Speakers - 2026

Title: Severe mandibular anterior tooth wear: Expanding the boundaries of the direct composite approach

Abstract

Introduction:
Tooth wear is a common clinical condition that is increasingly encountered in daily practice. Unlike physiological wear, pathological wear is characterized by disproportionate loss of tooth structure, often resulting in functional, esthetic, and biological complications that can impair oral health and quality of life. Adhesive, minimally invasive techniques have proven effective in managing moderate to severe cases, offering a conservative alternative to traditional full-coverage restorations.

Objective:
To describe the step-by-step rehabilitation of six severely worn mandibular anterior teeth with diastemata using a direct composite approach, chosen as the most conservative and financially feasible option compared with conventional prosthetic solutions.

Case Presentation:
A 68-year-old male patient was referred to the postgraduate clinic of Restorative Dentistry of National and Kapodistrian University of Athens, for restoration of his mandibular anterior teeth. Clinical examination revealed severe tooth wear while the teeth retained vitality, with no signs of periapical or periodontal pathology. The opposing arch presented with a recent removable prosthesis. The patient’s history and wear pattern confirmed the presence of wear primarily of mechanical etiology (attrition). Following initial photographs and digital impressions, a digital wax-up was designed and transferred intraorally through a mock-up to assess the proposed morphology and occlusion. Considering the antagonist dentition and the patient’s request for a conservative and economical solution, direct resin composite restorations were proposed as the most suitable treatment plan.

Shade selection was performed using the button technique and cross-polarization filter, and rubber dam isolation was achieved with dental floss ligatures. No tooth preparation was performed other than surface modification with Al2O3 (52 micromter) air-particle abrasion and a slight enamel bevel with a fine diamond bur. Palatal shells were constructed with a silicone index and a nanohybrid enamel composite. Dentin anatomy was free-hand sculpted with two dentin shades, while sectional matrices re-established proximal contours and closed the diastemata. The buccal enamel layer was placed, and final polymerization was completed under glycerin gel. Finishing and polishing were accomplished using diamond burs, a No.12 scalpel blade, rubber wheels, and diamond paste. After rehydration, the restorations demonstrated excellent integration and a highly natural esthetic outcome. At the one-year follow-up, the restorations maintained their optical properties, functional stability, and esthetic harmony.

Conclusion:
Direct composite restorations can provide a predictable, minimally invasive solution for severe anterior tooth wear, preserving vitality and tooth structure while delivering esthetic and cost-effective results with evidence of long-term stability. Within the limits of the direct approach, this case underscores its clinical potential as a viable alternative to more invasive prosthetic treatments.

What will the audience take away from the presentation?

1. Understanding the clinical boundaries of direct composites: Attendees will gain insight into the clinical possibilities of direct adhesive techniques in severe anterior wear and recognize the points at which prosthetic alternatives become necessary.
2. Step-by-step protocol: They will become familiar with a practical workflow — from digital planning and mock-up to shade selection, layering, and finishing — that can be directly applied in clinical practice.
3. Minimally invasive treatment strategies: The case will highlight how minimally invasive adhesive techniques preserve vitality and tooth structure while providing functional and esthetic outcomes.
4. Long-term performance considerations: Evidence-based data support the effectiveness of composite resins in wear cases, allowing clinicians to weigh direct composites not just as interim, but also as definitive solution in selected cases.