Usura dentale
Tooth Wear: The Book by Didier Dietschi, Carlo Massimo Saratti, and Serge Erpen on Minimally Invasive Protocols
Within the field of books on tooth wear and restorative dentistry, Tooth Wear – Interceptive Treatment Options with Minimally Invasive Protocols by Didier Dietschi, Carlo Massimo Saratti, and Serge Erpen stands out as a comprehensive clinical work devoted to the diagnosis, prevention, and conservative treatment of dental tissue loss.
The volume guides clinicians in selecting the most appropriate protocol and materials for managing different forms of tooth wear, integrating preventive procedures, direct restorative techniques, composite layering, anterior and posterior restorations, the Shell technique, indirect protocols, and CAD/CAM technologies.
This is not a purely theoretical manual, but a reasoned collection of clinical procedures developed through more than twenty years of experience. Its main objective is to intercept the condition before tissue loss becomes severe, using non-invasive, additive, or minimally invasive treatments at the most appropriate time.
When early intervention is no longer sufficient, the book also guides readers in the correct selection and use of adhesive indirect restorations and CAD/CAM solutions.
A Modern Reference for the Diagnosis and Treatment of Tooth Wear
Tooth wear is a complex clinical condition characterised by different degrees of severity and a progression that may fluctuate over time.
Dental tissue loss does not necessarily result from a single cause. In many patients, erosive, mechanical, functional, and behavioural factors interact, making it difficult to establish a single aetiological diagnosis or define a standard protocol applicable to every case.
For this reason, the authors propose an approach based on careful observation of the individual patient. The location, distribution, and extent of wear must be assessed together with the patient’s biomechanical, functional, and occlusal conditions.
The book explains that the combination of erosion and attrition is common and that each factor involved in tissue loss should be analysed individually, without automatically resorting to extensive restorative treatment.
Preventing Progression Before Restoring
One of the book’s central messages is that the treatment of tooth wear should not necessarily begin with prosthetic rehabilitation.
The clinician’s first responsibility is to recognise the early signs of the condition, identify risk factors, and introduce preventive or interceptive measures capable of slowing its progression.
According to the approach presented in the book, many severe cases are also the result of delayed intervention by the dental team. When the condition is not identified in its initial stages, the patient may present with such extensive tissue loss that more complex, expensive, and difficult-to-maintain treatments become necessary.
Tooth Wear therefore proposes a change in perspective:
- diagnose before damage becomes extensive;
- control the factors responsible for progression;
- use non-invasive procedures whenever possible;
- favour additive and minimally invasive protocols;
- use indirect or CAD/CAM restorations only when genuinely indicated.
The authors describe the book as a type of clinical “cookbook” designed to help professionals select the most appropriate protocol and material for each specific form of tooth wear. The priority is to prevent progression through accessible and non-invasive procedures, while still providing adhesive indirect and CAD/CAM protocols for more advanced cases.
An Approach Opposed to Overtreatment
Another distinguishing feature of the book by Didier Dietschi, Carlo Massimo Saratti, and Serge Erpen is its criticism of standardised solutions applied indiscriminately.
Tooth wear may affect individual teeth, groups of teeth, or the entire dentition. It may mainly involve the anterior region, the posterior region, or both arches with different levels of severity. Function, occlusion, habits, and patient expectations can also significantly influence the treatment plan.
Given such broad variability, a single therapy systematically applied to the entire mouth is unlikely to be the correct answer.
The authors therefore question the automatic use of extensive indirect or CAD/CAM rehabilitations. These technologies are not rejected, but placed within a more comprehensive diagnostic and decision-making process.
The book aims to present conservative and financially sustainable alternatives to traditional prosthodontics, challenging an approach to dentistry driven by overtreatment and the pursuit of purely photographic perfection. The stated objective remains to improve the patient’s health, function, aesthetics, and quality of life.
Didier Dietschi’s Experience in Adhesive Dentistry
Didier Dietschi is internationally recognised for his contribution to adhesive and aesthetic restorative dentistry.
His work has integrated research, education, and clinical practice, with particular attention to minimally invasive treatments and anterior and posterior restorations. One of his best-known contributions is the development of the Natural Layering Concept, the composite layering method also addressed in this volume.
In the profile included in the book, Dietschi is presented as a lecturer and researcher associated with the University of Geneva and the Academic Centre for Dentistry Amsterdam, as well as a clinician working in aesthetic restorative dentistry. His educational activity focuses on integrating scientific evidence, modern technologies, and minimally invasive adhesive procedures.
Tooth Wear brings together more than twenty years of work specifically dedicated to this condition, within a much broader clinical and academic career. The book transforms this experience into protocols designed for everyday practice without overlooking the real-world variables that can influence treatment outcomes.
Carlo Massimo Saratti and the Role of Function and Occlusion
Carlo Massimo Saratti contributes particularly to the sections devoted to function, occlusion, and vertical dimension.
In the treatment of tooth wear, restoring anatomical form cannot be separated from understanding functional relationships. Decisions involving the modification of occlusal surfaces, restoration of tooth length, or alteration of the vertical dimension must form part of a rational treatment plan.
The text presents Saratti as a clinician and lecturer with a specific interest in function and occlusion, as well as a contributor to the clinical and technical content of the volume.
This perspective helps prevent tooth wear from being viewed exclusively as an aesthetic issue. Restoring dental morphology also means re-establishing functional conditions compatible with the patient’s individual system and with the longevity of the restorations.
Serge Erpen and the Integration of Clinical and Laboratory Work
The management of complex tooth-wear cases requires close collaboration between the dentist and the dental technician, particularly when the treatment plan includes indirect restorations or digital workflows.
Serge Erpen contributes the technical and laboratory perspective, helping integrate clinical planning, material selection, restoration production, and new technologies.
The book particularly emphasises his interest in finding the best balance between analogue and digital solutions. This collaboration makes it possible to follow cases from diagnosis to final delivery, adapting the workflow to the patient’s specific needs rather than forcing every clinical situation into a single protocol.
The combined presence of clinical, functional, and dental-technical expertise makes the volume especially useful for teams managing complex adhesive rehabilitations.
Diagnosis and Prognosis of Tooth Wear
The first chapter is devoted to the diagnosis and prognosis of tooth wear, two essential steps in determining when to intervene and how invasive treatment should be.
The assessment should not be limited to identifying worn surfaces. Clinicians must understand:
- where tissue loss is located;
- which teeth are most affected;
- how the damage is distributed across the arches;
- the degree of progression;
- which erosive and mechanical factors may be involved;
- the functional and aesthetic consequences;
- the patient’s risk of further deterioration.
Tooth wear is described as a multifactorial condition with a fluctuating progression. Diagnosis must therefore be based on observation, medical and dental history, analysis of clinical signs, and evaluation of their development over time.
Prognosis helps distinguish cases that can be monitored from those requiring interceptive or restorative therapy.
This approach protects the patient from two opposite risks: treating too late or performing an extensive and disproportionate treatment too early.
Personalised Treatment Strategies
The second chapter addresses the core of treatment planning.
Once the diagnosis has been completed, the clinician must determine which teeth should be treated, which materials should be used, and in what sequence. The book does not propose a universal solution, but an adaptable decision-making system for the different manifestations of the condition.
Treatment may include:
- monitoring and prevention;
- interceptive procedures;
- direct composite restorations;
- partial or full moulding techniques;
- anterior restorations;
- posterior restorations;
- the Shell technique;
- adhesive indirect restorations;
- CAD/CAM procedures;
- combinations of direct and indirect techniques.
The same chapter also addresses dental restorative materials and interface management.
This structure highlights that material selection cannot be separated from the clinical protocol. The extent of wear, the quantity and quality of the remaining substrate, restoration position, functional load, and adhesive possibilities all contribute to determining the most appropriate solution.
One case shown in the sample material, for example, presents a patient with moderate generalised wear, dentine hypersensitivity, and different degrees of damage in different areas. The case demonstrates how erosion, attrition, function, and the patient’s aesthetic expectations must all be considered together.
Restorative Materials and Interface Management
There is no single ideal material for every tooth-wear situation.
The volume includes dedicated sections on material selection and restorative interfaces because treatment longevity also depends on correctly managing adhesion between the dental structure and the restoration.
Material selection should consider the possibility of:
- preserving as much healthy tissue as possible;
- adding material without extensive preparations;
- controlling restorative thickness;
- reproducing morphology, function, and optical properties;
- repairing or modifying the restoration over time;
- integrating direct, indirect, and digital techniques.
From this perspective, composites, indirect materials, and CAD/CAM solutions are not regarded as mutually exclusive alternatives. They are different tools that clinicians should use according to the clinical indication.
Occlusal and Functional Factors and Vertical Dimension
The third chapter examines occlusal and functional factors and the vertical dimension of occlusion.
This section is particularly important in cases where tooth wear has changed the morphology of dental surfaces, the length of anterior teeth, or the relationship between the arches.
Before restoring the teeth, clinicians must evaluate how the new anatomy will function within the patient’s overall system.
The book helps readers consider:
- occlusal relationships;
- available restorative space;
- loss of dental morphology;
- involvement of anterior and posterior regions;
- modification of the vertical dimension;
- functional adaptation;
- validation of the project before definitive treatment.
The goal is not to impose the same ideal configuration on every patient, but to develop a solution consistent with the individual biomechanical condition.
Direct Techniques and Preservation of Dental Tissue
Direct techniques occupy a substantial part of the volume.
Composite resin makes it possible to work additively, reducing or avoiding preparation of the remaining dental tissues. This approach may be particularly useful during the interceptive stages and in cases where the main objective is to stabilise the wear before it becomes more severe.
The fourth chapter includes:
- the Natural Layering Concept;
- freehand anterior restorations;
- strategies for direct posterior restorations;
- freehand posterior restorations;
- Partial Moulding;
- Full Moulding.
The presence of different protocols allows clinicians to choose the level of control and standardisation best suited to the individual case.
Freehand techniques rely on the operator’s knowledge of anatomy and layering. Moulding procedures, on the other hand, use guides or forms derived from the planned design, facilitating the transfer of the intended morphology.
A significant portion of the book is dedicated to direct anterior and posterior restorations, with a clear distinction between the different operative techniques and their clinical applications.
Natural Layering Concept and Composite Layering
One of the book’s central keywords is layering, addressed through Didier Dietschi’s Natural Layering Concept.
Restoring a worn tooth does not simply mean replacing lost volume. In anterior teeth, clinicians must correctly reproduce shape, brightness, translucency, and optical characteristics. In posterior teeth, they must recreate a functional anatomy compatible with occlusal contacts.
Layering involves the use of different composite masses to obtain a more natural integration of the restoration.
In the treatment of tooth wear, this concept is especially important because restorations may involve:
- incisal edges;
- palatal surfaces;
- facial surfaces;
- cusps;
- fossae and grooves;
- several teeth within the same arch.
The volume therefore connects knowledge of composite materials with the ability to restore anterior and posterior teeth conservatively.
Freehand Anterior Restorations
Anterior restorations are one of the main areas in which tooth wear may simultaneously affect aesthetics and function.
Loss of incisal edges may shorten the teeth, flatten the smile line, and change anterior functional relationships.
The book contains a dedicated section on freehand restorations, integrating the Natural Layering Concept with anatomical form management.
The Freehand approach requires control of:
- dental proportions;
- incisor length;
- facial and palatal morphology;
- material thickness;
- transitions between restoration and residual tissue;
- functional relationships;
- colour integration.
These procedures make it possible to progressively rebuild lost tissue through a direct and primarily additive treatment.
Posterior Restorations and Control of Occlusal Morphology
Posterior restorations present different challenges from anterior restorations.
In addition to aesthetic integration, clinicians must restore cusps, ridges, fossae, grooves, and occlusal contacts. In cases of widespread wear, several teeth may require treatment while maintaining consistency between the overall design and the anatomy of each individual tooth.
The book examines different strategies:
- freehand posterior reconstruction;
- Partial Moulding;
- Full Moulding.
This distinction allows the treatment to be adjusted according to the amount of lost tissue, anatomical complexity, and the need to transfer a diagnostic design accurately.
Partial Moulding and Full Moulding
The Partial Moulding and Full Moulding techniques are presented as specific options for direct posterior restorations.
In Partial Moulding, only part of the restorative morphology is transferred through a matrix or guide, leaving the clinician to manage the remaining components directly.
In Full Moulding, the transfer of the planned morphology plays a broader role in the procedure.
The value of these techniques lies in combining the benefits of a direct approach with greater control over morphology. This may be particularly useful in multiple-tooth treatments, where the reproducibility of anatomical and occlusal relationships becomes especially important.
Shell Technique
An entire chapter is devoted to the Shell technique, one of the main keywords associated with the volume.
The technique is positioned after the direct procedures and before the indirect techniques, within a progression that gradually expands the therapeutic options available to the clinician.
The general principle remains the reconstruction of lost tissues while avoiding unnecessary preparations and keeping treatment consistent with the book’s minimally invasive philosophy.
The clinical documentation shows the final assessment of aesthetic, functional, and occlusal parameters, followed by targeted modifications based on the patient’s requirements.
The Shell technique is therefore not presented as an isolated solution, but as one of several strategies that may be included within a personalised treatment plan.
Indirect Techniques and Adhesive Procedures
When the extent of wear, the residual morphology, or functional requirements make a fully direct approach less suitable, the book introduces indirect techniques.
The chapter covers three fundamental areas:
- adhesive procedures;
- indirect protocols;
- cementation procedures.
The focus on adhesion is consistent with the conservative approach of the volume. Even when an indirect restoration is selected, the aim remains to limit the removal of healthy tissue and make full use of modern adhesive protocols.
Cementation is not treated merely as a final step, but as a decisive stage for the stability of the interface and the clinical performance of the restoration.
CAD/CAM and Digital Workflows in the Treatment of Tooth Wear
CAD/CAM is one of the book’s main tags and is addressed in a dedicated chapter.
The authors do not present digital technology as a universal treatment, but as a tool to be used after appropriate diagnosis and individualised planning.
CAD/CAM workflows can help clinicians:
- design the new anatomy;
- assess restorative space;
- integrate aesthetic and functional planning;
- transfer the clinical project;
- produce indirect restorations;
- verify the proposed modifications in advance.
In the digital case included in the sample material, the wax-up is validated through a removable snap-on device. The patient is allowed to wear it for approximately one month to assess the aesthetic and functional changes before the definitive restorations are produced.
This step demonstrates one of the most interesting aspects of the digital workflow: the possibility of testing the project before making it definitive.
Technology is therefore placed at the service of clinical reasoning rather than used to replace it.
Integration of Analogue and Digital Techniques
One of the strengths of the volume is the absence of a rigid opposition between traditional and digital dentistry.
Freehand techniques, layering, moulding protocols, the Shell technique, indirect restorations, and CAD/CAM are treated as complementary tools.
The choice depends on:
- severity of wear;
- number of teeth involved;
- available dental tissue;
- aesthetic requirements;
- functional conditions;
- the patient’s financial possibilities;
- the experience of the team;
- the need for future maintenance.
This integration is also one of the objectives of the Italian edition, which was developed to demonstrate how traditional techniques can be combined with new methods and modern digital workflows.
Longevity, Follow-Up, and Maintenance
The treatment of tooth wear does not end when the restorations are delivered.
The condition may continue to be influenced by the factors responsible for the original tissue loss. The volume therefore devotes an entire chapter to longevity and maintenance.
The contents include:
- longevity and follow-up;
- maintenance and repairs;
- repair and replacement;
- daytime and night-time splints;
- a literature review on longevity.
This section completes the clinical approach of the book by emphasising that the preservation of results depends on regular follow-up, monitoring of the condition, and the possibility of selectively modifying the restorations.
Repairability is an important value of conservative protocols. Instead of treating every deterioration as an indication for complete replacement, clinicians may consider local maintenance, correction, or repair.
The final chapter also examines the use of splints and compares clinical experience with the available literature on treatment longevity.
Extensive and Detailed Clinical Documentation
With 850 pages and approximately 2,700 images, Tooth Wear is designed as a highly visual work.
The clinical documentation allows readers to observe the different stages of treatment, from diagnosis to the final result, including planning, material selection, direct protocols, indirect procedures, and digital workflows.
The extensive visual content is particularly important in a book covering techniques such as:
- layering;
- anterior restorations;
- posterior restorations;
- partial and full moulding;
- the Shell technique;
- CAD/CAM;
- adhesive cementation;
- repair and maintenance.
In the foreword, the book is described as a comprehensive source of evidence-based clinical procedures for the restorative treatment of patients affected by tooth wear, supported by high-quality clinical documentation.
A Book for Clinicians Who Want to Treat Tooth Wear Conservatively
Tooth Wear is intended for:
- restorative dentists;
- prosthodontists;
- professionals practising adhesive dentistry;
- dentists interested in minimally invasive protocols;
- clinicians performing anterior and posterior restorations;
- professionals using CAD/CAM technologies;
- dental technicians;
- postgraduate students and advanced trainees.
The volume may be useful both to professionals seeking to develop a diagnostic protocol and to experienced clinicians wishing to expand their treatment options.
The inclusion of direct, indirect, and digital techniques makes it possible to approach tooth wear without being restricted to a single restorative philosophy.
Why Read Tooth Wear?
Tooth Wear – Interceptive Treatment Options with Minimally Invasive Protocols is not simply a book about restoring worn teeth.
It is a work devoted to the decision-making process that precedes treatment: understanding the condition, identifying the correct time to intervene, and selecting the least invasive procedure capable of achieving the clinical objective.
The value of the book lies in its integration of:
- diagnosis and prognosis;
- prevention;
- function and occlusion;
- adhesive dentistry;
- layering;
- anterior restorations;
- posterior restorations;
- the Shell technique;
- indirect techniques;
- CAD/CAM;
- long-term maintenance.
For readers looking for a book on tooth wear by Didier Dietschi that combines clinical experience, minimally invasive treatment, and digital technologies, this volume offers a broad and structured guide to managing both early-stage cases and more complex restorative situations.
Frequently Asked Questions About Tooth Wear
1. What is Didier Dietschi’s book Tooth Wear about?
The book covers the diagnosis, prognosis, prevention, and treatment of tooth wear. It presents interceptive and minimally invasive protocols, direct composite techniques, anterior and posterior restorations, the Shell technique, adhesive indirect procedures, and CAD/CAM solutions.
2. Who are the authors of the book?
The authors are Didier Dietschi, Carlo Massimo Saratti, and Serge Erpen. The project combines expertise in adhesive restorative dentistry, function, occlusion, clinical planning, and dental-technical production.
3. Who is the volume intended for?
The book is intended for restorative dentists, prosthodontists, adhesive dentistry professionals, CAD/CAM users, dental technicians, and postgraduate students interested in the conservative treatment of tooth wear.
4. Does the book cover anterior restorations?
Yes. A dedicated section addresses freehand anterior restorations, reconstruction of worn tissues, and composite layering according to the Natural Layering Concept.
5. Which techniques are proposed for posterior restorations?
The volume covers freehand posterior restorations, Partial Moulding, and Full Moulding. These different procedures allow clinicians to choose the most appropriate level of guidance and morphological control for the case.
6. What is the Natural Layering Concept?
It is a composite layering concept developed by Didier Dietschi. In the book, it is applied to the aesthetic and functional reconstruction of teeth, with particular attention to anterior and posterior restorations.
7. Does the book cover the Shell technique?
Yes. An entire chapter is devoted to the Shell technique. The procedure is included among the restorative options available for treating tooth wear through a conservative and personalised approach.
8. Are CAD/CAM protocols included?
Yes. The volume contains a chapter devoted to CAD/CAM techniques and demonstrates how digital workflows can be integrated into planning, aesthetic and functional validation, and restoration production.
9. Does the book only propose full-mouth rehabilitations?
No. One of the text’s main messages is to avoid automatically applying a single therapy to every patient. The authors prioritise prevention, early intervention, and non-invasive or minimally invasive protocols, reserving indirect rehabilitation for cases in which it is genuinely necessary.
10. Does the book address restoration longevity?
Yes. An entire chapter is devoted to follow-up, longevity, maintenance, repair, replacement, and the use of daytime and night-time splints.
Chapters and Topics
- Diagnosis and prognosis of tooth wear
- Treatment strategies
- Treatment strategies
- Dental restorative materials
- Interface management
- Occlusal and functional factors and vertical dimension of occlusion
- Direct techniques
- Natural Layering Concept
- Freehand anterior restorations
- Strategies for direct posterior restorations
- Freehand posterior restorations
- Partial Moulding
- Full Moulding
- Shell technique
- Indirect techniques
- Adhesive procedures
- Indirect protocols
- Cementation procedures
- CAD/CAM techniques
- Longevity and maintenance
- Longevity and follow-up
- Maintenance and repairs
- Repair and replacement
- Daytime and night-time splints
- Literature review on longevity
