What are the most important steps in diagnosing and managing tooth wear, and where can the process break down?
First of all, tooth wear must be diagnosed at an early stage. Dentists should be able to recognise the first signs of tooth wear and identify the aetiological factors in order to take the correct preventive measures to stabilise the tooth wear. They should then see the patient once a year to monitor the wear and evaluate the effectiveness of the preventive measures. In my opinion, the main mistake dentists make is recognising the problem only once the wear is so pronounced that restorative treatment is indicated. At that point, treatment is more complex, and full-mouth rehabilitation may be difficult without a clear protocol for restoring the worn dentition using, for instance, direct composite restorations.

For the direct composite approaches you will discuss, in which clinical situations is each approach most appropriate?
The technique used is determined mainly by the preference and experience of the operator. The injection moulding technique can be used to build up all the teeth, and a highly filled flowable composite is used for this technique. The stamp technique, which uses a composite stamp in combination with a conventional composite, is used to build up premolars and molars, while the partial stamp technique can be used to build up the anterior teeth. Freehand modelling with a conventional composite can be used in cases of limited to moderate tooth wear; however, the dentist must be experienced in building up worn teeth to the correct morphology and function.

What is the webinar’s main message on improving predictability in tooth wear cases treated with direct composite restorations?
Dentists need to analyse the case in detail. The most important steps when treating patients with tooth wear are correct diagnosis, identification of the aetiology, implementation of preventive measures and ongoing monitoring. This is the essential starting point of treatment. When restorative treatment is indicated, dentists need to understand the clinical protocol for rehabilitation of generalised tooth wear, starting with correct bite registration, diagnostic wax-up and mock-up and continuing with building up the worn teeth using direct composite restorations. Good communication with the dental technician is very important here.