Tooth wear: A systematic reviewof treatment options

Erik-Jan Muts, MSc,a Hans van Pelt, DDS, PhD,b

Daniel Edelhoff, DMD, PhD, CDT,c Ivo Krejci, DMD, PhD,d andMaCen CenterGro erlands;Den ermany;Sch land

Statement of probclinician may have

ogy and Endodontics, School of Dentistry, University of Geneva.ed and Removable Prosthodontics, Center for Dentistry and Oral Hygiene, UniversityMedical Center Groningen, University of Groningen.aAssistant Professor, Department of Fixed anCenter Groningen, University of Groningen.bAssociate Professor, Department of Fixed anCenter Groningen, University of Groningen.cTenured Associate Professor, Department odProfessor and Chairman, Division of CarioleProfessor and Chairman, Department of FixMuts et ald Removable Prosthodontics, Center for Dentistry and Oral Hygiene, University Medical

f Prosthodontics, Dental School, Ludwig-Maximilians-University.The available evidence advises the use of diagnostic waxing anddiagnostic tooth arrangement. The use of centric relation is advisedfor the occlusal positioning for rehabilitation. Testing of the verticaldimension increases with a removable appliance and the use of aprovisional stage before denitive treatment is recommended. Bothcomposite resin and glass ceramic are indicated, and a protectiveappliance with regular posttreatment evaluation is advised for follow-up.

d Removable Prosthodontics, Center for Dentistry and Oral Hygiene, University MedicalPurpose. The purpose of this study was to identify similarities among treatment options for generalized tooth wear and todevelop an approach to rehabilitation based on the best evidence available.

Material and methods. A Medline and Cochrane search (for articles published from January 31, 2003, to January 31, 2013)was conducted. Minimally invasive and fully described treatments for generalized tooth wear with esthetically satisfying resultswere included. Five steps within the treatment procedures were analyzed: diagnostic waxing (DW), occlusal positioning (OP),vertical dimension increase (VDI), restoration, and follow-up.

Results. Common threads were established within the 5 treatment steps. Nine studies used DW, and 6 performed diagnostictooth arrangement (DTA). Centric relation was used in 5 studies, and VDI was tested in 8 studies, 5 of which used aremovable appliance. Seven studies implemented a provisional stage, and 5 used composite resin at that time. For denitivetreatment, composite resin (6 studies) and glass ceramic (6 studies) were used. Seven studies applied a protective appliance,and 5 scheduled regular posttreatment evaluation as means of aftercare.

Conclusions. Within the limitations of this systematic review, the present evidence is not strong enough to form conclusions,and the presented similarities cannot be substantiated with evidence. Therefore, comprehensive clinical research into thedesignated treatment of generalized tooth wear is recommended. (J Prosthet Dent 2014;-:---)

Clinical Implicationsrco Cune, DDS, PhDe

ter for Dentistry and Oral Hygiene, University Medicalningen, University of Groningen, Groningen, The Nethtal School, Ludwig-Maximilians-University, Munich, Gool of Dentistry, University of Geneva, Geneva, Switzer

lem. Treatment of tooth wear is increasing. Because no evidence-based guidelines aredifculties deciding which treatment option to choose to resolve complex situations.available, the

Selection criteria

describing the treatment of only poste-rior or anterior dentition or incomplete

Table I. Broad inclusion criteria

Generalized tooth wear.Complete description of treatment.Wear into dentin.Minimally invasive.No removable dentures.Esthetically satisfying.Minimal edentulous spaces prior to

Table II. Detailed inclusion criteria

Simple.Stepwise treatment.Adjustable and repairable.Cost-effective.

2 Volume - Issue -The prevalence of the pathologicalloss of calcied tooth substance in amechanical but particularly in a chem-ical way is globally perceived as anincreasing problem.1,2 Tooth wear af-fects tooth anatomy, and all kinds ofcomplications may arise if it is left un-treated. These complications resultfrom the loss of mineralized toothsubstance and include a higher risk oftooth sensitivity, pulpal complications,and discoloration.3,4 Probably evenmore important is the loss of functionand esthetics. The loss of occlusal ver-tical dimension may result in dentoal-veolar compensation or an increasedinterocclusal rest space.5 This will affectthe neuromusculature, efciency ofmasticatory function, and esthetics asthe position of the smile line, the hori-zontal occlusal plane, and the incisaledge position changes.4-6 Loss ofanterior guidance and canine protec-tion may increase horizontal stresses inthe posterior occlusal surfaces andthereby cause loss and fracture of res-torations.4 Moreover, instability of theocclusion will decrease masticatoryfunction and increase the incidence ofcheek and tongue biting.3,5,7 Thedescribed loss of tooth substance in-uences not only teeth and masticatorysystem but also quality of life.8

Dentists should therefore useadequate diagnostic tools and indicesto identify tooth wear while straight-forward treatment is still possible.5,7,8

Accurate monitoring and use of diag-nostic casts, indices, and/or intraoralphotographs are recommended.7,9 Ata certain stage, the restorative treat-ment of tooth wear is necessary toprevent the negative effects previouslydescribed.

The restoration of teeth with severewear is complex. Several approachesthat use different materials and tech-niques to restore worn dentition havebeen described.3,4,9 Unfortunately, noevidence-based guidelines are availableto help clinicians choose the mostappropriate therapy.10 At present, onlyexpert opinions guide the clinician.

The objective of this systematic re-view was to identify different treatmentThe Journal of Prosthetic DentisThe purpose of the inclusion criteriawas to select articles that describedmodern adhesive techniques and prac-tical techniques for clinicians to use inthe best interest of their patients. Thesecriteria included fully described treat-ment for generalized tooth wear withdata related to the clinical outcome.Both broad and detailed inclusioncriteria were used. According to thebroad inclusion criteria (Table I), thetreatment should be minimally invasive,esthetically satisfying, and performedwithout the use of long-term removabledentures. Studies were consideredminimally invasive when restorativeprocedures were performed with as lit-tle removal of healthy tissue asreasonably possible.12 This implies theuse of adhesive procedures. Treatmentswere found to be esthetically satisfyingwhen the original tooth proportions,smile line, horizontal plane of occlu-sion, and incisal edge position wereoptions for generalized tooth wear ac-cording to modern, and in particularminimally invasive, dentistry. Is there acommon thread in these treatmentpossibilities? In order to ensure a usefulapproach, the treatment should besimple, stepwise, adjustable, repairable,and cost-effective. Contemporary ad-hesive techniques meet most re-quirements. Remaining tooth structureneeds to be preserved, and less experi-enced dentists should be able to treatthe patient with satisfactory results.11

Important steps to look into are theneed for diagnostic waxing (DW),chosen occlusal position (OP), verticaldimension increase (VDI), restorations,and follow-up. Similarities or differ-ences in treatment options are estab-lished analyzing these 5 treatmentsteps. Common similarities withindifferent treatment options could beconsidered as the best available evi-dence for the choice of treatment forgeneralized tooth wear.

MATERIAL AND METHODStryrestored.4,5,13 Treatments of wear thathad progressed into the dentin wereincluded.

After the broad selection, detailedinclusion criteria (Table II) wereapplied. Studies were included thatdescribed simple, stepwise, adjustable,repairable, and cost-effective treat-ments. Treatment was considered sim-ple when the procedures were clearlyexplained and easy to execute, stepwisewhen treatment could be transferredstep by step from a long-term interimrestoration to a denitive stage or whena technique with direct composite resinwas used, adjustable and repairablewhen adhesive techniques were used,and cost-effective when a segmentedtransfer was possible or a direct com-posite resin was used.

Furthermore, only English-languagearticles concerning humans publishedin dental journals in the last 10 yearswere included. Because only adhesivetechniques could meet the selectioncriteria, the literature search was limitedto the past 10 years.4,14 This period wasexpected to contain the best evidenceavailable because the prevalence (andas a result probably the treatment) oftooth wear is increasing.1,2 Studiesdescribing highly invasive, estheticallydisappointing, complicated, non-adjustable, nonrepairable, or expensivetreatments were excluded. Studies

treatment.Muts et al

Table III. Search conducted in Medline and Cochrane databases

DatabaseSearchNo. Search Terms

No. ofResults

Medline (up toJanuary 31, 2013)

1 Tooth Wear/therapy[MeSH] 1366

2 #1 AND (last 10 years[PDat] AND Humans[MeSH] AND English[lang] AND jsubsetd

[text])

518

Cochrane (up toJanuary 31, 2013)

1 MeSH descriptor: [Tooth Wear] explode alltrees and with qualier(s): [Therapy-TH]

63

D

- 2014 3treatment descriptions were alsoexcluded.

Search methodology

A literature search of the Medlineand Cochrane databases (from articlespublished from January 31, 2003,to January 31, 2013) was performedto identify studies for inclusion. TheMedical Subject Heading (MeSH)Tooth Wear linked to the MeSH sub-heading therapy was used (ToothWear/therapy [MeSH]). The Cochranedatabase search was designed as a per-mutation of the Medline search strategyby manually selecting the studies of thelast 10 years. To ensure a highly sensitivesearch strategy, only the MeSH termTooth Wear/therapy [MeSH] wasused. This MeSH term also covers toothabrasion, tooth attrition, and tootherosion.

The results of the search wereextended by hand searching. Handsearching was performed by citation

2 #1 ANmining and expert recommendations.The performed searches are shown inTable III.

Table IV. Selection process used during

Assessment Inclusion C

Titles Relevant

Abstracts Broad inclusion cr

Full text Broad and detailed inclus

Included studies Combining su

Muts et alData collection

All 550 identied titles wereassessed for subject relevance andscreened for inclusion. The abstractswere then obtained from 111 appro-priate titles and assessed for inclusionaccording the broad inclusion criteria(Table I). Then 36 full texts were ob-tained and assessed according to thebroad and detailed inclusion criteria(Table II). This selection process waschosen to prevent unjustied exclusionat an early stage. Twenty publicationswere excluded.

To support the use of the inclusioncriteria, some excluded articles will beexplained. The study by Meyers15 wasexcluded because the esthetic result wasdisappointing and the original toothproportions were not restored. Thestudy by Avinash16 was also excludedbecause of the invasive treatment pro-cedures performed, even thoughenough space was available for nonin-vasive restorative treatment. The study

last 10 years (manual) 32by Fradeani et al17 was excludedbecause the treatment was consideredto be neither stepwise nor cost-effective.

data collection

riteria No. of Results

topic 111

iteria (Table I) 36

ion criteria (Table II) 16

bstudies 11Data analysis

The included studies were analyzedand described. The year, type of study,number of patients, follow-up period ofthe denitive treatment stage, andpublishing journal of the studies arelisted in Table V. The 11 differenttreatments for generalized tooth wearwere also assessed by analyzing the 5different treatment steps: DW, occlusalposition (OP), VDI, restoration, andfollow-up.

These steps were chosen becausethey provide the basics of treatmentprocedures, depend as little as possibleon the preference of the practitioner,and are probably well described inmost studies. More detailed procedures(such as, interocclusal record registra-tion) depend more on practitionerpreference. Each step was analyzed bymeans of research questions, andthe results were schematized on a chart.To determine a common thread indifferent treatment steps, there shouldbe similarity in at least 5 studies.

Seven research questions were askedabout each included study in accor-dance with the 5 different treatmentsteps, as shown in Table VI.

RESULTS

Description of studies

A total of 16 publications on thetreatment of generalized, complete-arch tooth wear met the inclusioncriteria (Table IV). By merging sub-studies, a total of 11 studies wereincluded and analyzed.Citation mining was performed bychecking the reference lists of retrievedarticles against the selection criteria; nonew articles were found. All articlesrecommended by experts had alreadybeen analyzed or included. Becausesome studies consisted of multiplepublications, those publications weremerged (Table IV, Fig. 1). A total of 11studies, consisting of 16 publications,were included in this review.

ti

4 Volume - Issue -First electronic search (M550

550 titles scanned111 titles selected

111 abstracts obtained

111 abstractsassessed

36 abstracts selected36 full-texts obtained

36 full-texts assessed16 publications

selected16 publications

analyzedAll included studies were casereports (8 studies) or case series(3 studies) that studied between 1 and4 patients and were published between2007 and 2012 (Table V). The follow-up period after the denitive treatmentstage ranged from 0 to 20 months. Thefollow-up of the interim stage was notincluded.

Results of analysis

The 5 treatment steps and potentialsimilarities between the treatment op-tions were analyzed by following thespecic research questions. The resultsof the analysis are described below andare shown in Table VII.

DW was used in 9 studies forcommunication with both the patientand the dental laboratory, for thefabrication of templates, for diagnostictooth arrangements (DTA), and forinterim and denitive restorations. Onestudy used computer-aided design

16 publications contained 11A total 11 studie

1 Schematic representation of

The Journal of Prosthetic DentisEDLINE and Cochrane)tles

75 abstracts did not meetthe broad inclusion criteria

(Table I)

20 full-texts did not meetthe broad and detailed

inclusion criteria(Tables I and II)

439 titles were not relevantto the subject or duplicated

during search process(CAD) waxing. Both diagnostic andanatomic waxings were used. Sixstudies performed a DTA with tem-plates and (temporary) composite resinto evaluate the treatment outcome and,if needed, to make adjustments.

Centric relation (CR) was theocclusal position of choice for rehabili-tation in 5 studies, and maximum inter-cuspation (MI) was used in 2 studies.The remaining studies did not mentionthe use of the occlusal position.

The VDI was tested before treatmentin 8 of 11 studies. Five studies used aremovable appliance, one of whichcombined it with anterior compositeresin. Four studies used a xed methodwith different materials, including (in)direct composite resin and metalinterim restorations. The overall periodof testing ranged from 1 to 3 months,but 1 study used an extended period of6 months. When using a removablesplint, the study authors recommended24 hours of use a day.

different studies (Table IV)s final included

searching process.

trySeven studies used an interim stagebefore the denitive treatment. Com-posite resin was the most used restor-ative material for this stage and wasused in 5 studies; 2 studies used it witha direct technique and 2 studies with anindirect technique, and 1 study com-bined both the direct and indirecttechniques. Furthermore CAD/CAM-fabricated high density polymethylmethacrylate (PMMA) was used in 2studies. One study used interim metaland acrylic resin restorative materials.

For the denitive treatment proce-dure, composite resin and glass ce-ramics were the most commonly usedrestorative materials. Six studies usedcomposite resin; 2 studies used itdirectly, 2 studies used it indirectly, and2 studies combined both techniques.Glass ceramics were used in 6 studies, 3of which explicitly used lithium dis-ilicate. Furthermore, 4 studies usedgold, 2 studies used metal ceramic, 1study used metal resin, and 1 studyused zirconia ceramic.

Seven studies prescribed a protectiveappliance (hard acrylic resin), and 2studies specically advised a Michigan-type protective appliance. Five studiesadvised regular evaluations to modifythe occlusion. In 4 studies, a (partial)provisional state was accomplished,and a step-by-step replacement of theinterim restorations with denitive res-torations was recommended; 3 studiesclearly explained their 2-phase tech-nique (interim and denitive stage) andthe restorative materials used fordenitive restoration; 1 study recom-mended the transfer only when neces-sary. Which restorative material wasrecommended was unclear; therefore,the presented treatment was consideredto be the denitive treatment.

DISCUSSION

Key ndings

The objective of this systematic re-view was to identify recent treatmentoptions for generalized tooth wear andto identify within these treatment op-tions a common thread of 5 importantMuts et al

Table V. Overview of included studies

Study Year Type of StudyNo. ofPatients

FollowPeriod

Dietschi18 2011 Case report * *

Edelhoff19 2012 Case report 1 0

Mizrahi23 2008 Case report 1 0

Spreaco27 2010 Case report 1 9

Mehta22 2012 Case series 2 0

Schwarz26 2011 Case report 1 6

Vailati29-32 2008, 2011, 2012 Case series 4 0-12

Reston24,25 2010, 2012 Case series 2 0

Stumbaum28 2010 Case report 1 0

Garcia20 2009 Case report 1 20

Hayashi21 2007 Case report 1 12

- 2014 5treatment steps. These ndings couldguide the clinician through the complextreatment of generalized tooth wear.

Level of evidence

All included studies were case re-ports or case series with small numbersof patients and short or no follow-uptreatment. Assessing the includedstudies on the rating of the publishingjournals is not possible, and thereforeno study quality rating was performed.The case reports and case series shouldbe accepted as proof of principlesand provide the best evidence to

*No result could be established.guide the clinician during treatment.

Table VI. Research questions

TreatmentStep Rese

1 DW 1 W

2 Was DW used fo

2 DW 3 Was CR or MI used

3 VDI 4 Was VD

5 If so,

4 Restoration 6 Which restorative materiaand

5 Follow-up 7 How w

CR, centric relation; DTA, diagnostic tooth arrangintercuspation; VDI, vertical dimension increase.

Muts et alNevertheless, the present evidence isnot strong enough to form conclusions(low level of evidence).10

Interpretation of results

DW and DTA were frequently used(in more than 5 studies) so a commonthread was determined. During thetreatment of severe tooth wear, the useof DW and DTA may benet theclinician in the following ways: it al-lows the treatment outcome to bepreviewed while adaptations are stillpossible; it informs the patient; itaids the fabrication of templates that

are advantageous during adhesive

arch Question

as DTA performed?

r treatment or treatment planning?

as occlusal position before treatment?

I tested before treatment?

how and for how long?

ls were used, including possible provisionaldenitive restoration?

as follow-up performed?

ement; DW, diagnostic waxing; MI, maximumfoundations and preparation; and itprovides better communication be-tween dentist, patient, and dentaltechnician.4,14,23,29,30 The disadvan-tages are the costs and time associatedwith DW and DTA.33

CR was most frequently used andwas determined to be a commonthread. Although the use of CR mayhelp the clinician during treatment,considering the molar occlusion in thedecision whether to choose MI or CR isprobably wise.29,34 Moreover, deter-mining CR may be difcult, and com-bined with an unfavorable molarocclusion, it may lead to an unnec-

-up(mo) Publishing Journal

Eur J Esthet Dent

Quintessence Int

Eur J Esthet Dent

Eur J Esthet Dent

Br Dent J

J Prosthet Dent

Eur J Esthet Dent, J Adhes Dent

Oper Dent

Int J Comput Dent

Bull Tokyo Dent Coll

Oper Dentessary increase in the horizontal over-lap.29 In contrast, CR is oftenrecommended because of its repro-ducibility.34 Changes in the occlusalscheme appear not to cause temporo-mandibular disorder-related problemswhen absent before treatment.35

The VDI was tested before treatmentin most studies; this step was deter-mined to be a common thread. In mostpatients, testing was performed with aremovable occlusal appliance. Thesimilarity was sufcient to use thistreatment step as a useful direction.According to previous studies, testingthe VDI is only needed when theremaining interocclusal rest spaceafter rehabilitation will be less than 2to 3 mm.6,22 Increasing the occlusal

mo

6 Volume - Issue -Table VII. Overview of analyzed treat

Study

DW

OPDW DTA VDI

Dietschi18 Yes * MI *vertical dimension seems to be a safeprocedure (signs and symptoms tend tobe self-limiting) and well accepted upto 5 mm.34,36 The testing periods variedin this study. If necessary, testing theVDI for a period of at least 1 month for24 hours a day is probably advised.5,22

In addition, Abduo34 concluded that

Edelhoff 19 Yes Yes CR Yes

Garcia20 Yes * CR Yes

Hayashi21 Yes * * Yes

Mehta22 Yes Yes CR Yes

Mizrahi23 Yes Yes CR Yes

Reston24,25 * * * *

Schwarz26 Yes Yes * Yes

Spreaco27 Yes Yes * *

Stumbaum28 * * CR Yes

Vailati29-32 Yes Yes MI Yes

CR, centric relation; DTA, diagnostic tooth arrangPMMA, polymethyl methacrylate; VDI, vertical dim*No result could be established.

The Journal of Prosthetic Dentisent steps

VDI Rest

Method Wk Interim

* * Nonetesting patient acceptance or adapta-tion with a removable method is lesspredictable than with a xed method.In this review, 4 studies used a xedmethod; therefore, this method was notconsidered to be a common thread.

The majority used an interimstage before denitive treatment. The

Occlusal splint 12 High-densityPMMA

(CAD/CAM)

Occlusal splint * None

Acrylic resin(anterior), metal

(posterior)

26 Acrylicresin, metal

Occlusal splint 4 Compositeresin (indirect)

Direct compositeresin (anterior),occlusal splint(posterior)

8 Compositeresin

(direct/indirect)

* * None

Directcomposite

resin

12 Compositeresin

(direct)

* * None

Occlusalsplint

4-8 High-densityPMMA

(CAD/CAM),composite

resin (indirect)

Directcomposite

resin (posterior)

4 Compositeresin

(direct)

ement; DW, diagnostic waxing; MI, maximum intercension increase.

tryratives

Follow-upDenitive

Composite resin(direct/indirect),

lithiumdisilicate

Protectivesplint, regularcheck-upsimplementation of an interim stageduring the treatment of generalizedtooth wear was established to be aparallel within 7 studies and could beused as guidance. The implementationof this stage is performed to evaluatetreatment outcome and patient accep-tance.14,19 Changes in esthetics and

Lithium disilicate Clinical evaluationand modication,segmented transfer

Composite resin(direct),

metal resin,gold

Protective splint

Gold, glassceramic

Protective splint,3 mo recall

Gold, metalceramic,composite

resin (indirect)

Protective splint(Michigan type)

Glass ceramic,gold,

metal ceramic

Protective splint(Michigan type)

Compositeresin (direct)

Protective splint,segmented transfer(when necessary)

Lithiumdisilicate

Evaluation ofocclusion,oral hygieneinstruction

Composite resin(direct/indirect)

Evaluation ofocclusion

Zirconiaceramic

Protective splint,segmented transfer

to zirconiaceramic

Composite resin(indirect), glass

ceramic

Segmentednal restoration

posterior

uspation; OP, occlusal positioning;

Muts et al

- 2014 7function can still be made with littleeffort and without consequences beforestarting the denitive restorative phase.This simplies the rehabilitation andcreates the opportunity to perform astepwise treatment and to spreadaccompanying costs over severalyears.19,30 In contrast, implementing aninterim stage does lengthen the treat-ment period and increase total treat-ment costs. In this review, compositeresin was established to be the restor-ative material of choice during theinterim phase.

For the denitive treatment proce-dure, both composite resin and glassceramics were the most commonly usedrestoratives and were used in at least 5of the included studies.

According to the recent literature,composite resin seems to be a suitablerestorative material for restoring worndentition.33,37,38 Jaeggi et al recom-mend the use of an indirect restorativematerial when the VDI exceeds 2 mmbecause restoring the anatomy andocclusion is difcult and depends onthe sculpting skills of the dentist.3 In thelong term, there seems to be little dif-ference between direct and indirectcomposites.39 Therefore, other indirectmaterials are indicated for long-termstability; glass ceramic (lithium dis-ilicate) and gold are preferred.33,40-43

Both a protective appliance andregular posttreatment evaluations werefound to be a common thread in thetreatment procedures and could be usedas guidance. An appliance protects therestored dentition from nonfunctional(damaging) habits during the night.4,7

Limitations

The literature research was limitedto the period of 2003 to 2013 tosimplify the data collection and toexclude studies based on nonadhesivetechniques. Studies based on adhesivetechniques published before 2003 mayhave been excluded, but all includedarticles were published in 2007 or later,indicating that suitable studies are likelyto have been published in the last 10years.Muts et alThe selection criteria used limitedthe reproducibility of this review. Byusing examples of exclusion, this wasobviated as much as possible. Assessingthe outcome of the studies was almostimpossible because most studies didnot provide useful photographs. Forexample, the study performed bySmales and Berekally44 did not provideany photographs for judgment.

Only 5 treatment steps were analyzedin this review. Obviously, the treatmentprocedure consists of many more treat-ment steps. For example, making afacebow registration was not included.Only 1 researcher performed datacollection and data analysis. Therefore,the selection and analysis procedure wasnot controlled by a second researcherand may have been biased.

This review identies and summa-rizes different treatment options fortreating generalized tooth wear. Com-mon similarities in different treatmentsteps may be considered as the bestevidence available to guide the clini-cian in these steps. Unfortunately,evidence-based guidelines are stillunavailable.10

CONCLUSIONS

Within the limitations of this sys-tematic review, it can be concluded thatthe present evidence is not strongenough to form rm conclusions, andthe presented similarities cannot besubstantiated with evidence. Therefore,comprehensive research into the desig-nated treatment of generalized toothwear is highly recommended.

The similarities established withinvarious treatment steps may still behelpful to the clinician. The presentavailable evidence advises the use ofDW and DTA and the use of CR as theOP for rehabilitation. Furthermore,testing of the VDI with a removableappliance and the use of a provisionalstage before denitive treatment is rec-ommended. Both composite resin andglass ceramic are indicated materialsfor nal treatment. A protective appli-ance with regular evaluation is indi-cated for follow-up.REFERENCES

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Corresponding author:Dr Erik-Jan MutsDepartment of Fixed and RemovableProsthodonticsCTM, UMCGAntomus Deusinglaan 19713 AV GromngeuThe NetherlandsE-mail: info@erikjanmuts.nl

Copyright 2014 by the Editorial Council forThe Journal of Prosthetic Dentistry.Muts et al

Tooth wear: A systematic review of treatment optionsMaterial and MethodsSelection criteriaSearch methodologyData collectionData analysis

ResultsDescription of studiesResults of analysis

DiscussionKey findingsLevel of evidenceInterpretation of resultsLimitations

ConclusionsReferences