Rethinking the decision-making process to treat gingival recession associated with non-carious cervical lesions

Abstract

The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.

Single gingival recession associated with non‐carious cervical lesion treated by partial restoration and coronally advanced flap with or without xenogenous collagen matrix: A randomized clinical trial evaluating the coverage procedures and restorative protocol

“…[23][24][25] The matrix was trimmed according to each defect size, placed to cover 1 to 2 mm of the restoration, and sutured independently of the flap. Thereafter, the flaps of both groups were advanced and sutured with sling and interrupted sutures 5 to cover the matrix and at least 2 mm of the apical margin of the restoration (Figures 1G and 2H).…”

“…2 It was suggested that CD with B-and B+ NCCLs should be treated with a combination of a restorative procedure to reconstruct the coronal zone of the NCCL, up to 1 mm of the root surface, and a surgical procedure for root coverage afterward. [3][4][5] Coronally advanced flap (CAF) with connective tissue graft (CTG) has been successfully used to treat CDs. [6][7][8][9][10] A recent study showed that both CAF and CAF + CTG can be successfully used as surgical techniques to treat single partially restored CD, and CAF + CTG achieved better coverage in CDs with a thin periodontal phenotype.…”

“…It was suggested that CD with B‐ and B+ NCCLs should be treated with a combination of a restorative procedure to reconstruct the coronal zone of the NCCL, up to 1 mm of the root surface, and a surgical procedure for root coverage afterward 3–5 . Coronally advanced flap (CAF) with connective tissue graft (CTG) has been successfully used to treat CDs 6–10 .…”

“…Geistlich Mucograft, Geistlich Pharma AG, Wolhusen, Switzerland 5. 5.0 VicrylTM-Ethicon Inc.-São José dos Campos, Brazil.…”

Effect of partial restorative treatment on stress distributions in non-carious cervical lesions: a three-dimensional finite element analysis

“…In order to address the esthetic issues, periodontal root coverage surgery should be considered [ 4 ]. Combining restorative treatment with periodontal root coverage surgery is applicable to CDs, resolving both defects [ 5 , 6 ]. The detailed procedures of the combined restorative-surgery approach have been documented in previous clinical studies [ 7 , 8 ].…”