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PubMed2005

In vivo correlation of noncarious cervical lesions and occlusal wear.

STATEMENT OF PROBLEM: The etiology of noncarious cervical lesions is not well understood. An understanding of the etiology helps the clinician determine appropriate treatment and management strategies. Purpose This study evaluated the relationship between noncarious cervical lesions and occlusal (or incisal) wear. MATERIAL AND METHODS: Casts (n = 299) made from dental students were articulated in a semi-adjustable articulator and evaluated. Data included the presence and contour of noncarious cervical lesions (NCLs) and the presence, location, and severity of any occlusal/incisal wear facets. Also included were Angle's classification, occlusal guidance patterns, midline, presence of tori, tooth restoration, reverse articulation (crossbite), open occlusal relationship, and posterior excursive contacts where present. Following a calibration procedure, 2 evaluators made independent observations on the casts. The first evaluator recorded for each tooth in each subject: presence and severity of NCLs, presence and extent of occlusal/proximal restorations, and presence of reverse articulation and open occlusal relationship. Following the first evaluation red rope wax was placed at the cervical margins of each tooth for the purpose of blinding the second evaluator from NCL observations. The second evaluator recorded severity and location of occlusal/incisal wear, presence or absence of posterior excursive contacts, Angle's classification, occlusal guidance pattern, any midline discrepancy, and presence or absence of tori. The Spearman correlation coefficient and chi 2 tests were used to analyze the data (alpha=.05). RESULTS: There was no relationship between noncarious cervical lesions and occlusal/incisal wear. There was also no correlation between NCLs and other parameters examined. CONCLUSIONS: Under the conditions of this study, noncarious cervical lesions are not related to occlusal wear.

Adult↗
PubMed1998

A study of the classification and treatment of noncarious cervical lesions by general practitioners.

PURPOSE: This study presented a survey to determine what general practitioners in Nova Scotia perceived to be the cause of noncarious cervical lesions, and to ascertain their most frequent method of treatment. METHODS: The survey was completed by 63% of the 343 dentists polled. RESULTS: Ninety-four percent classified the lesion as abrasion, and 66% rated toothbrushing as the most likely cause. Treatment methods were varied, with no clear preference. CONCLUSION: The most frequently used restorative materials were GI/composites (29%) and composites (27%). The results of the survey suggest that treatment provided for noncarious cervical lesions may not be based on the correct diagnosis.

Clinical Competence↗
PubMed1998

Marginal adaptation and retention of a glass-ionomer, resin-modified glass-ionomers and a polyacid-modified resin composite in cervical Class-V lesions.

OBJECTIVES: An 18-month follow-up clinical trial of one conventional glass-ionomer (HIFI Master Palette), three resin-modified glass-ionomers (Fuji II LC, Vitremer, 3M Exp. 155) and one polyacid-modified resin composite (Dyract) was conducted to evaluate their clinical effectiveness in Class-V cervical lesions. In addition, the interface between dentin and two resin-modified glass-ionomers and one polyacid-modified resin composite was examined by scanning electron microscopy (SEM). METHODS: After evaluation of the restorations immediately following placement (baseline), all patients were subjected to a strict recall schedule with controls at 6, 12 and 18 months. The clinical effectiveness was recorded in terms of retention and marginal integrity, clinical microleakage, caries recurrence, and tooth vitality. A chi 2-test (p < 0.05) was used to test for significant differences between materials. In case of restoration loss or special defects, a replica was made to examine the surface texture and restoration margins by SEM. In vitro, the interface was examined by SEM after an argon-ion-beam etching technique was used to enhance surface relief and disclose interfacial substructures. RESULTS: Retention appeared to be good for all the materials tested. Marginal discrepancies were localized at the incisal enamel and/or the cervical dentin margin, except for the polyacid-modified resin composite that showed most of the defects at the incisal enamel margin. None of the systems could guarantee margins free of microleakage for a long time. In vitro, the type of dentin pre-treatment defines to a great extent the morphology of the resultant interface between dentin and the restorative material tested. SIGNIFICANCE: In this clinical study, the retention rate of the tested materials was good and even excellent for some products. Perfect marginal adaptation deteriorated too fast. The marginal adaptation of the polyacid-modified resin composite at the enamel site would probably have been better by the use of selective enamel or total acid etching. Marginal sealing remains a problem. Future research should concentrate on improving the marginal adaptation and sealing capacities before a broader clinical use can be advocated.

Acrylic Resins↗
PubMedDate not supplied

Effect of restored and unrestored non-carious cervical lesions on the fracture resistance of previously restored maxillary premolar teeth.

OBJECTIVES: The effect of non-carious cervical lesions (NCCL) on tooth fracture resistance has not previously been investigated. The aims of this in vitro study were to examine the fracture resistance of a group of extracted maxillary premolar teeth with mesio-occlusal-distal (MOD) restorations of amalgam, and restored or unrestored simulated NCCL. METHOD: Forty sound maxillary, premolar teeth were divided at random into four groups, each of 10 teeth, which were fixed crown uppermost and long axis vertical in stainless steel moulds. Groups 1,2,3 and 4 were prepared with standardized parallel-sided MOD cavities, then restored with amalgam. Groups 1, 2 and 3 were further prepared with standardized NCCL. The NCCL in Group 1 were restored using a resin-modified polyalkenoate (glass-ionomer) cement, and the NCCL in Group 2 were restored with an adhesive composite resin system. The NCCL in Group 3 were left unrestored. The specimens were loaded compressively at 1 mm min-1 using a universal testing machine. RESULTS: Mean fracture loads (KN) of 1.08, 1.03, 0.98 and 1.14, respectively, were recorded for Groups 1, 2, 3 and 4. Two-way ANOVA and Scheffe's Multiple Range Test showed no statistically significant difference between the groups. CONCLUSIONS: It is concluded that the presence of a standardized NCCL in an extracted maxillary premolar tooth does not reduce the fracture resistance of the tooth when loaded compressively at 1 mm min-1. The restoration of NCCL with the materials tested did not result in an increase in the fracture resistance of the previously restored premolar teeth, when loaded compressively at 1 mm min-1.

Analysis of Variance↗
PubMed2003

Analysis of etiologic factors and periodontal conditions involved with 309 abfractions.

OBJECTIVES: Non-carious cervical lesions (NCCL), also termed abfractions, have long been thought to be produced by excessive brushing. Nearly 20 years ago an occlusal etiology was proffered (Lee & Eagle 1984). Controversy still exists concerning these two concepts. The present work was carried out to verify the occurrence of signs of excessive brushing or occlusal disturbances associated with abfractions. MATERIAL AND METHODS: All first consultants were screened for the presence of abfractions during one trimester. NCCL were found in 61 patients who consequently received a thorough examination searching for clinical evidence of excessive brushing or occlusal disturbances. The presence of plaque, calculus, periodontitis, or mobility was also noted. Simple frequency and percentage were used to describe the occurrence of different clinical signs in association with the presence of abfractions. RESULTS: Abfractions often exist in mouths presenting plaque (40.1%), calculus (41.7%), or periodontitis (20.4%). Ulceration of the gingiva is a rare finding (1.6%). However, subgingival apical limits were frequent (32.5%). NCCL coexist almost systematically with occlusal wear facets (94.5%). Lack of canine disclusion (77.2%) was also closely associated with the presence of abfractions. Conversely, mobility was seldom found (1.9%). CONCLUSIONS: Clinical signs of excessive brushing were lacking, whereas signs of occlusal disturbance were very consistent with the presence of abfractions.

Adult↗
PubMed2000

Determination of changes on tooth-colored cervical restorations in vivo using a three-dimensional laser scanning device.

The present study aimed at the determination of changes of tooth-colored cervical restorations in vivo using an optical 3-dimensional laser scanning device. The study was performed on 197 cervical restorations placed on incisors, canines, and premolars. Four different tooth-colored restoration materials, a composite, a polyacid-modified resin composite, and two resin-modified glass ionomer cements, were used for the restoration of the lesions. For the determination of changes, images were taken at baseline and 15, 24 and 36 months after the placement of the fillings using a 3D-laser scanning device. The images were superimposed automatically, and digital subtraction was made by a specially developed image analysis software. The total substance loss on the entire filling surface at 36 months for the resin-modified glass ionomer Photac-Fil was 44 (+/-23) microm, for Fuji II LC 45 (+/-26) microm, for Dyract 71 (+/-47) microm and for Tetric 18 (+/-12) microm. Differentiating between the class of lesion, a higher wear rate was observed at 36 months on restorations which had been placed in erosion/non-carious cervical cavities (66 (+/-33) microm). In conclusion, the composite material demonstrated a distinctly lower surface wear rate over time in comparison to the resin-modified glass ionomer cements and the polyacid-modified resin composite.

Adult↗
PubMed1998

The prevalence of tooth wear in a cluster sample of adolescent schoolchildren and its relationship with potential explanatory factors.

OBJECTIVE: To assess the prevalence of tooth wear in adolescents and its relationship with diet, saliva and gastro-oesophageal reflux. DESIGN: Single centre cluster sample epidemiological study. SETTING: A school in London in the summer of 1996. SUBJECTS: 11-14-year-old schoolchildren. MAIN OUTCOME MEASURES: The Smith and Knight tooth wear index (TWI), salivary factors, diet and symptoms of gastro-oesophageal reflux were recorded for all subjects. RESULTS: Results were obtained from 210 subjects. One subject refused to provide a saliva sample and 11 subjects provided insufficient saliva for analysis of buffering power (n = 198). 57% (95% confidence intervals 50.3-63.7%) of subjects had tooth wear on more than ten teeth and a median 12% (interquartile range 6-18%, 95% confidence intervals 8-14%) of surfaces were affected. However, dentine involvement was rare. The median intake of carbonated drinks was 2 cans (interquartile range 1-3) a day. However, there was no correlation with TWI (r = -0.09, P = 0.19). There was no relationship between tooth wear index (TWI) and salivary flow rate (r = -0.02, P = 0.78) or buffering capacity (r = -0.02, P = 0.76). A trend was observed for those with a reported history of regurgitation (n = 27) to have a higher maxillary TWI (median 8, interquartile range 2-13) compared with those who did not (5, 2-9, P = 0.06). CONCLUSIONS: Tooth wear is common in adolescents and the relationship with dietary acid, salivary buffering and symptoms of gastro-oesophageal reflux is complex and requires further investigation.

Adolescent↗
PubMed2004

The prevalence of non-carious cervical lesions in permanent dentition.

A non-carious cervical lesion (NCCL) is the loss of hard dental tissue on the neck of the tooth, most frequently located on the vestibular plane. Causal agents are diverse and mutually interrelated. In the present study all vestibular NCCL were observed and recorded by the tooth wear index (TWI). The aim of the study was to determine the prevalence and severity of NCCL. For this purpose, 18555 teeth from the permanent dentition were examined in a population from the city of Rijeka, Croatia. Subjects were divided into six age groups. The teeth with most NCCL were the lower premolars, which also had the largest percentage of higher index levels, indicating the greater severity of the lesions. The most frequent index level was 1, and the prevalence and severity of the lesions increased with age.

Adolescent↗
PubMed2005

Three-year clinical effectiveness of a two-step self-etch adhesive in cervical lesions.

A 3-yr randomized, controlled prospective study evaluated the clinical effectiveness of a mild two-step self-etch adhesive, Clearfil SE, in Class-V non-carious lesions. The hypothesis tested was that prior selective etching of enamel with phosphoric acid does not affect the 3-yr clinical performance of this adhesive. A total of 100 lesions in 29 patients were randomly restored in one or two pairs, according to two experimental protocols: (i) application of Clearfil SE according to the instructions of the manufacturer (C-SE non-etch); and (ii) similar application of Clearfil SE with prior etching of enamel cavity margins with phosphoric acid (C-SE etch). Clearfil AP-X was used as a restorative material. At 3 yr, 90% of the restorations were examined for retention, marginal integrity, marginal discoloration, caries recurrence, postoperative sensitivity, and preservation of tooth vitality. An excellent retention rate (100%) was noted after 3 yr of clinical functioning. Only one restoration of the C-SE etch group was clinically unacceptable owing to the presence of a severe cervical marginal defect. A pairwise comparison between both groups showed a significant difference only in the number of small marginal defects at the enamel side, which was higher in the C-SE non-etch group. These incisal defects were small and clinically irrelevant. Superficial marginal discoloration increased slightly in the C-SE non-etch group and was related to the higher frequency of small incisal marginal defects. In this latter group, localized marginal discoloration was observed significantly more in smokers. In conclusion, the clinical performance of the mild two-step self-etch adhesive, Clearfil SE, remained excellent after 3 yr of clinical functioning. Additional etching of the enamel cavity margins was not critical for its clinical performance.

Acid Etching, Dental↗
PubMed1998

Gingival recessions and noncarious cervical lesions: a soft and hard tissue challenge.

Gingival recessions and noncarious cervical lesions are frequent and closely related defects which can be successfully treated by mucogingival surgery and restorative therapy techniques either used alone or in combination depending on the defect characteristics. Proper treatment planning is guided by careful clinical diagnosis. A selection of treatment modalities are presented and useful hints proposed: the long term success is always strictly bound to the identification and elimination of the etiologic factors, to a correct treatment and a meticulous maintenance program.

Gingival Recession↗
PubMed1999

Development of noncarious cervical notch lesions in vitro.

PURPOSE: The initiation and progression of noncarious cervical notch lesions (NCCL) continues to perplex clinicians worldwide and poses a considerable restorative challenge. The purpose of this brief communication is to report what is believed to be the first in vitro production of notch-shaped lesions in the cervical third of premolar teeth. MATERIALS AND METHODS: The lesions, were produced by axial loading of selected permanent premolar teeth in a 10% aqueous solution of sulfuric acid over a period of 5 days, followed by immersion in water for 7 days. RESULTS: Results revealed macroscopic and microscopic features similar to those observed in noncarious cervical lesions in vivo. The lesions were incidental findings while the authors were studying stress corrosion of enamel at low pH. Although much remains to be investigated regarding the etiology and pathogenesis of NCCL, axial loading and a corrosive environment may be implicated in these processes. The artificial lesions arose in clinically sound teeth, suggesting that there is no simple clinical examination to identify teeth at risk from NCCL. CLINICAL SIGNIFICANCE: The relationship between the development of NCCL and applied stress indicates that occlusal factors may play the most significant role in the initiation and progression of NCCL.

Bicuspid↗
PubMed2003

Perioesthetic approach to the diagnosis and treatment of carious and noncarious cervical lesions: Part I.

Several factors can contribute to the development of noncarious cervical lesions. Therefore, these lesions can be described and classified according to their primary etiology. Traditionally, most dentists have treated noncarious cervical lesions only with restorative methods, for example, composite resin restorations. However, in many cases, a periodontal or a combined restorative/periodontal approach provides a better esthetic and functional result. In part I of this two-part report, we provide a review of noncarious cervical lesions and a series of clinical case reports showing surgical techniques used and the importance of the periodontal aspect of lesion management.

Adult↗
PubMed2002

Restorative management of the worn dentition: I. Aetiology and diagnosis.

In this, the first of a four-part series on the restorative management of the worn dentition, the aetiological factors, diagnosis of toothwear and preventive measures are summarized. Later papers will deal with the management of localized anterior and posterior toothwear, the use of 'Dahl type' appliances as an effective means for the restorations and the various treatment options for the management of the dentition showing generalized wear. The series will discuss the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition.

Acids↗
PubMed2001

Clinical evaluation of two one-bottle dentin adhesives at three years.

BACKGROUND: The method currently used to adhere resin to dentin involves etching, priming and bonding. Many commercial adhesives now combine priming and bonding functions in a single solution, and these are frequently called one-bottle adhesives. The purpose of this study was to compare the 36-month clinical performance of two commercial one-bottle adhesives. METHODS: The authors enrolled 33 patients with noncarious cervical lesions in the study. A total of 101 lesions were restored with either a filled, ethanol-based adhesive (OptiBond Solo, SDS Kerr) or an unfilled, acetone-based adhesive (Prime & Bond 2.1, Dentsply Caulk) and a hybrid resin-based composite. Enamel margins were not beveled, and no mechanical retention was placed. The restorations were evaluated at baseline and six months, 18 months and 36 months after placement using modified Cvar/Ryge criteria. RESULTS: The retention rates at 36 months were 93.3 percent for the ethanol-based adhesive and 89.4 percent for the acetone-based adhesive. The difference in retention rates was not statistically significant. In both groups, 12 percent of the retained restorations had marginal staining, but no recurrent caries was detected around any restoration. Other restoration characteristics such as marginal adaptation and color match remained excellent three years after placement. CONCLUSIONS: The performance of both adhesives was excellent during this 36-month clinical trial. At the most recent recall evaluation (that is, 36 months), the filled, ethanol-based adhesive exhibited slightly better bond durability, but the difference between the two materials was not statistically significant. CLINICAL IMPLICATIONS: The one-bottle adhesives evaluated in this study provided excellent clinical retention of Class V restorations without mechanical retention. When the materials are used properly, restorations are retained at a high rate during at least three years of clinical service.

Adult↗
PubMed2002

Abfraction.

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Dental Enamel↗
PubMed2002

Characteristics of noncarious cervical lesions: a clinical investigation.

BACKGROUND: The purpose of the authors' in vivo investigation was to analyze the characteristics of noncarious cervical lesions, or NCCLs, in adult patients who had a high incidence of them. METHODS: The patient pool consisted of a total of 57 patients and 171 teeth (three teeth per patient), with one NCCL per tooth. The characteristics the authors evaluated were shape, dimensions, sensitivity, sclerosis and occlusion. RESULTS: In terms of lesion characteristics, 91 percent of the lesions had axial depths of 1 to 2 millimeters, 49 percent had occlusogingival widths of 1 to 2 mm, 74 percent had an angular shape of 45 to 135 degrees, 76 percent had mild or moderate sclerosis, and 73 percent had no or mild sensitivity. In terms of occlusion, 75 percent of teeth had an Angle Class I occlusion on the involved side, 60 percent had group function or mixed excursive guidance, 82 percent had wear facets, and 99 percent had Type 0 or I mobility. In terms of tooth location, 70 percent of NCCLs were on posterior teeth, 65 percent were on maxillary teeth, and 46 percent were on premolars. CONCLUSIONS: The evaluated NCCLs were found mainly to have small dimensions of depth and width (< 2 mm) and to be roughly right-angled in shape, and many had sclerosis and low sensitivity. A majority of the dentitions studied had Class I occlusion, with group function, prevalent wear facets, and little or no mobility. Cervical lesions were more common with posterior maxillary teeth and premolars, especially first premolars, which had the highest prevalence of lesions. Older patients were more likely to exhibit noncarious cervical lesions, but no great difference in incidence was found between men and women. Clinical Implications. A knowledge of the NCCL characteristics and etiologic covariables aids in proper case selection for treatment, aids in selection of appropriate treatment protocols and improves assessment of prognosis.

Adult↗