Mastering Pathological Tooth Wear: Comprehensive Restorative & Functional Protocols

Target Audience: Restorative Dentists, Prosthodontists, Functional Dentists/Gnathologists, and Dental Technicians.

Course Overview

This advanced clinical curriculum delivers an evidence-based framework for diagnosing, planning, and executing full-mouth rehabilitation in patients with advanced tooth wear. Participants will master vertical dimension (VDO) management, centric relation (CR) registration, direct injection-molding techniques, adhesive ceramic protocols, and interdisciplinary management of severe bruxism and dental erosion.

Curriculum Overview

Lesson 1: Etiology and Biomechanics of Tooth Wear

• Pathogenesis and differential diagnosis: attrition, abrasion, and erosion

• Occlusal splints in bruxism assessment: wear patterns vs. active parafunction

• Systemic cofactors: salivary buffering capacity, GERD, and tongue mechanics

• Diagnostic screening questionnaires and risk-stratification algorithms

  Target Audience: Prosthodontists, Functional Dentists

Lesson 2: Dental Erosion: Diagnosis, Staging, and Management

• Extrinsic and intrinsic etiologies: GERD, eating disorders, dietary acids, and medications

• Grading erosive loss using the Basic Erosive Wear Examination (BEWE) index

• Analog and digital recording protocols via silicone indexes

• Desensitization strategies and dentin seal/surface protection protocols

  Target Audience: Prosthodontists, Functional Dentists

Lesson 3: Direct Composite Strategies: The Index Technique

• Minimally invasive philosophy and anatomical free-hand layering

• Single vs. double-layer silicone matrix protocols

• Flowable and thermo-viscous composite injection workflows

• Palatal veneer layering for anterior guidance restoration

  Target Audience: Prosthodontists, Functional Dentists

Lesson 4: Index Technique: Digital Planning and Clinical Execution

• Digital Smile Design (DSD) to 3D diagnostic wax-up translation

• Matrix customization, intraoral isolation, and adhesive placement

• Stress-bearing adhesive protocols for composite overlays

• Long-term wear fatigue, repair protocols, and maintenance

  Target Audience: Prosthodontists, Functional Dentists

Lesson 5: Fixed Prosthodontic Principles for Advanced Wear

• Conformative vs. reorganized occlusal approaches

• Occlusal analysis algorithms for severe tooth loss

• Biomechanical principles and indications for the Dahl approach

• Limiting biological and anatomical factors in full-mouth reconstructions

  Target Audience: Prosthodontists, Functional Dentists

Lesson 6: Diagnostic Wax-Up, Mock-Up, and Transition Strategies

• Precision articulator mounting and palatal contour modeling

• Functional mock-up evaluation: intraoral testing and 7-day phonetics/load checks

• Anterior guidance re-establishment via transparent keys and injection molding

• Posterior support stabilization and Michigan splint delivery

  Target Audience: Prosthodontists, Functional Dentists

Lesson 7: VDO Elevation and Centric Relation (Kois Principles)

• Evaluating functional envelopes and mechanical wear patterns

• Centric relation registration using the Kois Deprogrammer

• Analog and digital mounting workflows with the Kois articulator

• Determinants and limits of increasing Vertical Dimension of Occlusion (VDO)

  Target Audience: Prosthodontists, Functional Dentists

Lesson 8: Full-Arch Adhesive Rehabilitation: Direct and Indirect

• Full-arch direct composite injection molding protocols

• Indirect adhesive workflows: multi-stage sequencing for overlays and crowns

• Biologically Oriented Preparation Technique (BOPT) applications

• Material selection: lithium disilicate vs. monolithic zirconia veneers

  Target Audience: Prosthodontists, Functional Dentists

Lesson 9: Bruxism: Diagnostics and Sleep Medicine

• Sleep vs. awake bruxism: phenotyping and motor activity criteria

• Screening for sleep-related breathing disorders (SRBD) and sleep apnea

• Clinical assessment protocols and diagnostic auxiliary instrumentation

• Parafunction as a risk vs. protective factor

  Target Audience: General Dentists, Restorative Dentists, Prosthodontists

Lesson 10: Bruxism: Management and Rehabilitation Strategies

• Cognitive-behavioral modalities and habit-reversal therapies

• Pharmacological interventions: indications and drug-induced parafunction

• Occlusal appliance therapy: design, material selection, and balance protocols

• Sequencing full-mouth rehabilitation in active bruxists

  Target Audience: General Dentists, Restorative Dentists, Prosthodontists

Lesson 11: Interdisciplinary Dental Rejuvenation and Wear

• Differentiating physiological aging from pathological destruction

• Compensatory mechanisms: dentoalveolar extrusion and alveolar remodeling

• Pre-restorative orthodontics: intrusion, extrusion, and arch spacing

• Long-term stability protocols for functional aesthetic restorations

  Target Audience: Restorative Dentists, Prosthodontists, Orthodontists

Lesson 12: Gummy Smile and Short Clinical Crown Management

• Differential diagnosis: altered passive eruption vs. compensatory extrusion

• Cementoenamel junction (CEJ) surgical exposure and crown lengthening

• Interdisciplinary sequencing: periodontics, orthodontics, and restorative care

• Smile-line harmonization and facial aesthetic integration

  Target Audience: Periodontists, Prosthodontists, Restorative Dentists

Lesson 13: Behavioral Modulation, Proprioception, and Occlusion

• Neuro-muscular proprioceptive deprogramming and neuromuscular adaptation

• Airway optimization, nasal breathing, and their impact on sleep motor activity

• Splint therapy limitations and risk management

• Direct composite therapy within a conservative neuromuscular framework

  Target Audience: Functional Dentists, Gnathologists, Prosthodontists

Lesson 14: The Dahl Technique in Restorative Dentistry

• Monitoring wear progression and identifying localized interocclusal clearance loss

• Predictable VDO elevation using anterior composite platforms

• Occlusal scheme selection, axial loading, and articulation setups

• Restorative material longevity under uncontrolled functional loading

  Target Audience: Restorative Dentists, Prosthodontists

Lesson 15: Ceramic Rehabilitation in Advanced Wear

• Facially generated aesthetic workflows and digital functional analysis

• Preparation design: incisal wrap vs. butt-joint margins

• Neuromuscular adaptation to adhesive mock-ups

• Clinical performance comparison: direct molded composite vs. porcelain veneers

  Target Audience: Prosthodontists, Dental Technicians, Restorative Dentists

Lesson 16: Interdisciplinary Management of Severe Bruxism

• Biomimetic and additive prosthodontic philosophies for high-risk patients

• Selection criteria: partial adhesive restorations vs. full-coverage crowns

• Fully digital restorative workflows for parafunctional wear

• Implant mechanics: biomechanical failure reduction and occlusal scheme design

  Target Audience: Gnathologists, Prosthodontists, Orthodontists, Technicians