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PubMed2006

A critical review of non-carious cervical (wear) lesions and the role of abfraction, erosion, and abrasion.

The terms 'abfraction' and 'abrasion' describe the cause of lesions found along the cervical margins of teeth. Erosion, abrasion, and attrition have all been associated with their formation. Early research suggested that the cause of the V-shaped lesion was excessive horizontal toothbrushing. Abfraction is another possible etiology and involves occlusal stress, producing cervical cracks that predispose the surface to erosion and abrasion. This article critically reviews the literature on abrasion, erosion, and abrasion, and abfraction. The references were obtained by a MEDLINE search in March, 2005, and from this, hand searches were undertaken. From the literature, there is little evidence, apart from laboratory studies, to indicate that abfraction exists other than as a hypothetical component of cervical wear.

Dental Enamel↗
PubMedDate not supplied

[Histopathological and therapeutical aspects of cervical lesions].

The term "cervical lesions" definies all the alterations consisting in a loss of hard dental tissues located along the cement-enamel junction, and may be more specifically defined as carious lesions (LCC) and non-carious lesions (NCCL). The non-carious cervical lesions are characterized by the loss of mineralised dental tissue in the absence of a carious process. This definition includes three different lesion categories: abrasion, erosion and the cervical lesions caused by stress (abfractions). In this paper the authors explain the histological, clinical, preventive findings of NCCL and try to give some guidelines to choose the appropriate material to restore different types of non carious cervical lesions.

Dental Caries↗
PubMed1998

Wine tasting and dental erosion. Case report.

A case of widespread dental erosion is reported in an individual who had worked in the wine industry for ten years. This occupation involved daily tasting of at least 20 wines, but often more. The erosion manifested as dental sensitivity with there being cervical erosion, occlusal pitting, and loss of enamel around restorations. The effect of immersing unerupted human teeth in white wine (pH 3.3) was examined with the scanning electron microscope, where marked surface changes had occurred after 24 hours of exposure.

Adult↗
PubMed1994

The etiology and treatment of cervical erosion.

Erosion lesions are probably caused by a number of factors in combination. Symptomatic treatment is most indicated for lesions too shallow to restore. For the restoration of erosion, glass ionomer materials, because they eliminate the risk of secondary caries, remain the material of choice, although dentin-adhesive resins have been continuously improved. Recent light-cured glass ionomer restorative materials can be placed without most of the inconvenience inherent in earlier chemically cured materials, and like their chemically cured predecessors, can be veneered with composite resin to improve the esthetics of highly visible restorations.

Composite Resins↗
PubMed2005

Toothbrush abrasions and noncarious cervical lesions: evolving concepts.

Toothbrush abrasion at the cervical areas of teeth is generally thought to be a result of frequent or forceful toothbrushing, faulty or vigorous technique, filament stiffness or design, dominant hand dexterity, or abrasive dentifrices. However, a review of the evidence-based literature cannot conclusively establish any one factor as the primary etiology of cervical abrasions because of inherent methodological limitations and conflicting results. Rather, a variety of factors related to toothbrushing may act in concert with dental erosion and, possibly, occlusal loading in the creation of noncarious cervical lesions. Individual variation also may make some individuals more susceptible to development and may modify the progression of those lesions. Individual variations may involve oral and dental anatomy, periodontal status or phenotype, and periodontal disease history and treatment. Further research is needed to clearly assess the interaction of all those factors in the development of cervical lesions. Therefore, awareness of a multifactorial etiology in noncarious cervical lesions may help the clinician to formulate an appropriate treatment plan for the patient.

Acids↗
PubMed2000

Restoration of extensive erosion areas using an indirect composite technique.

Cervical erosion defects, particularly those of extensive size that are located in an area where control of the operative field is difficult, can present a significant restorative challenge. This article describes an indirect restorative technique to solve this problem. Following tooth preparation, an indirect restoration is luted to the tooth and the margins are finished and polished. Using an indirect technique minimizes operative field isolation time and the total chairside time required to restore the tooth. Clinical cases are presented to illustrate this technique.

Adult↗
PubMed2006

[Subtotal hysterectomy: evolving concepts with implications for practice].

INTRODUCTION: The advantages and drawbacks of total and sub-total hysterectomy remain a topic of debate. Our study reviews the literature concerning recent comparative and prospective studies regarding the options of total and subtotal hysterectomy. RESULTS: Subtotal hysterectomy may be useful in preventing severe complications when total hysterectomy is technically difficult. Furthermore, conservation of the uterine cervix may decrease vaginal erosion in genital prolapse repair when synthetic meshes are used. The type of technique does not appear to determine the persistence or development of problems related to sexual activity (frequency of intercourse, sexual desire, and achievement of orgasm). There are no apparent advantages to subtotal hysterectomy compared with total hysterectomy with respect to bowel or bladder function. Some women (5-20%) who had the subtotal procedure continued to have genital bleeding, although this can be avoided with endocervical electro-coagulation or resection. Cervical stump prolapse is uncommon (1.5-2%), 12 months after subtotal hysterectomy. The risk of carcinoma of the cervical stump is low, and treatment results are similar in both patients with carcinoma of the cervical stump and in patients with carcinoma of the intact uterus. CONCLUSION: When subtotal hysterectomy is necessary, it can be performed with a low rate of long term complications. Furthermore, for women undergoing hysterectomy for benign disease, it should be reasonable to discuss advantages and drawbacks of both procedures and offer a choice. Nevertheless, sub-total hysterectomy should be avoided in populations with restricted access to screening programs for cancer of the uterine cervix.

Female↗
PubMed2002

The prevalence, aetiology and clinical appearance of tooth wear: the Nigerian experience.

OBJECTIVE: To establish the prevalence and severity of tooth wear among Nigerians and to compare the pattern and aetiology with findings of earlier studies in Western populations. DESIGN: Clinical examinations for tooth wear using the tooth wear index (TWI). SETTING: The Federal Republic of Nigeria. PARTICIPANTS: Patients attending the Dental Hospital, Obafemi Awolowo University Teaching Hospital's Complex Ile-Ife. OUTCOME MEASURES: Attrition, abrasion and erosion. RESULTS: Of the 126 patients with tooth wear 81 had attrition, 20 had abrasion, 9 had erosion and 16 had attrition and abrasion combined. A total of 15,480 tooth surfaces were examined. 2,229 (14.4%) surfaces had tooth wear out of which 1,007 (6.5%) were pathologically worn down. The frequency of tooth wear increased with the age of patients. Most of the pathologically worn surfaces were just one point above maximum acceptable value. CONCLUSIONS: The aetiological factors associated with tooth wear are not different from those encountered in Western cultures but the pattern of wear differs. Pathological tooth wear presents as an age related phenomenon and is probably more severe in Nigerians.

Adult↗
PubMedDate not supplied

Non carious cervical lesions. A review.

Non-carious cervical lesions (NCCL) are characterized by a loss of hard dental tissue near the cement-enamel-junction. Commonly, their shape is like a wedge with the apex pointing inwards. Other times, they appear as regular depressions, like a dome or a cup. Their main characteristic is the presence of hard-mineralized tissue. According to the literature, the prevalence of cervical lesions is 85%, while their incidence is about 18% among permanent teeth. NCCL are currently classified as erosion, abrasion, or abfraction. Their etiology seems to be related to different factors: hexogen and endogen acids, mechanical abrasive action, tooth flexion under axial and non-axial loads. Moreover, it seems that a fundamental role is ascribable to tooth bending phenomena due to the strength components parallel or oblique to the occlusal level, which occur during the normal function as well as during parafunctions. The frequent therapeutic failures are probably due to the same factors causing the onset of the original lesion. Several materials have been proposed to restore NCCL: amalgam (abandoned), glass-ionomer cements, compomers, and composite resins. Early failures of these restorations have often been reported in the literature, probably due to the same factors which originally caused the lesions. Further investigations are required to determine more reliable restorative therapies.

Compomers↗
PubMed2003

Two-year clinical effectiveness of a resin-modified glass-ionomer adhesive.

PURPOSE: To evaluate the clinical effectiveness of a resin-modified glass-ionomer adhesive FujiBond LC (GC) in non-carious Class V cervical lesions. METHODS: 28 patients and 52 abrasion-erosion lesions were restored using FujiBond LC and a microfilled resin composite in a cavity design with the adjacent enamel margins beveled. Clinical parameters as retention, marginal integrity, clinical microleakage, caries recurrence, esthetics, gingival response, tooth vitality and post-operative sensitivity were evaluated at 6 months, 1 and 2 years. RESULTS: A 100% retention rate was recorded after 2 years of clinical service. However, only 15% of the restorations showed a perfect marginal adaptation. All marginal defects were small, either located at the incisal or at the cervical margin. The percentage of small marginal defects was obviously higher at the incisal enamel margin than at the cervical dentin margin. At the 2-year recall, half of the restorations exhibited a superficial, localized discoloration at the restoration margin, however none of the restorations showed deep, generalized discoloration. Remaining criteria of clinical effectiveness were rated as excellent.

Adult↗
PubMedDate not supplied

A randomized, controlled trial evaluating the three-year clinical effectiveness of two etch & rinse adhesives in cervical lesions.

A three-year randomized, controlled prospective study evaluated the clinical performance of two three-step etch & rinse adhesives (OptiBond FL, Kerr: O-FL; PermaQuick, Ultradent: PMQ) in Class V cervical erosion-abrasion lesions. The latter adhesive was also tested with two restorative composites with contrasting stiffness in order to evaluate the effect composite stiffness might have on the clinical longevity of cervical restorations. A total of 150 lesions were randomly restored in pairs of the three adhesive/composite combinations (PMQ combined with Amelogen Hybrid: PMQ/A-Hy, Ultradent; PMQ combined with Amelogen Microfill: PMQ/A-Mi, Ultradent; O-FL combined with Prodigy: O-FLJPro, Kerr) per patient and evaluated at baseline, after six months, one year, two years and three years of clinical service. After three years, the retention rate was 100% for O-FL/Pro and 98% for both PMQ/A-Hy and PMQ/A-Mi, thereby, satisfying the "full acceptance" guidelines specified by the American Dental Association. A pairwise comparison showed no significant difference in adhesive performance between restorations made using the microfilled and hybrid composite for any evaluation criteria (p>0.05).

Chi-Square Distribution↗
PubMed1996

Longevity of glass-ionomer restorative materials: results of a 10-year evaluation.

Three restorative materials used for cervical erosion /abrasion lesions were evaluated clinically after 10 years. Thirty adult patients with at least four cervical lesions received one restoration of each of Ketac-Fil, finished immediately, Ketac-Fil, finished after a delay, Chelon-FIl (all glass-ionomer cements), and Cervident (a resin composite). Restorations were placed without any tooth preparations. Eighteen patients returned for their 10-year examinations. Two experienced examiners provided the periodic evaluations. Complete retention at 10 years was 83% for Ketac-Fil, finished immediately; 78% for Ketac-Fil, finished after a delay; 67% for Chelon-Fil; and 17% for Cervident. All three glass-ionomer restorative materials exhibited statistically significantly greater retention that did Cervident. When a noninvasive procedure is desired, glass-ionomer materials are the restorative material of choice for abrasion/erosion lesions because of their long-term retention values.

Adult↗
PubMed1996

Three-year clinical effectiveness of four total-etch dentinal adhesive systems in cervical lesions.

A 3-year follow-up clinical trial of two experimental Bayer total-etch adhesive systems and two commercial total-etch systems. Clearfil Liner Bond System and Scotchbond Multi-Purpose, was conducted to evaluate their clinical effectiveness in Class V cervical lesions. Four hundred twenty abrasion-erosion lesions were restored randomly using the four adhesive systems. There were two experimental cavity designs, in which the adjacent enamel margins either were or were not beveled and acid etched. Clearfil Liner Bond System and Scotchbond Multi-Purpose demonstrated high retention rates in both types of cavity design at 3 years. The two experimental Bayer systems scored much lower retention rates in both cavity designs at 3 years. None of the systems guaranteed margins free of microleakage for a long time. At 3 years, superficial, localized marginal discolorations were observed, the least for Clearfil Liner Bond System, followed by Scotchbond Multi-Purpose and the two experimental systems. Small marginal defects were recorded at the cervical dentin and the incisal enamel margin. Retention of Clearfil Liner Bond and Scotchbond Multi-Purpose appears to be clearly improved over earlier systems, but marginal sealing remains problematic. The two Bayer systems were found to be clinically unreliable.

Acid Etching, Dental↗
PubMed1997

The Gluma bonding system: a clinical evaluation of its various components for the treatment of hypersensitive root dentin.

This study investigated the desensitizing effect of topically-applied Gluma on sensitive cervical erosion lesions. A total of 46 teeth exhibiting moderate to severe sensitivity to cold and instrumentation, in 15 patients, were included in the study. Mildly sensitive teeth and teeth with cervical caries lesions were excluded from the study. After each tooth was isolated with rubber dam, investigators applied cold air, as well as tactile stimuli using an explorer, and recorded the baseline responses. Nine of the 46 teeth then received Gluma primer only (group 1), 15 received cleanser followed by primer (group 2), 15 received cleanser followed by primer and sealer (group 3), and seven received a placebo (group 4). After two weeks, the teeth in group 4 were randomly placed in one of the other three groups. The responses of the teeth in each group to various stimuli were recorded immediately after the application of test materials, and subsequently at one week, two weeks, one month, three months, six months and one year. Statistical analysis indicates that the three treatment groups all showed significant differences compared to the untreated control group (p < .001). A reduction of sensitivity was noted immediately after primer, cleanser-primer, or cleanser-primer-sealer was applied. Treatment groups 2 and 3 demonstrated less sensitivity than group 1 (p = .02; p = .03, respectively). At the one-year recall, the observed order of treatment effectiveness by group was 2, 3, 1. In approximately 50 per cent of the teeth treated in the study, remission of sensitivity was seen after one year. All of the remaining teeth exhibited some relief of sensitivity. The treatments' success was found to be inversely proportional to the severity of the initial response.

Adult↗
PubMed2001

Examining the prevalence and characteristics of abfractionlike cervical lesions in a population of U.S. veterans.

BACKGROUND: Abfraction is believed to be caused by biomechanical loading forces. It may be due to flexure and ultimate fatigue of tooth tissues that occur away from the point of occlusal loading. Other possible causes of cervical lesions include toothbrush abrasion and erosion. The purpose of this study was to investigate the characteristics and prevalence of abfraction-like lesions in a population of U.S. veterans. METHODS: The authors evaluated 103 teeth with noncarious cervical lesions in 32 subjects and characterized them based on the surface on which the lesion was located, history of toothbrush abrasion, size of the lesion, presence of plaque, surface texture, and presence and size of occlusal wear facets. RESULTS: Clinical examination revealed that adjacent control teeth had a significantly lower percentage of surfaces with plaque than did teeth with cervical lesions. Control teeth also had significantly less gingival recession than did affected teeth. Seventy-five percent of subjects reported a history of using a firm toothbrush, and 78.1 percent reported using a brushing technique that is known to cause toothbrush abrasion in the affected area. Affected teeth had neither significantly different occlusal wear facets nor occlusal contacts than control teeth. No significant correlations were found between cervical lesion dimensions and facet area. CONCLUSIONS: Toothbrush abrasion is strongly suspected as contributing to the formation of the majority of wedge-shaped lesions in this group of subjects. A small subset of lesions is thought to have resulted from some other phenomenon. Although the presence or contribution of occlusal stresses in the direct formation of these lesions could not be measured directly, the possibility of abfraction could not be eliminated. CLINICAL IMPLICATIONS: Because the existence of abfraction could not be ruled out in about 15 percent of the cases, teeth with noncarious, wedge-shaped lesions warrant careful occlusal evaluation, with the possible need for occlusal adjustment or bitesplint therapy to treat bruxism.

Adult↗
PubMed2005

Raman spectroscopic study of noncarious cervical lesions.

The surface of noncarious cervical lesions (NCCLs) consists of sclerosed dentin. This type of dentin may affect the ability of adhesive restorative materials to bond well to its surface, but little information exists on the chemical nature of this dentin surface and how it may be affected during acidic treatment. The inorganic part of normal dentin and dentin from NCCLs before and after acid conditioning with phosphoric acid or polyacrylic acid was investigated. Ten premolars with NCCLs and four human third molars (control) were used. Replicas of NCCLs were examined using scanning electron microscopy (SEM). Surfaces and longitudinal sections of four NCCLs and control dentin discs were analyzed using Raman spectroscopy. The discs and NCCLs were sectioned, and treated with 35% phosphoric acid or 20% polyacrylic acid/3% aluminum chloride, and Raman spectra obtained. The area under phosphate nu1 of the dentin spectrum was computed to obtain a ratio with the area under the second-order spectrum of a silicon phonon comparative standard. Mean phosphate nu1 and silicon phonon ratios from normal dentin and NCCLs were compared using a linear model with repeated measurements and Tukey's pairwise tests. Mean ratios from different locations of the NCCLs were compared using one-way analysis of variance (ANOVA) and Tukey's pairwise tests. SEM micrographs of NCCL surfaces showed variation from relatively smooth with no dentinal tubule openings to surfaces with occluded tubules. The mean phosphate nu1 and silicon phonon ratios for NCCLs were higher than those of normal dentin in all treatment groups (P < 0.05). Ratios from the untreated specimens were higher than those of the polyacrylic acid-treated specimens, and those for the phosphoric acid-treated group were the lowest (P < 0.05). The ratios obtained for the surfaces of NCCLs were higher than those halfway towards the pulp, and those adjacent to the pulp were the lowest (P < 0.05).

Acid Etching, Dental↗
PubMed2005

Retention of a resin-modified glass ionomer adhesive in non-carious cervical lesions. A 6-year follow-up.

OBJECTIVES: The purpose of this study was to evaluate the clinical retention of a new resin-modified glass ionomer cement based adhesive combined with a hybrid resin composite or a poly-acid modified resin composite in non-carious cervical lesions during a 6-year period. METHODS: The resin-modified glass ionomer adhesive (Fuji Bond LC), was placed in 73 cervical lesions, 36 with a universal hybrid resin composite (Tetric Ceram) and 37 with a poly-acid modified resin composite (Hytac). Fifty-one in lesions with sclerotic dentin and 22 in non-sclerotic ones. Of the sclerotic lesions 38 were slightly roughened with a diamond bur before conditioning. The restorations were evaluated with slightly modified USPHS criteria every six months during a 6-year period. RESULTS: All except six restorations were evaluated during the 6 years. Twelve (17.9%) were lost, four Tetric Ceram (11.8%) and eight Hytac (24.2%) (p<0.05). Four were found in non-sclerotic lesions (20.0%) and eight in sclerotic lesions (17.0%). The differences between the sclerotic and non-sclerotic and the roughened and non-roughened lesions were not significant. CONCLUSIONS: The resin-modified glass adhesive showed a superior clinical retention combined with the resin composite material, with an annual failure rate of 2%.

Adult↗