Abstract
On ceramic veneers rehabilitation, teeth with non-carious cervical lesions (NCCLs), especially premolars, are often involved. Preparation to remove deep NCCLs may lead to excessive wear and a less conservative approach, which goes against the current principles of minimal wear and maximum preservation. However, no evidence exists indicating which technique could avoid excessive wear during the dental preparation for veneers associated with NCCL. Thus, this manuscript has two main purposes: 1) to present an aesthetic treatment with ceramic veneers and follow-up of 24 months of a patient with various levels of NCCL severity and 2) to evaluate various wear protocols for dental veneers associated with NCCL via Finite Element Analysis (FEA) to guide and justify the clinical decision of the clinical case described. A 37-year-old male patient presented for treatment with wear on the anterior teeth and with NCCLs of various severity degrees on the posterior teeth. The treatment chosen was rehabilitation with ceramic veneers on teeth 15 to 25. The best restorative approach for the NCCL teeth was evaluated via an FEA, simulating various protocols and lesion depths while also calculating the percentage of tooth structure loss. Restoring the premolar’s deeper NCCL with a composite resin core, before a ceramic veneer impression, presented better mechanical behavior in FEA and less tooth wear. For the 1.0 mm NCCL, beveling the lesion promoted good stress distribution, less invasive wear and an easier clinical procedure, as it did not involve a previous restorative procedure. It could be concluded that the restorative decision for premolars with NCCLs that will receive veneers should consider the set biomechanical behavior and especially the tooth structure wear necessary. For the case report presented, after two years of follow-up, no changes from the immediate result were observed, indicating that the cause of the lesions was eliminated, and that the treatment was effective, at least in the short-term. For FEA analysis, restoring the deeper NCCL prior to ceramic veneer impression, presented better mechanical behavior and less tooth wear. For the 1.0 mm NCCL, beveling the margin of the lesion generated the same good results.
Highlights
Non-carious cervical lesions (NCCL) are defined as a loss of dental hard tissue at the cemento-enamel junction not related to a carious process (CIEPLIK et al, 2017)
They usually result from a multifactorial process associated with abrasive and/or biocorrosive mechanisms and from occlusal stress when the action of paraaxial occlusal biomechanical loads promote loss of tooth structure (GRIPPO; SIMRING; COLEMAN, 2012; JAKUPOVIC et al, 2014; TEIXEIRA et al, 2018)
The biomechanical behavior of the S model was similar to SBV and SV. These models presented more homogenous stress distribution compared to the models with NCCL (L1 and L2), independent of depth
Summary
Non-carious cervical lesions (NCCL) are defined as a loss of dental hard tissue at the cemento-enamel junction not related to a carious process (CIEPLIK et al, 2017) They usually result from a multifactorial process associated with abrasive and/or biocorrosive mechanisms and from occlusal stress when the action of paraaxial occlusal biomechanical loads promote loss of tooth structure (GRIPPO; SIMRING; COLEMAN, 2012; JAKUPOVIC et al, 2014; TEIXEIRA et al, 2018). Removing or controlling the etiological factors involved in the development of the NCCLs is a very important step on their treatment, and the most effective measure on preventing their recurrence (SAWLANI et al, 2016; SOUZA et al, 2017) Restoring these NCCLs is very important for protection against more severe wear, preventing dentin hypersensitivity, enhancing aesthetics and Received: 08/04/19 Accepted: 20/12/19
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