IIDC 2013

1. Conservative Management Of
Tooth Surface Loss –
The Unconventional Way
Extensive tooth surface loss has been traditionally managed
by extensive indirect restorations in the form of crowns or
onlays. These procedures may not be deemed ‘conservative’
in the true sense of the word.
Due to improved composite materials and bonding
techniques a possibility to manage such situations with
direct restorations has emerged.
Slide No. 1 Dr. Abhijit Lele Poster No. 27

2. Pre-operative
Slide No. 2 Dr. Abhijit Lele Poster No. 27

3. Pre operative
•Severe wear on Buccal surfaces of
Right side posteriors.
Almost negligible wear on left
side posteriors
Restoring the left side posteriors was uncalled for since there was
negligible wear on those teeth.
Therefore it was decided to use the ‘DAHL’S Concept’ where in we
planned to restore the anteriors and the right side posteriors and leave
the left side posteriors out of occlusion. With time, they will supra-erupt
and will start meeting.
Slide No. 3 Dr. Abhijit Lele Poster No:27

4. Diagnosis and Treatment plan
• The cause of TSL was not entirely clear.
Gastric reflux combined with wrong brushing
pattern were suspected.
• Treatment plan
• 1. Control aetiology
• 2. Diagnostic casts with occlusal records in
RCP (CR)
• 3. Diagnostic wax-up
• 4. Prepare silicone indices on the wax-up
• 5. Build up teeth with direct composites using
the indices as matrices for developing the
desired anatomy
• 6. All the anteriors and right side posteriors to
be built up in composite. The left side
posteriors to be allowed to supra-erupt.
• 7. Provision of Hard Acrylic splint for
protection of restorations
Slide No. 4 Dr. Abhijit Lele Poster No. 27

5. Post-operative
Direct Composite Protrusive Contacts Post-op
Build-ups
Posterior Disclusion Post-op
Centric Contacts
In Lateral excursion
Slide No. 5 Dr. Abhijit Lele Poster No. 27

6. Conclusion
Management of TSL with direct
composite restorations offers
following advantages-
•Ultra-conservative
•Economical
•Less stressful
•Quicker
Quicke
Drawbacks-
•Needs complex clinical skills
•Long periods of intra-operative
time
•Life of restorations may be
shorter than indirect restorations
•Fear of getting ridiculed by peers
Slide No. 6 Dr. Abhijit Lele Poster No. 27

7. Conclusion
Management of TSL with direct
composite restorations offers
following advantages-
•Ultra-conservative
•Economical
•Less stressful
•Quicker
Quicke
Drawbacks-
•Needs complex clinical skills
•Long periods of intra-operative
time
•Life of restorations may be
shorter than indirect restorations
•Fear of getting ridiculed by peers
Slide No. 6 Dr. Abhijit Lele Poster No. 27