Severe occlusal wear is no longer a rare finding in daily practice. Bruxism, erosion, long-term parafunction, and aging dentitions increasingly present clinicians with flattened occlusal surfaces, reduced vertical dimension, and compromised function. The challenge lies in restoring form and function without further sacrificing remaining tooth structure.
Additive occlusal onlays and posterior occlusal veneers have emerged as a biologically respectful, adhesive-driven solution, allowing clinicians to rebuild occlusion while preserving enamel. This article explores when, why, and how additive occlusal onlays should be used in cases of advanced occlusal wear.
Understanding Severe Occlusal Wear
Severe occlusal wear is typically characterized by:
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Loss of cuspal anatomy and occlusal vertical dimension
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Flattened occlusal tables with exposed dentin
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Sensitivity, reduced masticatory efficiency, or muscle fatigue
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Increased risk of fractures due to weakened tooth structure
Traditionally, these cases were managed with full-coverage crowns, often requiring aggressive reduction. However, modern adhesive dentistry has shifted the paradigm toward additive, partial-coverage restorations.
Why Choose Additive Occlusal Onlays?
Additive occlusal onlays focuses on building up, not cutting down. Their advantages include:
1. Maximum Enamel Preservation
Minimal or no occlusal reduction is required beyond surface refinement. Preserving enamel significantly improves bond strength and long-term survival.
2. Reversible Occlusal Rehabilitation
In vertical dimension increase cases, additive onlays allow clinicians to test occlusal schemes before committing to definitive full-mouth rehabilitation.
3. Reduced Biological Risk
Rounded internal contours and supragingival margins lower the risk of pulpal insult and periodontal complications.
4. Predictable Adhesive Performance
Modern ceramics such as lithium disilicate or hybrid ceramics perform optimally when bonded to enamel-rich substrates.
Case Selection: When Additive Onlays Are Indicated
Additive occlusal onlays are ideal in cases involving:
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Generalized attrition with intact axial walls
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Worn posterior teeth with preserved enamel rims
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Bruxism patients requiring conservative occlusal buildup
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Occlusal vertical dimension rehabilitation in stages
They are not indicated when there is insufficient bonding substrate, uncontrolled caries, or vertical cracks extending subgingivally.
Clinical Preparation Principles for Additive Occlusal Onlays
Unlike traditional crown preparation, the goal here is surface optimization, not aggressive reduction.
Key Preparation Concepts:
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Smooth, rounded internal anatomy
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No sharp line angles or stress concentrators
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Minimal occlusal reduction (often 0–0.5 mm)
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Clear interproximal definition without box preparation
This anatomy-driven philosophy ensures optimal ceramic thickness distribution and stress management.
Bur Selection and Occlusal Sculpting Strategy
Precision in additive onlay cases depends heavily on bur geometry. Anatomy-matched diamond burs allow clinicians to refine occlusal surfaces while respecting natural morphology.
In these cases, the MR.BUR Occlusal Onlay Kit FG is designed specifically for:
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Controlled depth marking
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Occlusal anatomy reshaping using concave and convex profiles
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Smooth cusp blending and transitional refinement
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Fine finishing of interproximal and occlusal margins
Dedicated occlusal shaping burs reduce guesswork and help maintain consistent occlusal thickness, critical in additive restorations.
Occlusal Design Considerations in Worn Dentition
When rebuilding occlusion additively, clinicians must consider:
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Functional cusp placement and load direction
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Mutually protected or group function occlusion
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Even ceramic thickness to prevent fracture
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Polished, low-friction occlusal surfaces for bruxers
Diagnostic wax-ups or digital mock-ups are strongly recommended to guide occlusal morphology.
Material Choice for Additive Occlusal Onlays
Commonly used materials include:
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Lithium disilicate – high strength, excellent esthetics
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Hybrid ceramics – shock-absorbing for bruxism cases
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High-strength composites – transitional or reversible stages
Material selection should align with occlusal load, parafunctional habits, and long-term treatment planning.
Conclusion
Managing severe occlusal wear no longer requires aggressive tooth reduction. Additive occlusal onlays provides a conservative, adhesive-driven pathway to restore function, esthetics, and occlusal stability, especially in worn dentitions and vertical dimension rehabilitation cases.
By combining careful case selection, anatomy-guided preparation, and purpose-designed occlusal shaping instruments, clinicians can deliver predictable outcomes while preserving what matters most: healthy enamel and biological integrity.
In the United States, from Chicago to Los Angeles, dental practices are shifting toward streamlined composite polishing techniques that reduce chair time while enhancing results. American clinicians continue to invest in systems that support high-quality, esthetic outcomes for every patient.
Would additive occlusal onlays change how you approach your next severe wear case?
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