non carious cervical lesion

NON-CARIOUS CERVICAL LESION

NON-CARIOUS CERVICAL LESION

:INTRODUCTION:

Gradual loss of tooth structure is a physiologic process that accurs throughout life.most often it so slow that is rarely poses any problem to the patient.

Loss of tooth structure from the cervical region of the teeth accurs due to pathological processes like erosion,abrasion & abfraction which may act independently. This lesions are seen in half of the population.prevelance increase with age.The incresing popularity of adhesive restorative material like GIC & composite resins.

:Non-carious cervical lesion are associated with erosion, abrasion and abfraction:

Erosion: This is the loss of tooth substance by a non-bacterial chemical process.

Abrasion;

Dental abrasion is the pathological wearing away of teeth due to abnormal process, habits or abrasive substances.

Abfraction:

This is the pathologic loss of tooth substance due to bio-mechanical loading forces that result in flexure and ultimate fatigue of enamel and dentin at a location away from loading.

:Etiology of non-carious cervical lesion:

EROSION

Extrinsic Intrinsic

1) dietary acids Citrus fruits Carbonated Drinks Pickled foods

1) gastric disorders GIT ulcers Hiatus hernia Chronic alcoholism

2) Environmental erosion wine tasting metal plating 2) Eating disorders Anorexia nervosa bullimia nervosa3) chronic vomiting4) Pregnancy morning sickness

ABRASION

1).Tooth brushing- - Over vigorous brushing - Use of hard tooth brush - Improper brushing technique2).Abnormal habits- - Biting a pipe stem - Biting finger nail

ABFRACTION

1)Excessive occlusal stresses2)Para-functional habits- - Bruxism -Clenching

:SALIVA:

The quantity and quality of saliva may also have role in the development of non-carious cervical lesions. Drugs and conditions which reduce salivary flow can accelerated the loss of tooth structure in the cervical region.

Currently it is a accepted that non-carious cervical lesion have a multifactorial etiology and are not related to any one factor. A combination of erosion, abrasion and abfraction may operate in the initiation and progression of these lesions.

:Clinical Features:

Erosion AbrasionAbfraction

Location:Facial or lingualFacialFacial

Shape:

Broad,shallowSaucer shapeWedge shapeV-shapeWedge shape

Margins:Not well definedSharp and well definedsharp

EnamelSurface:Smooth and polishedSmooth may show scratchesRough,may show grooves

TeethAffected:Lingual surface of maxillary anteriorsFacial surface of maxillaryCanine to molarregionSub-gingival location possible

:DIAGNOSIS:

)(.History: Note down any history of intrinsic or extrinsic erosion. The dentist must try to identify digestive problems like anorexia, gastric regurgitation, etc..

A diet diary is useful in detecting excessive consumption citrus fruits, carbonated drinks, vit C tablets, vinegar, etc.. which are the common cause of dietary erosion.

The dentist must also question about abnormal habits like clenching, grinding, etc.. which may be factors responsible for abfraction.

)(.Clinical Examination:

Tooth mobility

Open contacts

Tited or drifted teeth

Atypical occlusal wear

Overerupted teeth

Cross bites,deep bites & open bites

Fewer number of occluding teeth

)(.Radiograph:

Altered lamina dura and periodontal space.

Evidence of hyper-cementosis, resortptions.

Pulpal calcification.

)(.Clinical Management:

1). Tooth sensitivity: Exposure of dentin in the cervical area may result in dentine hyper sensitivity.

2). Compromise esthetics: Loss of tooth structure in the cervical region of teeth may produce an un-esthetic appearance especially in the anterior region.

3). Risk of tooth fracture: Deep, wedge shaped lesions in the cervical area of teeth can increase the risk for tooth fracture due to lowered strength at this critical regions.

4). Pulpal damage: Deep cervical lesions are also likely

to results in re- reversible pulpitis and pulpal death.

5). Caries: Non-carious cervical lesions also favour plaque accumulation which would eventually lead to the development of caries.

6). Poor periodontal health: The gingival may be irritated and

inflamed due to non-carious cervical lesions.

:TREATMENT OPTIONS:

1) Dentin desensitization.

2) Restorations.

3) Endodontic therapy.

4) Periodontal therapy.

:DENTIN DESENSITIZATION:

This is a viable treatment option for those situations where minimal amount of dentin is exposed (less then 1mm) and the patient experiences hyper sensitivity. This may be managed by any of the methods suggested for dentin desensitization such as:

Fluoride varnishes or fluoride iontophoresis.

Dentin bonding agents.

Use of desensitizing tooth pastes.

:RESTORATIVE TREATMENT:

1). Considerable loss of enamel and dentin.

2). Esthetics is compromised.

3). Deep lesions affecting the strength of the tooth and pulpal intergritty.

4). Caries beginning in the cervical lesion.

5). Significant sensitivity of the exposed dentin.

:CHOICE OF RESTORATIVE MATERIAL:

Class V non-carious lesions may be restored with any of the permanent restorative materials presently available. Amalgam, direct gold, cast gold inlays and ceramic inlays are no longer preferred as they require some amount of cavity preparation to make the restoration retentive.

Currently composite resins and GIC are more popular to restore non-carious cervical lesions primarily because they are adhesive and do not require any extensive cavity preparations.

COMPOSITE RESINS GIC

Advantages:-Superior esthetics.-Excellent polishability.-High bond strength.-Good abrassion resistance.Advantages:-Adhesion to tooth structure fluoride relese.-Biocompatibility.-Cofficient of thermal expansion.

Disadvantages:-Technique sensitivity-Polimerization shrinkage may open marginal gapes.Disadvantages:-Less esthetic-Brittelness-Sensitive to moisture contamination

:ENDODONTIC THERAPY:

When cervical tooth is extensive resulting is pulpal involvement, endodontic therapy is necessary followed by post placement and full coverage restoration in the form of crown.

:PERIODONTAL THERAPY:

Periodontal therapy is required when non-carious cervical lesions are associated with considerable gingival recession and mucogingival defects.

Root coverage procedures using free gingival grafts or connective tissue grafts.

Root coverage using non-grafting procedures like rotational and coronally advanced flaps or guided tissue regeneration.

:REFERENCES:

THANK YOU

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non carious cervical lesion

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