Evidence-based, patient-centred management of tooth wear: 15-years insights from the Radboud Tooth Wear Project

The Radboud Tooth Wear Project (RTWP) is a longitudinal clinical research programme integrating data collected over 15 years from randomized clinical trials and prospective cohort studies, including monitoring, direct composite and indirect composite rehabilitations. The project includes 184 patients with moderate to severe tooth wear (Tooth Wear Index≥2), recruited between 2010 and 2018 across five study arms. Outcomes were assessed using validated indices and longitudinal monitoring, including intra-oral 3D scanning, with follow-up up to 9 years. Primary outcomes comprised wear progression, restoration performance, and patient-reported outcome measures (PROMs), including Oral Health-Related Quality of Life (OHIP) and orofacial aesthetics (OES). RTWP findings support the view of tooth wear as a predominantly physiological, age-related process, underpinning a shift towards preventive, risk-based, and patient-centred management. Monitoring showed wear rates ranging from 10 to 500 µm/year, with median patient level progression of 20-100 µm/year and substantial variability between patients, teeth, and surfaces. Direct composite showed annual failure rates of ≤2.2% anterior and ≤2.9% posterior at 5.5-year follow-up. For the indirect procedure, molar restorations showed significantly higher failure rates than the direct approach (HR = 3.37), with annual failure rates of 8.5-15.5% versus 3.2-5.4%. Minimally invasive CAD/CAM composite restorations resulted in annual failure rates of 2.5-8.1% at 5.5-year follow up. These findings support a shift away from early invasive intervention towards risk based, patient-centred strategies. Regular monitoring using standardized indices, combined with aetiological assessment of chemical and mechanical risk factors, remains essential. Shared decision-making plays a key role in aligning treatment with patient expectations. Clinical significance: This manuscript focuses on patient-centred care (PCC), informed by 15 years of experience from the Radboud Tooth Wear Project. It outlines shared decision-making across diagnosis and therapy and shows how treatment strategies affect PROMs. Tooth wear management should improve health-related quality of life, tailoring choices to needs, expectations, and risk.