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PubMed2005

Evaluation of a profilometrical method for monitoring erosive tooth wear.

The in vivo monitoring of erosive wear is difficult because lesions mostly progress relatively slowly and reliable reference points are difficult to obtain. To date, only a few methods for clinical monitoring of erosive loss have been described, which either require extensive equipment or do not provide sufficient sensitivity. The aim of the present study was to evaluate, using study models (epoxy resin material), a procedure that permits the reliable and accurate monitoring of erosive substance loss within acceptable observation periods. The method is the profilometric measurement of erosive tissue loss using acid-resistant markers, which represent both a reference area and a structure for the defined retracing of a given erosive lesion surface. The study model magnified values slightly (2.8%; not significant), the precision was < 4 microm, and the repeatability was good (95% limits of repeatability ranging from -4.7 to 5.2 microm). The estimated detection threshold for erosive loss is 15 microm, which appears to be adequate for monitoring. The method is indicated for special dental care in cases of severe dental erosion (e.g. eating disorders) and for clinical studies.

Dental Enamel↗
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

Potential for load-induced cervical stress concentration as a function of periodontal support.

PURPOSE: The purpose was to determine, photoelastically, the locations of occlusal load-induced stress concentrations within a maxillary premolar as a function of degree of periodontal support. MATERIALS AND METHODS: Composite three-dimensional models of a maxillary first premolar were fabricated for quasi-three-dimensional photoelastic stress analysis. Individual materials were used to model enamel, dentin, periodontal ligament, and alveolar bone. Three levels of periodontal support reduction (0%, 20%, 25%) were simulated by varying the socket depth. Vertical loads of 10 lb were applied to: (1) tip of buccal cusp, (2) tip of lingual cusp, and (3) center of occlusal surface. The resulting stresses were monitored and recorded photographically in the field of a circular polariscope arrangement. RESULTS: Cuspal loading concentrated stress around the cervical region below the loaded cusp, being highest under buccal cusp loading. The location of the stress concentration shifted apically as periodontal support diminished. CLINICAL SIGNIFICANCE: Observed cervical stress concentration corresponded well to the common location of abfractions seen in clinical situations. Since the location of cervical stress concentration varied with occlusal conditions, occurrence of abfractions must be highly dependent upon each patient's occlusion. Periodontal support reduction shifted the location of highest stress away from the cementoenamel junction. Therefore, abfractions are less likely to occur on periodontally compromised teeth compared to stable teeth.

Alveolar Process↗
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↗
PubMed2000

Prevalence of noncarious cervical lesions and their relation to occlusal aspects: a clinical study.

PURPOSE: The purpose of this study was to assess noncarious cervical lesions in young patients and to establish a possible relation with occlusal aspects. MATERIALS AND METHODS: Forty-eight dental students (28 males; 20 females) between the ages of 16 and 24 years, were investigated to verify the presence of noncarious cervical lesions and their relation to some occlusal aspects. The assessment involved a questionnaire, clinical examinations, and model analysis. RESULTS: The results indicated that the lower first molars (21.3%), the upper first molars (16.0%), the upper first premolars (12.8%), the lower first premolars (11.7%), and the lower second premolars (11.7%) were the teeth most affected by the lesions. Age was a significant factor with respect to the presence of lesions; the students with noncarious cervical lesions were older than the students who showed no lesions. Among the 79 teeth exhibiting lesions, 62 (78.5%) showed wear facets. In the group with lesions, the mean, per subject, was 15.0 teeth with wear facets, whereas in the group without lesions the mean was 10.8 teeth with wear facets per subject, suggesting that occlusal stress has some effect on lesion development.

Adolescent↗
PubMed2002

Diagnosis and management of maxillary incisors affected by incisal wear: an interdisciplinary case report.

UNLABELLED: In the attempt to restore anterior teeth affected by erosion and bruxism, many clinicians have been frustrated with the constant restorative failures. Frequently, these failures are attributed to the restorative materials employed, especially in cases in which composite resins are used. However, some flaws of the restorations are related to the oversight of occlusal principles. The purpose of this article is to discuss the etiology, signs, and symptoms of incisal wear, with special attention to that caused by bruxism and chemical erosion. Relatively simple management techniques (e.g., occlusal adjustment, adhesive restorations) are proposed, and the diagnosis and management of a representative clinical case is presented. CLINICAL SIGNIFICANCE: In some cases of bruxism and/or dental erosion, it is possible to acquire space to recuperate the esthetics and function of maxillary incisors affected by incisal wear through a conservative treatment associated with the control of the etiologic factors.

Adult↗
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↗
PubMed2005

Esthetic noncarious Class V restorations: a case report.

UNLABELLED: When restoring anterior and posterior teeth affected by noncarious cervical lesions, many clinicians overlook the etiologic factors responsible for the lesions' development, resulting in frequent restorative failures. The treatment approach for noncarious cervical lesions must not be based only on restorative procedures since a variety of causative and aggravating factors are related to their formation. This article discusses a treatment protocol and techniques for the restoration of noncarious Class V lesions and presents a clinical case in which esthetic restorations are achieved. CLINICAL SIGNIFICANCE: Treatment options for noncarious Class V lesions can range from simply eliminating the causative factors of the lesions and regularly monitoring their progression to specific restorative procedures. Resin composites are the best materials for restoring cervical defects owing to their bonding ability, physical properties, and esthetic potential. A straightforward technique for the successful restoration of noncarious Class V lesions is presented.

Bruxism↗
PubMed2004

Clinical studies on the appearance of natural anterior teeth in young and old adults.

OBJECTIVES: To evaluate the typical appearance of natural anterior teeth in young and elderly people and to develop guidelines for the natural appearance of dentures. DESIGN: Clinical examination and photography. Inclusion criteria were a dental state with natural anterior teeth and no more than two crowns. SUBJECTS: A study group (SG) consisting of 64 patients ranging in age from 60 to 86 years (67.3 +/- 5.8) and a control group (CG) composed of 64 dental students aged 21-33 years (25.8 +/- 2.4). SETTING: Dental schools of the Johannes-Gutenberg-University Mainz and the University of Leipzig. RESULTS: Most participants were content with the appearance of their own natural teeth. With relaxed lips a mean of 1.5 (+/-0.19) mm of upper incisors and 1.6 (+/-0.19) mm of lower incisors were visible in the SG compared with 2.5 (+/-0.16) and 0.4 (+/-0.07) mm in the CG, respectively. The subjects in the SG showed a greater diversity in position of teeth in the anterior arch and this was more often with incisors than with canines. Features such as stains, cracks and defects were much more noticeable in the SG. An inter-dental 'black triangle' seemed to be a typical feature of an aged dental appearance. CONCLUSION: The majority of people older than 60 years who still have their own natural anterior teeth would not wish for a change in appearance if they needed a prosthodontic reconstruction. Thus techniques for customisation should be promoted to obtain a natural appearance in dentures.

Adult↗
PubMed2006

Symmetry of non-carious cervical lesions in canines and premolars.

OBJECTIVES: Clinically non-carious cervical lesions (NCCLs) are frequently seen. The aim of this study was to investigate the relationship between the shape and symmetry of NCCLs, wear of cuSPS and triangular ridge, and the curvature of the tooth root. METHODS: One hundred and twenty-nine extracted human upper canine teeth and 274 extracted human upper premolar teeth with NCCLs were used in this study. The specimens were studied using photographs and three-dimensional scanning. RESULTS: Asymmetric NCCL was observed in 69.0% of the canines and 44.5% of the premolars. Wear of cusp and lingual ridges was observed in 82.9% and 93.0% of the canines, respectively. Wear of the buccal cusp and buccal triangular ridge was observed in 85.4% and 89.8% of the premolars, respectively. On the other hand, the wear of lingual cusp and lingual triangular ridge was observed in 89.1% and 93.8% of the premolars, respectively. The curvature of the root was observed in 48.1% of the canines and 43.4% of the premolars. CONCLUSIONS: There was no relationship between the symmetry of NCCLs, and the wear of cuSPS and triangular ridges for either canines or premolars. Although there was a relationship (p < 0.05) between the symmetry of NCCL and the curvature of the root in the canines, no relationship was observed between the symmetry of NCCL and the curvature of the root in the premolars.

Bicuspid↗
PubMed1992

Root caries prevalence in black and white North Carolina adults over age 65.

The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.

Aged↗
PubMed1997

Prior fluoridation in childhood affects dental caries and tooth wear in a south east Queensland population.

Fluoride exposure in early life has an effect on dental caries experience, but does it affect tooth wear in later life? Ninety-six South East Queensland subjects were studied. Their histories revealed three groups; a fluoride (F-) in water supply, a F- by supplement, and a non-fluoridated (non F-) group. Significantly higher caries experience was found in the non-F- group compared with F- in water group and the F- supplement group. No statistically significant difference in caries experience was found between the F- in water and F- supplement groups. Overall, tooth wear affected more sextants of the dentitions of non-fluoridated, high-caries subjects than of fluoridated low-caries subjects. Comparisons of wear patterns on sextants of the dentitions, between the fluoridated and non-fluoridated groups, revealed that in sextants where attrition was present no marked differences were discernible between the two groups. However, in most sextants where incisal, palatal, occlusal or non-occlusal erosion was found, this type of wear was commoner in non-fluoridated subjects. The exceptions were the mandibular molar sextants, where prior fluoride-exposure did not appear to protect against occlusal erosion patterns. This study showed that fluoride exposure during the first 12 years of life, which reduced dental caries in this population, may also protect teeth from wear to some extent.

Adolescent↗