Noncarious Cervical Lesions: The Decision To Ignore or Restore

Abstract

A variety of unusual noncarious cervical lesions (NCL) are depicted that appear to negate W.D. Miller's toothbrush/dentifrice abrasion theory and demonstrate that other factors may be involved in their etiology. Confusion exists in the designation of NCL ever since G.V. Black stated in 1908 that toothbrush/dentifrice abrasion is an erosive effect. Since abrasion and erosion are two distinct activities, it is suggested that dentistry adopt the same terminology as chemical engineering in order to foster improved communication between the sciences. The term “abfraction” has been used to supplant erosion because it seems more appropriate when describing the loss of tooth substance attributable to effects of occlusal loading forces as well as the physiochemical breaking that occurs during stress corrosion. Numerous reasons, based on accepted engineering principles, indicate that NCL should be restored. It is incumbent on dentists to become cognizant of these reasons, since this would help them inform patients of the benefits to be gained by restoring such deficient areas.

Abrasive Wear of Four Direct Restorative Materials by Standard and Whitening Dentifrices

“…These areas involve the dentin, accumulate calculus, and are often sensitive (Grippo, 1992). Grippo further suggested that if the complex etiology of these lesions is not addressed, it is better to abrade restorative material rather than have continued loss of tooth structure.…”

“…Today, however, there is a subscription to the philosophy that the lesions described by Pindborg have multiple etiologies (Addy and Hunter, 2003;Addy and Newcombe, 2005;Grippo, 1992;Grippo, Simring, and Coleman, 2012;Sangnes, 1976). Cervical tooth wear has been attributed to mechanical stress, attrition, erosion, and abrasion.…”

Effects of occlusal load on the stress distribution of four cavity configurations of noncarious cervical lesions: a three-dimensional finite element analysis study

“…Therefore, the severity of geometric discontinuity of NCCL can be expected to have strong influence on the development of internal stress in the tooth 13) . These types of stress concentration may contribute to fatigue of tooth structure and accelerate the progression of abfraction 14) . Also, the processes of abrasion and erosion may advance more rapidly on damaged tooth structure 8,13) .…”

The influence of occlusal loads on stress distribution of cervical composite resin restorations: A three-dimensional finite element study

“…Loss of tooth structure in the cervical area of a NCCLs may cause esthetic problems and discomfort due to dentinal hypersensitivity 1,3,6) , but not all lesions require restorations 11) . The decision to restore NCCLs is based on the desire to strengthen the tooth and decrease the theoretical stress concentration and flexure, mitigate lesion progression, prevent hypersensitivity and pulp involvement, improve oral hygiene and enhance esthetics 11,12) . Tooth-colored direct restorative materials such as glass ionomer cement, composite resins, and resin-modified glass ionomer are available 13) .…”