full rehabilitation in increased VDO.
Methods: This Randomized Controlled Trial (RCT) included patients with generalized severe tooth wear. Patients were randomly assigned to one of 2 restorative groups: (1) Direct: All restorations were completed with direct composites (Clearfil PhotoBond; SA Primer and Clearfil APX for load bearing areas and Empress direct (Vivadent) for anterior veneers; (2) Hybrid: First molars were treated with indirect composite (Clearfil Estenia C&B cemented with Panavia (Kuraray), while other teeth were restored directly according to the direct group. All patients received full mouth reconstructions in increased VDO and were evaluated after 3 years using modified FDI-criteria. Kaplan Meier and Cox regression analyses were used for longevity analysis (p<0.05).
Results: 42 patients (age: 36.8 ± 6.6y) were restoratively treated and all subjects were evaluated at follow up of 36 months (mean follow up: 37.5 ± 3.3). Only restorations on first molars were included in the analysis; 80 direct and 80 indirect restorations. After 3 years of observation 545 failures were found. The majority of failures were (chip)fractures (n=37). The annual failure rate on molars was 5.7% for direct composite and 18.4% for indirect restorations. The Cox-regression resulted in a Hazard ratio (HR) for indirect restorations of 3.8 (p<0.001).
Conclusions: To restore patients with severe tooth wear direct composite restorations were more successful then indirect composite restorations, mainly due to fracture.