Non-carious Cervical Lesions Research Articles

Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration.

To synthesize the literature regarding noncarious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated. A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration. NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies, whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineralization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multistep and single-step adhesives have been used. Dentin etching should be increased to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion. Noncarious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multistep or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators.

Clinical Performance of a "No Wait" Universal Adhesive in Noncarious Cervical Lesions: A Two-year Randomized Controlled Clinical Trial.

To evaluate the 24-month clinical performance of a "no wait" universal adhesive with different application modes in comparison with an etch-and-rinsew and two-step self-etch adhesive in non-carious cervical lesions (NCCLs). A total of 234 non-carious cervical lesions in 34 patients were restored following 5 different adhesive approaches: 1. Clearfil Universal Bond Quick, self-etch mode (CUQ-SE); 2. Clearfil Universal Bond Quick, selective etch mode (CUQ-SLE); 3. Clearfil Universal Bond Quick, etch-and-rinse mode (CUQ-ER); 4. Clearfil SE Bond (self-etch adhesive) (CSEB); 5. Tetric N-Bond Universal, etch-and-rinse mode (TBU-ER). All NCCLs were restored with a nanohybrid composite (Tetric N-Ceram). The restorations were evaluated at baseline, 6, 12, and 24months of clinical service regarding retention, marginal adaptation, marginal discoloration, secondary caries, post-operative sensitivity, color match, surface texture using modified United States Public Health Service (USPHS) criteria. The patient recall rate at 24 months was 73.5%. Eleven restorations, 6 of the CUQ-SE group, 4 of the CSEB group and 1 of the TBU-ER group, were clinically unacceptable due to retention loss. Regarding marginal adaptation and discoloration, CUQ-SE and CSEB groups exhibited higher bravo scores than other groups after 24 months (p < 0.05). At the end of 24-month examinations, no significant differences were detected among the groups regarding secondary caries, post-operative sensitivity, color match and surface texture. The clinical survival rates of the "no wait" universal adhesive at self-etch mode after 24 months were not acceptable. The "no wait" universal adhesive showed clinically acceptable performance in selective-etch and etch-and-rinse mode according to the evaluated USPHS criteria.

Comparative Evaluation of Postoperative Sensitivity Using Three Different Tooth-Colored Restorative Materials in Non-carious Cervical Lesions: A Split-Mouth Design In Vivo Study.

IntroductionThree different tooth-colored restorative materials were evaluated and compared for postoperative sensitivity using a split-mouth design. This is a double-blinded clinical trial assessed for a one-month follow-up period in patients with non-carious cervical lesions (NCCLs).Materials and MethodsA total of 60 NCCLs in 20 participants were considered in this split-mouth design study and randomly divided into three different groups: Flowable composite (n = 20), resin-modified glass ionomer cement (RMGIC) (n = 20), and Zirconomer® (n = 20). The restorations were evaluated for postoperative sensitivity at baseline (BL-day 0), three, seven, and 21 days using the Schiff cold air sensitivity scale. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States) using a post hoc test for postoperative sensitivity and one-way Anova to analyze all the groups together at the time interval of three, seven, and 21 days.ResultsIn Group 1 (flowable composites) and Group 3 (Zirconomer), a statistically significant difference in terms of reduced postoperative sensitivity was seen after three and seven days. However, a significant reduction in postoperative sensitivity was seen after three, seven, and 21 days in Group 2 (RMGIC).ConclusionIn this study, RMGIC showed reduced postoperative sensitivity after restoring NCCLs compared to Zirconomer and flowable composites. Compared with flowable composites and Zirconomer, RMGIC showed better clinical performance in terms of less postoperative sensitivity after restoring NCCLs.

Virtual Medicine and Teledentistry during covid 19:systematic Reviews

Background Covid19 pandemic has changed the vision on how to deal in emergency situations. Advanced technology and spreading growth of internet connection encourage people to use it to obtain helpful advice in critical climate of covid 19 crisis. The aim of this study to through the light on importance of teledentistry in critical emergency situations. Methods/Design A systematic literature review depends on collecting data from an evidence-based studies.Searches were made of eight electronic databases: the Cochrane Oral Health Group’s Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), , EMBASE, PsycINFO, CINAHL, Scopus and Web of science ,MEDLINE(PubMed). Results Systematic reviews have demonstrated the successful use of teledentistry in diagnosis of gingivitis/periodontitis, plaque and calculus, and presence of teeth exhibiting gingival recession, furcation involvement, erosion, tooth wear, and non-carious cervical lesion, as well as presence of carious, filled, and crowned teeth and implants. In a second opnion assessments and in the periapical radiograph’s interpretation and in education purpose also used. Conclusion Teledentistry improve oral healthcare follow up in critical situation.

Numerical Modeling of a New Type of Prosthetic Restoration for Non-Carious Cervical Lesions.

The paper considers a new technology for the treatment of non-carious cervical lesions (NCCLs). The three parameterized numerical models of teeth are constructed: without defect, with a V-shaped defect, and after treatment. A new treatment for NCCL has been proposed. Tooth tissues near the NCCLs are subject to degradation. The main idea of the technology is to increase the cavity for the restoration of NCCLs with removal of the affected tissues. The new treatment method also allows the creation of a playground for attaching the gingival margin. The impact of three biomaterials as restorations is studied: CEREC Blocs; Herculite XRV; and Charisma. The models are deformed by a vertical load from the antagonist tooth from 100 to 1000 N. The tooth-inlay system is considered, taking into account the contact interaction. Qualitative patterns of tooth deformation before and after restoration were established for three variants of the inlay material.

Clinical Behavior of the Gingival Margin following Conservative "Coronally Dynamic" Restorations in the Presence of Non-Carious Cervical Lesions Associated with Gingival Recession: A Pilot Study.

Gingival recessions (GR) are often associated with the presence of non-carious cervical lesions (NCCL). The latter result in the disappearance of the cement–enamel junction (CEJ), with consequent difficulties both in measuring the recession itself and in performing root coverage techniques. The restoration of cervical lesions is consequently an important aspect in the treatment of GR, with the re-establishment of a “new” CEJ. This pilot study aimed to verify whether restorative therapy alone, with the execution of a restoration that mimics the convexity of the natural CEJ and thanks to a slight horizontal over-contour, can stabilize a clot in the intrasulcular site and consequently is able to change the position of the gingival margin in a coronal direction. In periodontally healthy patients, with a non-thin gingival phenotype, 10 GR-associated NCCL restorations were performed using a protocol inspired by concepts of prosthetic conditioning, with a progressively reduced convexity (“coronally dynamic restoration”) and de-epithelialization of the gingival sulcus. We observed that 70% of the treated teeth showed a reduction in crown length after 15 days (−0.267 mm), without an increase in probing depth. While considering the limitations of the sample and the need to evaluate the different parameters that can affect the result, the coronally dynamic restoration of NCCL with GR was able to influence the position of the gingival margin in a coronal direction.

Eight-year clinical evaluation of two types of resin composite in non-carious cervical lesions.

In this clinical study, the 8-year clinical performances of a flowable resin composite was compared with that of a conventional resin composite. Ninety non-carious cervical lesions (NCCLs) in 19 participants were involved in this trial. NCCLs were restored with a flowable composite (Clearfil Flow FX: FX, Kuraray Noritake, Japan) or a conventional resin composite (Clearfil AP-X: AP) in conjunction with a one-step self-etch adhesive (Clearfil S3 Bond). Each participant had both types of resin composite restorations that were randomly allocated. The restorations were evaluated at baseline and annually up to 8years using modified USPHS criteria. The data were statistically analyzed using the Fisher's exact test, Kaplan-Meier method, and a multivariate Cox-regression with frailty models (p < 0.05). The 8-year participant recall rate was 95%. One hundred percent retention was recorded for AP, whereas four out of 46 restorations were lost for FX during the 8years. The incidence of marginal staining increased over time regardless of the type of resin composite, showing 48% for AP and 57% for FX after 8years. Wear of the resin composite occurred only for the flowable material and there was a significant difference between the types of resin composite (p = 0.024). Overall survival rates at 8years for AP and FX were 98% and 82% respectively (p = 0.110). The flowable resin composite presented lower wear resistance and showed a lower survival rate compared with the conventional composite after eight years of clinical service. Flowable resin composites may show greater wear after long-term clinical service. UMIN000028745, Date of registration: August 19, 2017.

Clinical Effectiveness of Composite Resin Bonded with Universal Adhesive for the Restoration of Non-Carious Cervical Lesions Using Air Abrasion: A Randomised Controlled Trial

Restorative treatment is very challenging for non-carious cervical lesions (NCCLs) due to functional and structural complexities. The purpose of this randomised controlled trial (RCT) was to evaluate the clinical performance of nanocomposite restorations bonded using universal adhesive in self-etch mode with and without air abrasive surface treatment for NCCLs. A total of 70 NCCLs, from a group of consenting patients who fulfilled the inclusion criteria, were recruited for the study. The study was carried out following CONSORT guidelines. Block randomisation was done for equal allocation of lesions into; Group 1 (surface treatment with alumina air abrasion) and Group 2 (control group without mechanical surface treatment). The lesions were restored with nanocomposite using a universal bonding agent in self-etch mode. The clinical performance of the restorations was evaluated by two examiners using modified United States Public Health Service (USPHS) criteria at baseline, 3 months, 6 months and 12 months. A Chi-square test was performed for inter-group comparison. Cochran’s Q test and Dunn’s post hoc analysis were used for intra-group comparison. The inter-group comparison revealed no statistically significant difference between the experimental and control group for all the parameters assessed. With the intra-group analysis, it was found that there was a significant decrease in the performance of the restorations concerning marginal staining, marginal adaptation and surface texture during the evaluation period (p &lt; 0.05). However, all of them demonstrated clinically acceptable performance. According to the results of this RCT, it was concluded that airborne particle abrasion of NCCLs did not improve the clinical performance of nanocomposite resin bonded using universal adhesive.

Evaluation of the Effectiveness on Dentin Hypersensitivity of Sodium Fluoride and a New Desensitizing Agent, Used Alone or in Combination with a Diode Laser: A Clinical Study

(1) Background: Dentine Hypersensitivity (DH) is a frequent clinical problem that causes long-term painful discomfort to patients and is a diagnostic and therapeutic challenge for dentists. The aim of this research was to verify the efficacy of a Sodium Fluoride (NaF) gel and the VivaSens® varnish used alone or in combination with a Creation Soft Diode Laser (DL) to treat DH pain. (2) Methods: The study included 121 Non-Carious Cervical Lesions (NCCLs) in 48 patients who complained of DH pain of variable intensity, between 4 and 7 points in VAS, after application of a cold stimulus. Four study groups of 12 patients each were created and subjected to four different types of treatment. Group 1 comprised 27 NCCLs with a total VAS score of 142, who received a topical treatment of NaF. Group 2 comprised 34 NCCLs with a total VAS score of 179, who were treated with NaF in association with DL. Group 3 comprised 31 NCCLs with a total VAS score 172, who received the VivaSens varnish. Group 4 comprised 29 NCCLS with a total VAS score of 155, who were treated with VivaSens in association with DL, using a power of 0.2 Watt in continuous emission and a fiber of 400 µm diameter. (3) Results: The results for each NCCL were evaluated by the cold stimulus response and recorded according to the VAS at the end of each treatment (t1) as well as after one week (t2), 1 month (t3), and 6 months (t4). All treatments resulted in pain relief at all study times, but the best results were obtained for Group 4 at t1, with a total VAS score of 26, and for Group 2 at t2, t3, and t4, with total VAS scores of 41, 51, and 65, respectively. (4) Conclusions: The treatment with VivaSens allowed pain relief immediately after its application, but the greatest long-term benefits (t2, t3, and t4) were obtained with the topical application of NaF associated with a DL.

Simulation of Non-Carious Cervical Lesions by Computational Toothbrush Model: A Novel Three-Dimensional Discrete Element Method.

Non-carious cervical lesions (NCCLs) are saucer-shaped abrasions of a tooth. NCCLs can form due to various etiologies, including toothbrushing wear, acid erosion, and mechanical stress. Owing to this complex interplay, the mechanism of NCCLs in tooth abrasion has not been established. This study aims to develop a numerical method using a computational toothbrush to simulate NCCLs. The forces acting on the teeth and the amount of abrasion generated were evaluated. The discrete element method using in-house code, connected particle model, and Archard wear model were applied for brushing. In the toothbrush model, 42 acrylic tufts were fixed into a toothbrush head. The teeth models with enamel properties comprised four flat plates and two grooves to simulate the anterior teeth and NCCLs. The brushing speed and depth for one cycle were established as simulation parameters. The force applied within the ununiform plane was concentrated on several bristles as the toothbrush passed through the interproximal space. The brushing force (depth) had a greater effect on tooth abrasion than the brushing speed. Toothbrushing abrasion was mainly concentrated in the interproximal space. Therefore, forceful tooth brushing can cause NCCLs from the interproximal space to the cervical area of the tooth.

The Relation Between Non-Carious Cervical Lesions and Possible Etiological Factors – A Study from a Tertiary Care Setting of Pakistan

Objective: To investigate and compare the risk factors of Non carious cervical lesions in relation to demographics, dietary, social and hygiene maintaining habits in Pakistani population presenting to Armed Forces Institute of Dentistry Rawalpindi.&#x0D; Study Design: Cross sectional analytical study.&#x0D; Place and Duration of Study: Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Dec 2018 to May 2019.&#x0D; Methodology: Two hundred patients of both genders ranging from age 12 to 70 years with a mean age of 46.4 ± 12.4 were studied for Non carious cervical lesions presence on convenience sampling technique. Questionnaires regarding their diet, acidic food consumption, social habits, frequency and pattern of brushing were being filled. Chi square statistics were used to compare groups and results were noted.&#x0D; Results: Old age (55.4 ± 0.8 years), vegetarian diet (p≤0.001), consumption of acid foods (p≤0.001), bruxism (p≤0.001), harder tooth brushes (p≤0.001) with variable movements (p≤0.001) showed higher incidence of non-carious cervical lesions. Whereas use of fluoridated toothpastes (p≤0.001) and xylitol gums (p=0.02) demonstrated protection against the occurrence of these lesions.&#x0D; Conclusion: The presence of Non carious cervical lesions was linked with the use of harder toothbrushes, variable vigorous pattern for tooth brushing, consumption of a vegetarian diet, and greater consumption of acidic food and bruxism. Effective policies should be developed for oral health and awareness of such conditions.

Modifications of the Dental Hard Tissues in the Cervical Area of Occlusally Overloaded Teeth Identified Using Optical Coherence Tomography.

Background and objectives: Occlusal overloads produce a series of manifestations in teeth, especially attrition and non-carious cervical lesions (NCCL). Optical Coherence Tomography (OCT) can highlight and evaluate tooth lesions. The aim of this study was to examine the changes of dental hard tissues in the cervical area because of occlusal overload by macroscopic examination and using in vitro Swept Source OCT examination. Materials and Methods: The study was performed on 21 extracted teeth with occlusal trauma. After macroscopic and OCT examination, the 2D OCT images were transformed into 3D images using ImageJ software. Statistical analysis of macroscopic and OCT images was performed with Statistical Package for Social Sciences. Results: On 21 teeth, 88 cervical lesions (cracks) were identified. Upper premolars with an occlusal Smith and Knight tooth wear score of 2 had the most NCCL. Statistical analysis revealed significant differences in the median widths of cervical lesions between teeth with score 1 and score 3. Additionally, we obtained statistically significant differences in median widths between the buccal and oral surfaces. Conclusions: These cracks can be considered precursors of NCCL. NCCL can be located on dental surfaces in the cervical area other than the buccal one. A 3D reconstruction of OCT images emphasized that cracks are located especially at enamel level, evolving towards the enamel–dentin junction, with multiple ramifications.

Etiological Factors Associated with Non-carious Cervical Lesions: A Study at the Municipal Center for Oral Health of Ouagadougou, Burkina Faso

Etiological Factors Associated with Non-carious Cervical Lesions: A Study at the Municipal Center for Oral Health of Ouagadougou, Burkina Faso

Prevalence of non-carious cervical lesions and orthodontic treatment: a retrospective study

BackgroundThis study aimed to assess the distribution of non-carious cervical lesions (NCCLs) by tooth type, investigate the prevalence of NCCLs in patients undergoing orthodontic treatment, and identify the possible associated factors.Material and methodsA total of 160 patients were enrolled in this retrospective study. Data on the following variables were collected from pre-and post-orthodontic treatment records: age, sex, Angle’s malocclusion, facial pattern, number of activation sessions, compensatory treatment, and retreatment. Frontal, right and left lateral intraoral photographs of each patient were evaluated to identify the presence or absence of NCCLs in each tooth and assess the distribution of NCCLs in the 3840 teeth from the enrolled patients. Furthermore, patients were classified as NCCLs present, irrespective of the number of NCCLs on the teeth or NCCL absent. Bivariate and multivariate Poisson regression analyses with robust variance were used to assess the association between the NCCLs and each independent variable. Prevalence ratio and 95% confidence intervals were calculated and p < 0.05 was considered statistically significant.ResultsThe prevalence of NCCLs before and after orthodontic treatment was 22.71% and 30.91%, respectively. Premolars were the most affected teeth, followed by the first molars, canines, and incisors. After statistical analysis, age was found to be the variable factor that influenced the prevalence ratio, with NCCL being the most prevalent when orthodontic treatment was performed in adulthood.ConclusionsPremolars were most commonly affected by NCCLs. Furthermore, age seemed to contribute to the increased prevalence of NCCLs in adults undergoing orthodontic treatment.

NaOCl Application after Acid Etching and Retention of Cervical Restorations: A 3-Year Randomized Clinical Trial

This study evaluated the retention of composite resin restorations in noncarious cervical lesions (NCCLs) performed with or without pretreatment with 10% NaOCl solution (deproteinization). A randomized, controlled, split-mouth, double-blinded trial was carried out. Thirty patients with at least two NCCLs were included in the study. The NCCLs were randomly allocated into two treatment groups: control (acid etching with 37% phosphoric acid + placebo solution + Adper Single Bond 2/3M Oral Care + Filtek Z350/3M Oral Care) or experimental group (acid etching with 37% phosphoric acid + 10% NaOCl solution + Adper Single Bond 2 + Filtek Z350). A calibrated examiner evaluated the restorations at baseline (1 week) and recalls (6, 12, 24, and 36 months) using the FDI criteria. The primary outcome evaluated was retention of the restorations. Data were analyzed by the Kaplan-Meier method and the log-rank test (α=0.05). After 3 years, 64 restorations were evaluated in 23 patients. The annual failure rate was 9% for the control group and 17.8% for the experimental group (deproteinization technique). Considering the failures and their distribution among the characteristics of the patients and NCCLs, no statistically significant differences were observed for the control and experimental treatment groups (p=0.077) or the number of teeth in the mouth (p=0.320). Restorations in the mandible (p=0.039) and premolars (p=0.013) showed significantly lower clinical survival rates. The deproteinization pretreatment with a 10% NaOCl solution did not promote additional retention of restorations in NCCLs. (clinicaltrials. gov: NCT03086720).

Noncarious cervical lesion pretreated using antimicrobial photodynamic therapy and diode laser in reducing dentin hypersensitivity bonded to different restorative material: Valuation of bond values and invitro dye leakage

AimThe present study aimed to appraise the effect of Diode laser (DL), riboflavin, and curcumin on the bond strength of adhesive restorative material and the effects of pretreatment on microleakage scores. Material and MethodsNinety caries-free human permanent premolars were obtained and disinfected. All specimens were mounted till CEJ. To provide standardization, a 2 × 2 mm flat non-carious cervical lesion (NCCL) dentin surface was exposed. This was followed by dentin surface roughening/cervical groove preparation with a round bur. After tooth surface preparation, ninety specimens were divided arbitrarily into three groups. Group 1: NCCL exposed to DL; group 2: NCCL pretreated with riboflavin photosensitizer (RFP) and group 3 pretreated with curcumin photosensitizer (CP). All the three groups were further divided into two subgroups A1, A2, B1, B2, C1, and C2 based on the restorative material used (n = 15). Subgroup A1, B1, and C1 were restored with composite resin (CR). Subgroup A2, B2, and C2 were restored with RMGIC. Ten samples from each subgroup were evaluated for shear bond strength (SBS) testing under a universal testing machine (UTM). Five from each subgroup were evaluated for microleakage assessment. Bond strength and microleakage analysis were performed using analysis of variance (ANOVA) with a Post-hoc test (Tukey's post hoc test) at a significance level (p = 0.05). ResultsThe group A1, DL-CR shows the highest SBS (16.41± 0.4 MPa). However, CP-RMGIC groups demonstrated the lowest bond integrity. RFP-CR and the DL-CR group displayed comparable outcomes of SBS (p>0.05). The highest microleakage was observed with CP-RMGIC. The least microleakage was displayed by DL-CR. ConclusionNoncarious cervical lesions pretreated with diode laser and riboflavin photosensitizer showed better shear bond strength and reduced microleakage when bonded to composite resin than non-carious cervical lesions pretreated with curcumin.

Periodontal--Restorative Approach for Treating Non-Carious Cervical Lesions With Multiple Gingival Recessions: A Case Report

Background: Non-carious cervical lesions (NCCLs) are commonly associated with multiple gingival recessions. These cases cause aesthetic issues, dentin hypersensitivity and increased plaque accumulation. Therefore, they require multidisciplinary treatments. Zucchelli proposed the combined periodontal–restorative approach using envelope coronally advanced flap (CAF) in managing multiple gingival recessions with NCCLs.&#x0D; Objective: This case report highlights the effectiveness of Zucchelli’s modified envelope CAF in combination with a restorative approach for the treatment of multiple Miller class- III gingival recessions with type-3 NCCLs.&#x0D; Case Report: Zucchelli’s approach was used to determine maximum root coverage (MRC). Restorative treatments in covering the NCCLs were limited to 1 mm apical to the calculated MRC. Modified envelope CAF was performed with full and partial thickness flap. After root exposure, root planning was done and restorative finishing was performed to acquire the ideal restorative finish line without marginal overhanging. Root surfaces were conditioned for 2 min. Adjacent interdental papillae were deepithelialized, and the flap was repositioned and secured using sling sutures to establish a tight seal, allowing the clot between the root concavity and the flap to mature. Periodontal dressing was applied.&#x0D; Results: After 12 days, healing was uneventful with good aesthetic and functional results. Complete root coverage according to MRC predictions was obtained, and periodontal health was normal.&#x0D; Conclusion: Zucchelli’s modified envelope CAF with restorative approach shows good outcomes in treating multiple gingival recessions with NCCLs, given the correct determination of MRC.&#x0D; Keywords: gingival recession, periodontal plastic surgery, root coverage

The Effect of Flowable Composite Resins on Periodontal Health, Cytokine Levels, and Immunoglobulins.

Objective This study investigated the effects of flowable resin composites (FCR) on the restoration of noncarious cervical lesions (NCCL) and their impact on periodontal tissues. Materials and Methods 30 periodontally healthy patients were assigned into three groups randomly; group VF: self-adhering FCR, group NF: fluoride-releasing FCR, and group SF: microhybrid FCR. Gingival crevicular fluid (GCF) volume levels of osteoprotegerin (OPG), immunoglobulins (IgA, IgM), and interleukins (IL-1, IL-1β, and IL-10) in GCF were analyzed with ELISA tests. Clinical success rates were evaluated using USPHS criteria during the 12-month follow-up. Results The GCF volume was increased mostly in group SF (1.34 ± 0.09 μl). While the titer of interleukin was increased in all groups, higher increases were observed in IL-1 and IL-1β in group NF (170.78 pg/ml and 39.35 pg/ml). Increased IL-10 was observed in group VF (14.33 ± 0.85 pg/ml). IgA levels varied partially among all groups (p > 0.05), and even IgM levels were elevated immediately after the restoration process but returned to normal on the 28th day (p < 0.05). Group NF failed in most of the USPHS criteria, while the material group VF and group SF presented acceptable results except in the marginal adaptation criterion (p < 0.05). Conclusions Clinical efficacy of self-adhering FCR was found the best for restoration of NCCL while fluoride-releasing FCR stimulated the periodontal response and had negative effects on GCF volume, cytokine, and immunoglobulin levels.

Role of non-carious cervical lesions multicausality in the behavior of respective restorations

ObjectivesTo evaluate biocorrosion and eccentric occlusal loading interplay in marginal quality of cervical restorations. MethodsCervical wedge-shaped cavities were prepared in extracted premolars and restored with a composite. Premolars underwent either an erosive challenge (E: 1% citric acid/10 min), eccentric occlusal loading (EOL: 150 N/2.5 Hz/106 cycles), E before EOL (E + EOL), E intermediate to EOL (EOL/E/EOL), E after EOL (EOL + E), or no E or EOL (C: control). Marginal quality was analyzed based on a series of Optical Coherence Tomography images. Each of the margins was assigned a gap score (0, 1, 2, or 3) and measurement (μm). For each margin, scores data were analyzed with Kruskall Wallis and Dunn tests, and μm data, with Kruskall Wallis. Overall and for each group, the different margins were compared using Wilcoxon signed-rank test, and the correlation between scores and μm, Spearman's correlation coefficient (α = 0.05). ResultsE and EOL, even if associated, did not influence enamel marginal quality. EOL/E/EOL impaired dentin/cementum marginal quality only in the case of scores and compared to E. E + EOL, EOL + E or EOL and even C, without differences between each other, did not influence results differently from E or EOL/E/EOL. Margins in dentin/cementum always showed lengthier gaps. Except for C, E and EOL + E cervical margin, there was a strong positive correlation between scores and μm. ConclusionsEccentric occlusal loading and/or biocorrosion cannot be assumed as causes of marginal failure of cervical restorations in wedge-shaped cavities. A relevant concern may still be the establishment of adhesive interfaces in dentin/cementum. Clinical significanceAlthough non-carious cervical lesions are strongly being recognized multifactorial and their respective restorations not always behave as expected, biocorrosion and eccentric occlusal loading interplay cannot serve as an explanation for marginal gaps they often present.

OCT Evaluation of Marginal and Internal Interface Integrity of Class V Composite Restorations after 36 to 48 Months.

To compare a self-etch and a two-step etch-and-rinse adhesive in terms of internal and marginal composite-tooth bond failure separately on enamel and dentin/cement at 36-48 months after restoration placement using optical coherence tomography (OCT). Twenty-seven patients with two or three class V composite restorations of noncarious cervical lesions 36-48 months after placement were included. The one-step self-etch adhesive Futurabond M ([Voco] group SE, n = 25) and the two-step etch-and-rinse adhesive Solobond M ([Voco] group ER, n = 20) combined with the nanohybrid composite Amaris (Voco) were evaluated. The four-step etch-and-rinse adhesive Syntac classic combined with Tetric EvoCeram (Ivoclar Vivadent) served as the control (n = 18). Spectral-domain OCT (SD-OCT, 1310-nm center wavelength) was applied. Marginal gaps and internal interfacial adhesive defects were quantified in cross-sectional OCT images. Groups were statistically compared using the Friedman/Wilcoxon test (α = 0.05). In enamel, nonsignificantly different percentages of marginal gap formation and internal interfacial adhesive defects were found between the groups (pi ≥ 0.258). In dentin/cement, SE showed significantly less marginal gap formation compared to ER (p < 0.001) and control (p = 0.001), and at the internal dentin-composite interface less adhesive defects were found compared to ER (p < 0.001) and control (p = 0.003). The self-etch adhesive used in the current study appears recommendable for restoration of noncarious cervical lesions with composite.