Minimal intervention dentistry: part 5. Ultra-conservative approach to the treatment of erosive and abrasive lesions P. Colon* 1 and A. Lussi 2 rubbing of an external element such as a toothbrush or other aggressive agents. It can also be due to simple teeth to teeth contact between occlusal or proximal surfaces and is called attrition. 1,2 The increasing prevalence of these lesions has been demonstrated by recent studies. 3,4 These three aetiological processes of erosion, abrasion and attrition give rise to extremely variable clinical situations. This can also result in other diverse clinical features when these three processes are combined. These lesions show three specifc features: • Absence of dental, diseased tissue requiring removal as is the case in dental caries disease • Loss of dental tissues are also a consequence of physiological wear such as daily acid exposure, toothbrushing and interdental contact. In certain cases, the distinction between physiological and pathological can be diffcult to determine • The aetiological factors are sometimes diffcult to control and impossible to eliminate as they result at the same time from normal physiological function. Consequently its mostly adverse pathological effects on the pulp can result in invasive treatments, whereas totally non-invasive restoration treatments should be recommended in the large majority of clinical situations. Nevertheless, even with minimal loss of substance, this process will continue if the aetiological factors have not been INTRODUCTION Tooth wear lesions result from chronic attacks on dental tissues without bacterial involvement. This process can involve attack from acids (erosions) or by mechanical The therapeutic management of tooth wear lesions does not require the removal of diseased tissue. Nevertheless, diverse etiological factors may be associated with the condition and they could be diffcult to eliminate; this has to be considered when planning therapy. Interceptive procedures should be reserved for such situations while regular monitoring is recommended for other cases, in accordance with advice provided for using the Basic Erosive Wear Examination (BEWE). Direct and indirect adhesive procedures with composite resins allow treatment of most clinical situations, including even extensive restorations. The possibility of managing subsequent interventions should be considered when planning the initial therapeutic approach. eliminated, requiring complex rebuilding of the two arches (Fig.1). Since the tooth wear lesions are bacteria free, it is important to keep in mind that these lesions could be associated with carious disease and that ‘ultra-conservative’ treatment may require the use of additional protocols focused on patient benefts. Finally, it has been shown that certain lesions are the direct consequence of eating disorders, obsessive compulsive disorders (OCD), stress and gastro-oesophageal refux disease (GORD), which require combined medical and dental intervention. 5 Tooth wear lesions can also be associated with bruxism phenomena. 6 Ultraconservative treatment should include: • Maximum preservation of remaining dental structures • Future therapeutic intervention under the same conditions (repair, replacement) • Control of aetiological factors • Treatment of any general systemic factors by a medical team. 1 Université Paris Diderot, Service d’Odontologie, Hôpital Rothschild, AP‑HP, Paris, France; 2 Zahnerhaltung, Präventiv‑ und Kinderzahnmedicizin, Zahnmedizinische Kliniken der Universität, Bern, Switzerland *Correspondence to: Professor Pierre Colon Email: pierre.colon@univ‑paris‑diderot.fr Refereed Paper Accepted 15 November 2013 DOI: 10.1038/sj.bdj.2014.328 © British Dental Journal 2014; 216: 463-468 • Stresses the importance of a conservative approach to the treatment of erosive and abrasive lesions. • Explains how to plan an initial therapeutic approach. • Suggests there is no unique solution and treatment plans must be made on a case by case basis. IN BRIEF PRACTICE 1. Contribution of the operating microscope to dentistry 2. Management of caries and periodontal risks in general dental practice 3. Management of non-cavitated (initial) occlusal caries lesions – non-invasive approaches through remineralisation and therapeutic sealants 4. Minimal intervention techniques of preparation and adhesive restorations. The contribution of the sono-abrasive techniques 5. Ultra-conservative approach to the treatment of erosive and abrasive lesions 6. Microscope and microsurgical techniques in periodontics 7. Minimal intervention in cariology: the role of glass-ionomer cements in the preservation of tooth structures against caries 8. Biotherapies for the dental pulp This paper is adapted from: Colon P, Lussi A. Approche ultraconservatrice du raitement des lesions érosives et abrasives. Réalités Cliniques 2012; 23: 213-222. MINIMAL INTERVENTION DENTISTRY II Fig. 1 Erosive and abrasive lesions could lead to considerable defects. Here is the clinical case of a woman, 35 years old, with anorexia and bulimia when she presented to the consultation BRITISH DENTAL JOURNAL VOLUME 216 NO. 8 APR 25 2014 463 © 2014 Macmillan Publishers Limited. All rights reserved