A 15-year body of research from the Radboud Tooth Wear Project (RTWP) is challenging the assumption that severe tooth wear automatically requires restorative treatment.
The project, conducted at Radboud University Medical Center in the Netherlands, evaluated both monitoring strategies and restorative rehabilitation approaches in patients with moderate to severe tooth wear. The findings support a more patient-centred and minimally invasive approach to management.
One of the key observations was that patients without functional or esthetic concerns who underwent counselling and monitoring alone did not show deterioration in oral health–related quality of life over time. In contrast, patients who sought treatment because of sensitivity, functional problems, or esthetic concerns experienced significant improvements following full-mouth rehabilitation with direct resin composite restorations.
The researchers also found that tooth wear progression is highly individualized and difficult to predict. Using long-term 3D measurements, progression rates varied considerably between patients, between teeth, and even across different surfaces of the same tooth. Commonly suspected risk factors alone were insufficient to reliably predict progression.
The findings reinforce the importance of counselling and monitoring before initiating irreversible restorative treatment, particularly in patients without symptoms or clear treatment demand. According to the authors, this phase helps improve patient awareness, identify potential etiological factors, and delay entry into repeated restorative cycles.
When restorative intervention becomes necessary, the project supports minimally invasive adhesive approaches. Direct composite resin rehabilitations demonstrated acceptable medium-term survival and improved patient-reported outcomes, although maintenance requirements remained common, particularly in molar restorations.
The RTWP ultimately emphasizes that tooth wear management should not be based solely on the amount of tooth structure lost. Functional impact, patient expectations, symptoms, and long-term maintenance considerations should all influence treatment planning.
As minimally invasive dentistry continues to evolve, the findings highlight an important clinical principle: not every worn dentition requires immediate restoration, and in many cases, careful monitoring may be an appropriate part of care.
Severity alone does not determine restorative need
Some patients with visible wear remain comfortable and stable, while others experience active tissue loss, sensitivity, functional difficulty or unacceptable appearance. Establish cause and activity before treatment. Serial photographs, indices, scans or study models can support monitoring, while prevention should address acid exposure, reflux, parafunction and occupational or behavioural contributors.
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