Worn Teeth: LIT Classification, Raising the VDO, What the Lab Needs

A patient in their thirties sits down with short, flat incisors, cupped dentine on the molars and no room left to restore anything without cutting more tooth. The questions come fast: is this wear still active, how much should the bite open, composite or ceramic, and what does the lab need to plan it?

This guide covers the evidence: how common severe wear is, the new LIT classification, how safe it is to raise the vertical dimension of occlusion (VDO), which restorations hold up, and what the lab needs.

Quick Answer

Diagnose and record the wear first, find the cause and monitor before restoring, because the European consensus says restorative treatment is typically best delayed as long as possible. When restoring is needed, plan it backward from a diagnostic wax-up at the proposed VDO, test that wax-up in the mouth as a mock-up, open the bite as little as the restorations require, and send the lab scans, a bite at the new VDO, photos and a clear Rx.

How Common Is Severe Tooth Wear?

A clinical survey of young adults examined 3,187 patients aged 18 to 35 in general practices in seven European countries with the Basic Erosive Wear Examination (BEWE). Each person was scored by their most worn surface: 42.9% scored 0, 27.7% scored 1, 26.1% scored 2 and 3.3% scored 3. Heartburn or acid reflux and repeated vomiting were among the risk factors, and fresh fruit and juice intake was linked to more wear.

Should You Restore Worn Teeth or Monitor Them?

The European consensus statement on severe tooth wear puts diagnosis, prevention, counseling and monitoring first: restorative intervention is typically best delayed as long as possible, and then should be conservative and minimally invasive.

Fifteen years of the Radboud Tooth Wear Project support that view. In 184 patients with moderate to severe wear monitored with validated indices and intraoral 3D scans for up to 9 years, wear ran from 10 to 500 µm a year, with a median of 20 to 100 µm per patient and large differences between patients, teeth and surfaces. The authors argue for risk-based, patient-centered care rather than early invasive treatment.

Monitoring is easy to document: in 75 tooth wear patients, grading occlusal and incisal wear on photographs gave the same median scores as grading on casts. Restore when the patient has pain, function problems, esthetic concerns they want treated, or wear that keeps progressing despite prevention.

What Is the LIT Classification for Tooth Wear?

LIT was published in the Journal of Esthetic and Restorative Dentistry in 2025 by Albertini and colleagues. The authors note that no earlier classification combined the extent and location of wear with the specialties needed to treat it. LIT stands for three questions:

L: Location of the wear

Where the tissue loss sits and how far it extends. In planning terms: is the wear anterior, posterior or generalized, and which surfaces are involved? That decides how much space the restorations need and where it can come from.

I: Interdisciplinary workflow

Which disciplines the case needs and in what order. In a typical practice that might mean orthodontics to create space or a physician for suspected reflux; sorting this out early avoids restoring teeth that will later move or keep eroding.

T: Therapeutic approach

The type, extension and material of the restoration, matched to the magnitude of the wear, with minimal invasion and tooth preservation as the rule. The authors present LIT as a way to improve diagnosis, communication and predictability between clinician, team and patient.

LIT also works as the header of the plan you send to the lab.

Is It Safe to Raise the Vertical Dimension?

A systematic review screened 902 studies and kept 9. It concluded that, whenever indicated, a permanent increase in VDO is a safe and predictable procedure, that fixed restorations give more predictable adaptation than removable ones, and that the negative signs and symptoms seen were self-limiting. A companion clinical review advises applying a minimal increase, while noting that up to 5 mm can be justified to create space for restorative material and to improve anterior esthetics.

A later review of the TMD question reached the same place: the evidence is weak, the masticatory system adapts quickly to moderate changes, mild symptoms are usually transient, and there is no indication that a permanent change in VDO produces long-lasting TMD. The exception is the patient who already has TMD: the clinical review recommends raising the VDO with a removable appliance first to control symptoms before any irreversible work.

The Dahl approach for localized wear

When only the anteriors are worn, the Dahl concept creates space locally: originally a removable metal bite platform, now usually bonded restorations placed high on the worn teeth. A meta-analysis of anterior composite restorations for localized wear (6 studies, 141 patients, 1,068 restorations) reported 88% survival over 2 to 10 years, 68% success, and re-established posterior occlusion in 85% of composite Dahl cases.

Which Restorations Hold Up on Worn Teeth?

Direct composite is the most studied minimally invasive option. In a prospective Radboud trial, 34 patients received 1,256 composite restorations in an increased VDO; after 3.5 years success was 94.8% and survival 99.3%; most failures were repairable, chip fractures being the most common, and anterior restorations finished in two sessions failed 4.6 times as often as those finished in one. At 5.5 years annual failure rates were up to 2.2% anterior and 2.9% posterior.

Indirect options behave differently by tooth. In a randomized trial, indirect composite tabletops on first molars failed considerably more often than direct composite (hazard ratio 3.37). CAD/CAM composite restorations in 22 severe wear patients reached annual failure rates of 0.29% on front teeth, 1.56% on premolars and 2.93% on molars for repair or replacement failures. Lithium disilicate did best: 103 adhesively bonded IPS e.max Press occlusal onlays in 7 full-mouth patients had 100% survival for up to 11 years, with no debonding and one marginal crack.

A 2025 systematic review of 43 studies put the pattern in one sentence: indirect restorations failed less but can be more invasive and take more operator time, while direct methods failed more but stay minimally invasive. In the randomized trials it pooled, indirect ceramic had mean annual failure rates of 0.09% for minor and 0.13% for major failures. A 2022 review of 16 studies found no technique clearly superior. For material details see inlays and onlays vs. full crowns and restorations for bruxers.

How Do You Plan the Case With the Lab?

Worn dentitions are planned backward. A diagnostic wax-up defines the new occlusal plane and VDO, and a mock-up made from it tests that plan in the mouth and guides minimal preparation. In one published case, a corrected second wax-up became a therapeutic mock-up to test the new VDO before lithium disilicate occlusal onlays stabilized it.

For direct composite, the same wax-up can become a transparent silicone index for the injection technique, which translates the wax-up into composite without preparation; a 2025 case report built the index from a digital wax-up on a 3D-printed model and needed only minimal adjustment of the rebuilt canine guidance.

What to send for a worn-dentition case

• Full-arch scans of both arches and a bite at the current VDO.
• A bite record at the proposed VDO, or the planned opening in millimeters with the reference point.
• Face photos at rest and smiling, plus retracted and occlusal views (see dental photos for the lab).
• The LIT summary: where the wear is, other disciplines involved, and the planned restoration and material per tooth or segment.
• Which teeth are treated in which phase, and whether provisionals should carry the new VDO.

Worn-Dentition Cases at Elegant Dental Laboratory

Elegant Dental Laboratory is a full-service lab at 2308 McDonald Ave in Brooklyn, New York, founded in 2007, with more than 35 technicians and every case made in house. For worn dentitions we make the diagnostic wax-up, the mock-up and a reduction guide, and a patient-approved smile preview, face photos and smile design files can come with the case. Provisionals are milled in PMMA, recommended for wear up to 1 year, and we keep the design so the approved shape can be copied into the finals.

Finals include IPS e.max inlays, onlays and table tops, e.max crowns and veneers, zirconia and full gold, and on request you can review the design, contacts and occlusion before milling. We make hard, soft and dual-laminate night guards. Our warranty runs up to 7 years on final restorations and does not cover bruxers without a night guard. Our drivers pick up and deliver free in all five New York City boroughs and 13 northern New Jersey counties, with prepaid UPS labels for practices anywhere. Call 877-335-5221 or start working with us.

FAQ

How much can I raise the vertical dimension?

As little as the restorations need; a clinical review notes that up to 5 mm can be justified.

Do patients get TMD after the bite is opened?

Mild symptoms usually resolve; reviews find no indication of long-lasting TMD. Patients with existing TMD should try the new position in a removable appliance first.

Composite or ceramic for a worn dentition?

Direct composite is least invasive but needs repairs; indirect ceramic fails least but removes more tooth and takes more time.

When is a Dahl approach appropriate?

For localized anterior wear with sound posterior teeth: the anteriors are restored in an increased VDO and the posteriors settle back into contact.

What should I send the lab for a wax-up?

Full-arch scans, bites at the current and proposed VDO, face and intraoral photos, the planned opening in millimeters, and the restoration plan per tooth. A detailed dental lab Rx prevents most back-and-forth.

Reviewed by Gary Fingerman, founder and CEO of Elegant Dental Laboratory, Brooklyn, New York (founded 2007). Last reviewed: October 27, 2026.