Abstract
The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.
Highlights
Gingival recession (GR) defects are highly prevalent among different populations and can affect up to 100% of individuals, regardless of oral hygiene conditions.[1]
Randomized clinical trials and systematic reviews have shown that the combination of coronally advanced flaps (CAFs) and connective tissue graft (CTG) is considered the gold-standard procedure, with the highest
It has been shown that approximately 50% of GR defects are associated with an non-carious cervical lesion (NCCL),[4,5] resulting in a combined defect (CD) that reduces the probability of achieving complete root coverage through treatment.[6,7]
Summary
MATHIAS-SANTAMARIA(a) Laís Fernanda Ferreira FERRAZ(a) Renato Corrêa Viana CASARIN(b) Giuseppe Alexandre ROMITO(c) Enilson Antônio SALLUM(b) Giovan Paolo PINI-PRATO(d) Márcio Zaffalon CASATI(b). (a)Universidade Estadual Paulista – Unesp, Institute of Science and Technology, Department of Diagnosis and Surgery, São José dos Campos, SP, Brazil. (b)Universidade Estadual de Campinas – Unicamp, Piracicaba Dental School, Department of Prosthodontics and Periodontics, Piracicaba, SP, Brazil. (c)Universidade de São Paulo – USP, School of Dentistry, Department of Stomatology, São Paulo, SP, Brazil. (d)Tuscany Academy of Dental Research – ATRO, Florence, Italy. Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript
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