Comparison of LavaŽ crowns to composite restorations in severe toothwear

Objectives: a pilot study comparing failure rate of Lava crowns and direct composite restorations in the management of severe tooth wear. Methods: a convenience sample of 30 subjects were diagnosed with erosion, attrition or combined aetiology and all had exposed dentine. Subjects were grouped according to treatment modality; Lava (3M ESPE, Germany) crowns or Spectrum APH composite (Dentsply, UK) restorations. Variables assessed included demographics, occlusion, Occlusal Vertical Dimension (OVD), number of restorations and failures since placement. Failure was assessed using modified Ryge criteria. Results: A total of 27 males and 3 females participated with 15 subjects in each treatment group. There was no statistical difference between the mean age of the Lava group (45.07 yrs, SD 15.16) and the composite group (57.20 yrs, SD 12.04). In the Lava group, 6 subjects had erosion, 5 had attrition and 4 had combined aetiology. In the composite group, 5 had erosion, 4 had attrition and 6 had combined aetiology. A total of 73 Lava crowns and 115 composite restorations were placed with a mean of 5 crowns and 8 composites per subject. OVD was increased in 13 subjects managed with Lava crowns and 10 with composites. One Lava crown failed (1.4%) and 4 composites failed in 2 subjects (3.5%) with no statistical difference between groups, Fisher exact test 0.65, p>0.05. The overall mean observation period from time of placement was 5 months with a range of 1-15 months. Conclusion: In this pilot study, all subjects had tooth wear with, in some cases, complete loss of coronal tooth substance. These results show that both treatment modalities are successful in challenging clinical situations e.g. edge-to-edge incisal relationship and where an increase in OVD was required. Long term data with an increase in sample size is needed but the early results are encouraging.