Types Of Non-carious Cervical Lesions Research Articles

Retrospective Analysis of the Association of Non-Carious Cervical Lesions with Bruxism

Recently, bruxism became the center of attention for the etiological research of non-carious cervical lesions (NCCLs). The present study aims to investigate the presence and types of NCCLs associated with bruxism. Retrospective keywords search of the clinical notes of all patient charts in axiUmTM was performed using the terms “bruxism”, “attrition”, “abrasion”, “erosion”, and “abfraction”. All bruxer patients 18 years and older who presented to the UNLV School of Dental Medicine (01/01/2014 to 09/30/2018) with the complete record were included. To determine the statistical analysis implications, the chi-square test was used. Commonest types of NCCL associated with bruxism were attrition and abfraction. Five hundred seventeen cases had multifactorial lesions. Anterior maxillary teeth followed by mandibular anterior were the most affected teeth. Abfraction lesions were mainly sighted in maxillary premolars, followed by maxillary canines. Within the limitation of the present investigation, it was concluded that attrition and abfraction were highly associated with bruxism.

Non-carious cervical lesions - can terminology influence our clinical assessment?

Introduction Abfraction is a theoretical term used that has been classified as a type of non-carious cervical lesion (NCCL) and characterised by the microstructural loss of hard dental tissue in areas of high stress concentration. There is a lack of consensus among researchers and clinicians as to whether occlusal loading, particularly interferences or eccentric loading, generates sufficient tensile stress to be an aetiological factor in the loss of hard dental tissue at the cemento-enamel junction (CEJ).Aim This narrative review article assesses the evidence behind the theory of abfraction.Results It is difficult to control all influencing factors in a clinical trial making it challenging to generate sufficient evidence to conclusively support the theory of abfraction. There is limited evidence occlusal forces are an aetiological agent in non-carious cervical lesion development. However, if occlusal forces do play a role, the term non-carious cervical lesion is more reflective of the limited role it may play and a multifactorial aetiology.Conclusion The term 'abfraction lesion' remains misleading and could be removed from our diagnostic vocabulary.

Diagnosis attitudes and restorative practices of non-carious cervical lesions by a group of Brazilian dentists from the state of Rio de Janeiro

This study aimed to identify diagnosis and restorative practices of non-carious cervical lesions (NCCLs) by a group of Brazilian dentists from the State of Rio de Janeiro. After ethical approval, a questionnaire was sent for a group of dentists registered at the Regional Council of Dentistry of the State of Rio de Janeiro (CRO-RJ, Brazil) and the answers were collected in a period of 15 days. The questionnaire considered training experience and attendance profile, diagnostic attitudes and restorative practices for direct restorations of NCCLs. The data were presented in a descriptive way and Chi-square tests (95% significance) were used to verify possible relations between dentists training/attendance profiles and NCCLs diagnosis/restorative attitudes. Most part of dentists considered the etiology as multifactorial and seek to distinguish the different types of NCCL, but only a minority respond to use auxiliary methods for diagnosis. Cotton-roll is the most used method for moisture control and 51.6% do not use gingival retraction/separation techniques. Two-step total-etch adhesive systems and hybrid/microhybrid composite resins were the most commonly refereed materials for direct restorations. Only 8.3% considered that restorations can last for a period of more than 5 years in clinical service. There was significant relation between remuneration and the type of isolation (p = 0.038) and also with gingival retraction/separation techniques (p = 0.043). It can be concluded that (a) the majority of the respondents revealed to seek distinguishes among the different types of NCCLs, but only a minority use auxiliary methods to diagnosis; (b) the form of remuneration influence the attitudes regarding the isolation method; (c) the two-step total-etch adhesive systems are the most used to restore NCCLs, (d) and that for the most part of the respondents the restorations of NCCLs made with resin composites do not last for more than 5 years.

The prevalence and morphological types of non-carious cervical lesions (NCCL) in a contemporary sample of people.

Non-carious cervical lesions (NCCLs) were examined in 6541 extracted human teeth and classified based on the morphology of the lesions. As a result, NCCLs were found on 38.7% of teeth (41.6% on maxillary teeth and 36.0% on mandibular teeth), and were most frequent on canines and first premolars. According to the new method of classification, the morphology of NCCLs was classified both by the surface contour (SC) and by the cross-sectional contour (CC). Three types of NCCLs appeared to be dominant. The causes of these NCCLs were discussed based on their morphologies, positions where these NCCLs were frequently found, and the results of previous studies. NCCLs with a horizontal oval SC and a round CC (Type I), which were frequent on the labial surfaces of maxillary canines and buccal surfaces of maxillary first premolars, may be associated with wear by friction and chemical degradation. NCCLs with a vertical oval SC and a round CC (Type II), which were frequent on the lingual surfaces of mandibular incisors and canines, might be mainly related to chemical degradation. NCCLs with a horizontal oval SC and a wedge shape CC (Type III), which were extensively found on the buccal surfaces of maxillary premolars, had formed most probably due to wear by friction and microstructural loss by stress. This new method can classify the morphology of NCCLs more precisely and deduce the mechanisms of the formation of NCCLs more clearly than former methods.

Abfraction lesions: etiology, diagnosis, and treatment options.

Abfraction is a type of noncarious cervical lesion (NCCL) characterized by loss of tooth tissues with different clinical appearances. Evidence supports that abfraction lesions, as any NCCLs, have a multifactorial etiology. Particularly, the cervical wear of abfraction can occur as a result of normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The interaction between chemical, biological, and behavioral factors is critical and helps to explain why some individuals exhibit more than one type of cervical wear mechanism than others. In an era of personalized dentistry, patient risk factors for NCCLs must be identified and addressed before any treatment is performed. Marked variations exist in dental practice concerning the diagnosis and management of these lesions. The lack of understanding about the prognosis of these lesions with or without intervention may be a major contributor to variations in dentists’ management decisions. This review focuses on the current knowledge and available treatment strategies for abfraction lesions. By recognizing that progressive changes in the cervical area of the tooth are part of a physiologically dynamic process that occurs with aging, premature and unnecessary intervention can be avoided. In cases of asymptomatic teeth, where tooth vitality and function are not compromised, abfraction lesions should be monitored for at least 6 months before any invasive procedure is planned. In cases of abfraction associated with gingival recession, a combined restorative-surgical approach may be performed. Restorative intervention and occlusal adjustment are not indicated as treatment options to prevent further tooth loss or progression of abfraction. The clinical decision to restore abfraction lesions may be based on the need to replace form and function or to relieve hypersensitivity of severely compromised teeth or for esthetic reasons.

Non‐carious cervical lesions: influence of morphology and load type on biomechanical behaviour of maxillary incisors

The aim of this study was to measure the effect of simulating two different loads on maxillary incisors displaying eight morphological types of non-carious cervical lesions, unrestored and restored with an adhesive restoration, by quantifying the stress distributions generated using finite element analysis. Virtual models of maxillary incisors were generated using the CAD software (RhinoCeros). After composing virtual dental and supporting structures with and without non-carious cervical lesions, each model was meshed using a control mesh device (ANSYS Finite Element Analysis Software). All of the virtual models were subjected to two load types, oblique load and vertical load, to simulate occlusal forces of 100N each. Comparisons were made between simulated teeth with non-carious cervical lesions, with and without composite resin restorations, and a simulated sound tooth. Data summarizing the stress distributions were obtained in MPa using von Mises criteria. Oblique loading on simulated non-carious cervical lesions resulted in greater stress concentration compared with vertical loading, and non-carious cervical lesions with acute angles displayed higher stress concentrations at the depth of the lesion. Restoring the lesions with an adhesive restoration, such as composite resin, appeared to overcome this stress concentration. Restoring NCCLs with adhesive restorative materials, such as a nanohybrid composite resin, appears to recover the biomechanical behaviour similar to sound teeth.

Characteristics of non-carious cervical lesions - an ex vivo study using micro computed tomography

The aetiology of non-carious cervical lesions (NCCLs) is not well understood and still controversial. The aim of this ex-vivo study was to examine the morphological characteristics of NCCLs for clinical evidence of enamel loss above the cemento-enamel junction (CEJ) as suggested by the abfraction theory. Fifty extracted human teeth with various types of NCCLs were collected and scanned by micro computed tomography. The reconstructed three-dimensional models were evaluated from multiple aspects, including longitudinal cross-section series. The location of internal line angle and proximal exits of the lesions were evaluated in relation to the level of CEJ. The coronal margins of the lesions were inspected for evidence of enamel loss above the CEJ using the bucco-lingual longitudinal sectional images. Coronal margins of the lesions were located along and/or under the CEJ for all of the 50 samples. In most of the lesions, regardless of lesion type, the proximal exits and internal line angles were located below the CEJ. This study did not detect clinical evidence of enamel loss above the occlusal margin of NCCLs as would have been expected according to the general abfraction mechanism.

Stress analysis of non carious cervical lesion and cervical composite resin restoration

Noncarious cervical lesions(NCCLs) are characterized as structural defects found on the tooth surface of the cement-enamel junction. Loss of tooth structure through noncarious mechanisms may vary in etiology and clinical presentation for each individual but presently many clinician now classify this as tooth failure of abfraction due to the stress applied in the cervical area of the tooth under oral physiological and pathological loads. In the current study, we investigated the stress distribution of maxillary premolar with NCCL using simulated 3D finite element analysis. The results were as follows: 1. In the sound maxillary premolar, the stresses were highly concentrated at cervical enamel surface of the mesiobuccal line angle, asymmetrically. 2. Once the lesion has been formed, the highest stress concentration was observed around the apex of the wedge shaped lesion. 3. In four types of NCCL, the patterns of stress distribution were similar and the peak stress was observed at mesial corner and also stresses concentrated at lesion apex. 4. Lesion cavity modification of rounding apex, reduced stress of lesion apex. 5. When restoring the notch-shaped lesion, material with high elastic modulus worked well at the lesion apex and material with low elastic modulus worked well at the cervical cavosurface margin.

Correlations of noncarious cervical lesions and occlusal factors determined by using pressure-detecting sheet

Objectives The purpose of this clinical study was to examine the relationships of v-shaped noncarious cervical lesion (NCCL) formation with occlusal factors. Methods A total of 159 male self-defense force officials with a mean age of 36.2 years participated in this study. All present teeth were examined for the presence and type of NCCL using the Tooth Wear Index (TWI). The subjects were then interviewed about bruxing and toothbrushing habit. Finally, occlusal force, occlusal contact area and average pressure were measured using a pressure-detecting sheet. Subject-level logistic regression was carried out to assess the associations of factors with presence of v-shaped NCCL teeth. Subjects without v-shaped NCCL were designated as control subjects. Results Totally, 4518 teeth were examined. Seventy-eight subjects (49.1%) had one or more teeth with typical v-shaped NCCL (259 teeth). The number of teeth with v-shaped NCCL of grade 2 (defect less than 1 mm in depth) was 195 (4.3%), and the number of teeth with v-shaped NCCL of grade 3 (defect 1–2 mm in depth) was 54 (1.2%). The prevalence of teeth with v-shaped NCCL was significantly higher in the maxilla than in the mandible. Most of the NCCL teeth were premolars. There was no significant difference between teeth with NCCL on the right side and those on the left side. Subject-level logistic regression analysis revealed that age (OR = 1.11), toothbrushing pressure (400 g, OR = 2.43) and occlusal contact area (>23.0 mm 2, OR = 4.15) were associated with the presence of NCCL teeth. Conclusions It is concluded that aging, toothbrushing pressure and occlusal contact area are associated with the presence of NCCLs.

The aetiology of the non-carious cervical lesion

Erosion and abrasion have been widely reported as causes of non-carious cervical lesions (NCCL). However, more recently, tooth flexure has been implicated in the formation of these lesions generating renewed interest in the pathogenesis of the non-carious loss of cervical tooth substance. This paper considers the causes of erosion and abrasion, related to modern lifestyles, and reviews the literature concerning tooth flexure as a cause of NCCL. A description of different types of NCCL is given, as an aid to determining the aetiology, yet at the same time accepting that the causation and pathogenesis of NCCL is probably multi-factorial resulting in many different clinical presentations. Consideration is given to the indications for treatment of NCCL and to the selection of materials for restoring such defects.