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Tooth structure loss may occur on all tooth surfaces and for many reasons. Prior to rendering treatment, the restorative dentist must determine a diagnosis for the problem, identify etiologic factors, and educate the patient about the need for restorative intervention. Therefore, a complete and comprehensive clinical examination, a patient interview and co-diagnosis, and an understanding of treatment appropriateness are necessary. This article addresses some of the etiologic factors leading to tooth structure loss, explains the various clinical appearances of these mechanisms, and suggests treatment considerations.