Sir, sadly, the rhetoric from Dr Kelleher and Professor Burke is not surprising, failing to address any of the issues raised in my initial response and adding nothing to the debate.1 I made no mention of abfraction and I don't subscribe to any occlusionita tribe, whatever that may be. No treatment was undertaken on temporomandibular disorder grounds but to generate a favourable occlusion ensuring long-term success. Much is made of anterior marginal ridge preservation but current studies relate to molar/premolar teeth where occlusal forces are completely different. Simply extrapolating this data to anterior teeth is unsound.

In regard to the case referred to, composite rehabilitation had failed rapidly due to not addressing occlusal risk factors previously discussed and outdated traditional composite techniques.2 The restorations also failed to meet the aesthetic expectations of the patient so the next logical stage would be addressing the occlusal risk factors and 360 Bioclear composites or minimally invasive ceramics, which in my experience far outperform traditional composites.

It appears some hospital-based dentists have little appreciation of the aesthetic aspirations of many private patients (where the majority of tooth wear is treated) and their treatment follow-up is often short-term with little experience of treatment longevity, particularly regarding traditional composite techniques in more compromised cases.

Veneers with palatal coverage which break through contacts have been described in the form of the overlap preparation nearly a decade ago, in an often cited and excellent BDJ book.3 The 360 veneer concept is a development on this design in compromised cases which incorporates the synergy of modern monolithic high-strength ceramics, minimal biologically controlled preparation and contemporary bonding protocols. The restoration provides superb aesthetics, restoration longevity, and the risk of failure lies with the restoration and not the tooth. It is a far cry from early, heavy-preparation traditional ceramic crowns. It is not a new concept, having been previously published four years ago.4

Interestingly, I recently gave an online lecture to dental practitioners: 'The definitive guide to anterior ceramic and composite restorations', where a number of cases were discussed and preparation designs presented such as in Figure 1 (these restorations were provided as traditional composite restorations had failed prematurely). The overwhelming response to the 360 veneer concept was supportive. This lecture is available at dhti.co.uk as part of my evidence-based toolkit so readers can make their own informed decision on the concept and the limitations of traditional composite techniques.

Fig. 1
figure 1

360 veneer preparations, conditioned for bonding showing the enamel nature of the preparations

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