PMC3272350_01
Varying severities of erosion observed in the (a) anterior maxillary facial surfaces, (b) anterior maxillary palatal surface, and (c) posterior mandibular occlusal surfaces of a 23-year-old female.
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Studies into the use of dentine bonding agents as a management strategy have found that the coating was retained for a short period of time only.  Figure 5 shows an example of directly applied resin composite bonded at an increased vertical dimension in order to provide long-term protection to (a) the eroded palatal surface of a maxillary incisor and (b) the occlusal surfaces of mandibular molars (compare with Figure 1).
Localized tooth wear of a 15 year old.
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Frequent sipping of small quantities of acidic drinks will also increase their erosive potential.  Figure 2 shows localized tooth wear due to frequent sipping of carbonated drinks in a 15 year old.
Photographs of a patient with attritional wear of the maxillary and mandibular teeth.
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The specific pattern of wear coincides with how and where the patient bruxes or rubs their teeth forcibly against one another during their parafunction.  Figure 3 illustrates a pattern of attritional TW which shows even wear of the maxillary and mandibular teeth.
Photographs of (a, b) extensively abraded crowns and (c, d) the subsequent treatment.
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Figure 4 shows photographs of a patient who chewed sand as a habit. Figures 4(a) and 4(b) show the extensive abrasion of her third full mouth reconstruction in five years.
Biologically pragmatic treatment of erosion using direct resin composite in a 23-year-old female (compare to Figure 1).
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fig5
Studies into the use of dentine bonding agents as a management strategy have found that the coating was retained for a short period of time only.  Figure 5 shows an example of directly applied resin composite bonded at an increased vertical dimension in order to provide long-term protection to (a) the eroded palatal surface of a maxillary incisor and (b) the occlusal surfaces of mandibular molars (compare with Figure 1). TW is conservative, predictable, and usually aesthetically acceptable to patients (Figure 5). The use of resin composite is also safe with minimal long-term pulpal or structural complications being reported when this is applied to the external aspects of teeth in thick section.
Photograph of a female patient with erosion caused by bulimia.
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Photograph of reversible "mock up" with direct resin composite on the unetched enamel of just the eroded anterior teeth to allow patient evaluation prior to treatment. This "mock up" or composite simulation was done to check that it met with the patients approval of the proposed changes in appearance. Once it did, the temporary composite "mock up" was removed and just the anterior eroded teeth were directly bonded freehand at the agreed increased vertical dimension with hybrid resin composite.
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Pragmatic "one-hit" direct resin composite bonding has been shown to be clinically successful with minimal or no-long-term iatrogenic effects, and the use of three-step (etch, primer, and bond) bonding system is still the gold standard for mixed enamel/dentine bonding.  Figure 7 shows the result after the affected teeth were temporarily "mocked up" with directly applied hybrid resin composite at an increased occlusal vertical dimension.
Patient showing moderate-to-severe wear treated by night guard vital bleaching followed by direct resin composite bonding. No destruction of any of the residual sound tooth tissue was involved.
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Management of posterior TW using adhesively retained gold onlays at 15 years after cementation.
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These provisional restorations will secure the space gained by the anterior bonding. The premolars or molars in between these newly bonded teeth can then be definitively restored at leisure during subsequent appointments with an appropriate approach and materials, all depending on the degree of wear or the existing restorations in the posterior teeth.  Figure 9 shows photographs of gold adhesive onlays used to restore worn posterior teeth at 15 year followup.