What are the four main types of tooth wear, and how are they clinically distinguished?

The four primary mechanisms of tooth wear are erosion, attrition, abrasion, and abfraction — and each presents with distinct clinical features that inform treatment planning. Erosion results from chemical dissolution of hard tissue by acidic substances, either intrinsic (gastric acid from reflux or eating disorders) or extrinsic (dietary acids from soft drinks and citrus). It typically presents as generalized, smooth surface loss without sharp margins. Attrition is wear caused by direct tooth-to-tooth contact — most commonly from bruxism or parafunctional habits — and appears as flattened, often shiny facets that match on opposing teeth. Abrasion is mechanical wear from an external force (most commonly improper toothbrushing technique) and commonly appears as a rounded, smooth notch at the cervical area near the gumline. Abfraction, attributed to biomechanical loading from eccentric occlusal forces, presents as a wedge-shaped cervical lesion with sharp line angles. Importantly, these mechanisms rarely act in isolation. Research confirms that the most clinically significant interaction is between attrition and abrasion, which are potentiated by erosive damage to dental hard tissues — meaning what appears to be one type of wear is often the result of two or more processes working together. Source: Shellis RP, Addy M. "The interactions between attrition, abrasion and erosion in tooth wear." Monogr Oral Sci. 2014;25:32–45. PubMed PMID: 24993256.

How prevalent is significant tooth wear in the adult population?

Tooth wear is far more common than many patients — and even some clinicians — realize. A best-evidence consensus statement published in the Journal of Prosthodontics found that tooth wear prevalence exceeds 30% of the adult population in early adulthood, and that prevalence increases substantially with age. Despite this, the long-term functional and restorative impact of wear is poorly characterized in longitudinal studies, which underscores the importance of early clinical identification and patient education before wear becomes severe enough to require full reconstruction. A separate review of adults aged 18–35 from European populations found that nearly 29% exhibited measurable signs of tooth wear — reinforcing that this is not a condition limited to older patients or those with obvious parafunctional habits. Source: Bartlett D, et al. "Tooth Wear: Best Evidence Consensus Statement." Journal of Prosthodontics. 2021;30(S1):S20–S29. doi: 10.1111/jopr.13312.

When is it clinically appropriate to increase the vertical dimension of occlusion (VDO) during full mouth reconstruction?

Determining whether and how much to increase the VDO is one of the most consequential decisions in full mouth rehabilitation. It is generally indicated when a patient presents with significant loss of tooth structure that has resulted in reduced face height — clinically observable as drooping at the corners of the mouth, reduced lower facial height, or an overclosed appearance at rest. When no true loss of vertical dimension has occurred (i.e., the teeth have supraerupted to compensate for wear), space for restorations may need to be created through other means: periodontal crown lengthening, orthodontic repositioning, or surgical intervention. A systematic review published in the Journal of Esthetic and Restorative Dentistry found that when VDO changes are required, an evaluation phase using provisional restorations is strongly recommended before delivery of final restorations. Interim provisionals allow the clinician to verify patient tolerance to the new occlusal relationship, identify and correct any functional discrepancies, and refine esthetic outcomes — all before the irreversible commitment of final restorations. The review also confirmed that VDO should be regarded as a dynamic parameter within a physiological tolerance zone, rather than a fixed anatomical constant. Source: Chantler N, et al. "Importance of an Evaluation Phase When Increasing the Occlusal Vertical Dimension: A Systematic Review." J Esthet Restor Dent. 2025. doi: 10.1111/jerd.13331.

Why are provisional restorations critical in full mouth reconstruction, and how long should they be worn before final restorations are placed?

Provisional restorations serve a far greater purpose in full mouth reconstruction than simply protecting prepared teeth between appointments. They function as a clinical test drive for the final case — validating the proposed VDO, occlusal scheme, tooth proportions, and esthetics in the patient's actual oral environment before any irreversible steps are taken. Specifically, well-designed provisionals allow the clinician and lab to confirm: (1) that the patient's neuromuscular system has adapted to the new occlusal position; (2) that phonetics and comfort are not compromised; (3) that the esthetic result meets patient expectations; and (4) that any needed occlusal adjustments can be identified and refined. A PMC-published clinical review confirms that VDO was first re-established using provisional restorations with patients monitored over a minimum one-year follow-up period, demonstrating improved function, aesthetics, and occlusal stability before final restorations were fabricated. The duration of the provisional phase is case-dependent — straightforward cases without VDO changes may require only weeks, while cases involving significant bite opening or complex staging may require three to six months or longer to allow for adequate neuromuscular adaptation and TMJ response. Source: Fayad MI. "A Literature Review of Vertical Dimension in Prosthodontics Theory and Practice — Part 1: Theoretical Foundations." PMC. 2024. PMC11161034.

How does a diagnostic wax-up contribute to the success of full mouth reconstruction?

A diagnostic wax-up is not simply a visualization tool — it is a functional blueprint that guides every phase of the reconstruction. When fabricated correctly and in close collaboration with the dental lab, it communicates the proposed tooth forms, VDO changes, occlusal scheme, and esthetic goals before a single tooth is prepared. The wax-up allows the clinician to verify adequate restorative space and proper anterior guidance, generate prep guides and matrix stents for provisional fabrication, preview tissue contours and emergence profiles, and establish patient expectations through an intraoral mock-up. Without this step, the clinician is essentially designing the case on prepared teeth — under significant time pressure and with limited reversibility. Research on full mouth rehabilitation consistently identifies a systematic, evidence-based approach — beginning with articulated study casts and a diagnostic wax-up — as essential for achieving predictable functional and esthetic outcomes. The wax-up also serves as the reference for fabricating provisional restorations that will be worn during the evaluation phase, making its accuracy directly consequential to the success of the entire case. Source: Yaghoobi et al. "Functional and aesthetical full-mouth rehabilitation of a patient with severely worn dentition and deep bite using minimally invasive approach." Clin Case Rep. 2023. doi: 10.1002/ccr3.8257.

What role does the dental lab play in full mouth reconstruction, and when should lab communication begin?

The dental lab should be considered a clinical partner in full-mouth reconstruction—not a downstream fabrication service. Early, proactive communication between the dentist and lab directly improves case predictability and reduces remakes, adjustments, and patient disappointment. Lab involvement ideally begins at the diagnostic wax-up stage, before any tooth preparation occurs. At this phase, the lab needs: pre-operative models, bite records, a proposed VDO, high-quality digital photographs including full-face, full-smile, and shade images, and a clear treatment narrative including tooth numbers, restoration types, and any proposed tissue management. This information allows the lab to create a functional wax-up that truly reflects the clinical environment — not a generic, idealized tooth form. A comprehensive review of occlusal concepts in full mouth rehabilitation emphasizes that the objective of reconstruction is not merely restoring tooth structure, but re-establishing functional and biological harmony across the entire stomatognathic system — including the periodontium, muscles of mastication, and temporomandibular joints. Achieving that requires the lab to understand the full clinical picture, which only comes through thorough early communication. Source: Agrawal KR, et al. "Occlusal Concepts in Full Mouth Rehabilitation: An Overview." J Indian Prosthodont Soc. 2014;14(Suppl 1):S1–S7. PMC4257939.full-mouth rehabilitation emphasizes that the objective of reconstruction is not merely to restore tooth structure, but to re-establish

Full Mouth Reconstruction: The Pathway To Success

Not all wear looks the same —
because not all wear has the same cause.

A full-mouth reconstruction poses a significant challenge in dentistry, requiring collaboration between the clinician and the dental lab. It is crucial for restoring functional harmony, pulpal health, esthetics, and safeguarding the dentition from further harm in patients experiencing excessive wear.

A complete transformation of the mouth can have a profound impact on an individual’s confidence and well-being. Such complex cases require meticulous preparation and support to ensure favorable outcomes.

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Full Mouth Reconstruction Challenges

1. Tooth wear

Full Mouth Reconstruction: The Pathway to Success

The primary reason for prescribing full mouth rehabilitation is tooth wear, which necessitates this type of treatment. The objective is to restore the teeth to a functional and youthful state. An examination is crucial (as demonstrated in the image above) to determine the underlying causes of the wear.

Possible inclusions:

Erosion due to acid in the mouth is usually related to dietary issues and appears as a hollowed-out area on the tooth’s surface.
Attrition caused by grinding or an improper bite – this can usually be diagnosed by visualizing a flattened tooth surface.
Abfraction is caused by a misaligned bite or teeth grinding, creating irregular forces to the tooth. Abfractions often appear as a notch on the side near the gumline.
Abrasion is created from an external force, usually mechanical (toothbrush). A tooth that has experienced this type of wear usually has a notch at the gumline.

2. Vertical dimension of occlusion

Full mouth rehabilitation aims to address tooth wear and optimize oral health by addressing proper function, muscle concerns, periodontal health, and temporomandibular joint issues. It aims to restore harmony among these factors, thereby improving overall oral well-being.

Initiating the journey towards restoration can commence following a thorough evaluation. To ensure an effective approach aligned with occlusal principles, it is crucial to determine the patient’s vertical dimension of occlusion (VDO).

Individuals who exhibit excessive wear are typically classified into one of the following categories:

Drooping at the corners of the mouth usually indicates a loss of vertical dimension, which requires an increase in the VDO.
No loss of vertical dimension and space is available. May require gingivoplasty and adjustments to the opposing to make room for restorations.
No loss of vertical dimension and space is limited. These cases usually show wear on the anterior and minimal wear on the posterior. These cases may require ortho, repositioning, or surgery to make room for restorations.

Once the patient’s dental health is assessed, a treatment plan is created to determine which teeth to treat, the vertical dimension of occlusion, available space, and condylar position for restorative options.

Full mouth reconstruction isn’t just about restoring teeth. It’s about restoring function, health, and harmony
to the entire system.

3. Digital photography

After the diagnosis is made, it is important to work with the dental lab. Involving the lab early on in the process is crucial. The proposed treatment plan can be further refined and strengthened by providing the dental lab with preliminary models and a functional diagnostic wax-up.

To begin the process, you must take the necessary digital photographs.

The suggested photos include:

A picture of the full face from forehead to chin
A close-up picture showing a full smile
A close-up picture of the lips at rest
An overall shade picture with the shade tab held next to the tooth, with the body and incisal of the tab next to the body and incisal of the tooth
An incisal shade picture with the incisal edge of the shade tab held directly above the incisal edge of the tooth (see the above image).

4. The Plan

A picture is worth a thousand adjustments — especially when it shows the shade tab in exactly the right place.

Before starting the fabrication of the functional wax-up, it is crucial to communicate the proposed plan and manage the patient’s expectations.

To accurately transmit the data necessary for the fabrication of the wax-up, the following must be provided:

Provide the number of teeth to be restored. This should include the tooth numbers and information regarding types of restorations.
Indicate any tissue surgery that might be necessary.
Describe any proposed changes to the VDO.
Provide information concerning what material to use in the fabrication of the restorations.
List any specific concerns or goals the patient is hoping to receive.
Provide information regarding the desired staging of the case. This depends on whether there will be a change in the VDO.

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4. Functional wax-up

What gets approved in wax is what
gets built in porcelain.
Make sure the conversation happens
before the prep begins.

Using this information, a functional wax-up that meets the specified requirements can be created. The wax-up can be made using the traditional chemical impression method or a digital scan.

Once the wax-up is finished, the following is submitted to the patient for approval.

A functional wax-up
A stent of the wax-up
Prep guides

Preparation can begin after the wax-up is approved, and the proper VDO staging strategy should be followed. This is an important step in ensuring the appropriate function of the case. The staging will fall into one of three possible scenarios:

There is no change in the VDO.
There is a change in the VDO
Both arches are being restored.

5. Temporaries

Full Mouth Rehabilitation - Burbank Dental Lab

Once the patient wears the temporary dentition, it’s important to gather their feedback to ensure their satisfaction. It’s recommended to take the same pictures as step one to visually compare the temporaries in the mouth.

Additionally, ensure that new impressions are taken while the temporary restorations are in position. In cases where no modifications were made to the occlusion or vertical dimension of occlusion (VDO) on the temporaries, only a single bite recording, from one temporary restoration to another, is required. However, if adjustments were made to the occlusion or VDO, it is necessary to take three bite recordings for each modified provisional restoration in relation to the prepared teeth.

Now that all pre-planning information has been gathered, Burbank Dental Lab can begin fabricating the final restorations using the most suitable material for each case.

It is possible to do a bisque try-in of the restorations as an added step before the final glaze.

This is not always necessary, but it is available.

Once everything is finalized, the case is glazed and sent in for insertion (see the image above).

Restoring patients’ oral health by addressing wear-related problems is a crucial aspect of dentistry. Despite the complexities involved, there are methods to guarantee consistent and anticipated outcomes.

Over the years, Burbank Dental Lab has successfully restored numerous cases involving full-mouth rehabilitation and complex dental procedures, and they are enthusiastic about assisting you throughout the entire process.

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