Non-Carious Cervical Lesions PDF

Non-Carious Cervical Lesions MESHAL ALHAQBANI RESTORA 570 Introduction to NCCLs Tooth structure loss at the cemento–enamel junction (CEJ), with no involvement of bacteria, is referred to as non -carious cervical lesions (NCCLs). Clinically, NCCLs present as shallow or deep depressions, disc- or w...

Non-Carious Cervical Lesions MESHAL ALHAQBANI RESTORA 570 Introduction to NCCLs Tooth structure loss at the cemento–enamel junction (CEJ), with no involvement of bacteria, is referred to as non -carious cervical lesions (NCCLs). Clinically, NCCLs present as shallow or deep depressions, disc- or wedge-shaped defects at the CEJ. Understanding their causes, impacts, and management strategies is essential for effective dental care and patient education.  What are NCCLs? NCCLs refer to not caused by dental caries. They typically occur at the gum line and can affect both and of teeth. Early recognition is crucial to prevent further damage.  Causes of NCCLs " Tooth wear " or " tooth surface loss " has been proposed to be the result of two major mechanisms , namely mechanical wear ( abrasion and attrition ) and chemical wear ( erosion ). A literature review found that the prevalence of severe wear commonly are of sever tooth wear increase with age. NCCLs can be differentiated in - Rounded ( saucer-like ) - V- shaped ( wedge-like ) - Mixed defects - Rounded shapes progress more in height - V-shaped progress in height and depth Classification Erosion : resulting from dissolution of hard tissue by acidic substances. Progressive loss of tooth substance by chemical or acid effects (no bacteria are involved in NCCL) Abrasion: process of wearing down or eroding a surface through friction or scraping.It's essentially the mechanical removal of material from a surface. Abfraction: Grippo introduced the term to describe three types of dental lesions:C-shaped,V-shaped,and mixed. These lesions are caused by stress concentration and are known as "Stress-Induced lesions." Tooth substance is lost in areas of high stress. Studies have found a link between canine tooth occlusal forces and these lesions. Tensile stress can lead to wedge-shaped cervical lesions, but recent research suggests that occlusal loading might not be the main cause. They are also named “Dental Wear”, They appear as a wedge, or depressions (dome or cup). But they may also appear as shallow, concave, notched or irregular  MAIN CAUSE ? A number of research have proposed that tensile and compressive stresses play a primary role in causing enamel and dentin fracture creating wedge-shaped cervical lesion, while abrasion and erosion play a secondary role.It should be emphasized that noncarious cervical lesions (NCCL) may occur as part of a multifactorial event whose mechanism is not clear completely yet. Moreover, the association of occlusal loading factors and noncarious cervical lesions may not necessarily support a causal relationship. Therefore, there is little direct evidence supporting abfraction as the primary factor in causing non-carious cervical lesions. More recently, authors have introduced new terms describing tooth wear: “Biodental engineering factors” they have been defined as the effect of piezoelectricity at the cervical area, and “stress corrosion”. They have been used to describe a multifactorial physiochemical degradation of the CEJ area. In addition, “dental compression syndrome” is tooth deformation related to malocclusion, parafunctional habits and temporo-mandibular joint disorders.  Etiological facts Excessive consumption of acidic and carbonated beverages (71,42%) gastro-oesophagyal reflux disease (14,28%) incorrect technique of brushing (28,57%) vicious habits-nail biting (14,28%) daily consumption of sunflower seeds (9,52%) use of toothpicks as auxiliary hygiene (19,04%) night teeth grinding (4,76%) Intrinsic factors: parafunctions, vit C, aspirin tablets, powders, Ectasy, acid food and drinks. Gastrointestinal reflux (gastroesophageal reflux disea (or GERD), bulimia and bruxism. Extrinsic factors: acid food (erosion), reduced salivaflow, drugs that change the buffering power of saliva, dental floss, tooth brushes, poorly washed vegetables, immune system disease.  Diagnosis Diagnosis involves a thorough and may include radiographic assessment. Dentists look for signs of , sensitivity, and the presence of or heavy occlusion to confirm NCCLs.  Management Strategies Management of NCCLs may include , such as fillings or crowns, and preventive measures like. Addressing the underlying causes is also crucial to prevent recurrence. Preventive Measures Preventing NCCLs involves , using a soft-bristled toothbrush, and minimizing acidic food intake. Regular dental check-ups are essential for early detection and intervention. Role of Patient Education Educating patients about NCCLs is vital. Understanding the , , and strategies empowers patients to take proactive steps in maintaining their oral health. Case Studies Reviewing case studies highlights the of NCCLs and their management. These examples illustrate the importance of tailored treatment plans based on individual patient needs.  When to treat ❖Fast lesion progression ❖Negative impact on quality of life ❖High sensitivity ❖Poor esthetics ❖Food and plaque collection ❖Deep enough to compromise strength of the tooth  How to treat ❖NCCLs have sclerotic dentin walls with hypermineralized intertubular dentin Tubules are occluded with crystalline deposits , intact collagen and hybrid layer are lacking Bond strength is significantly lower than to regular dentin ❖Roughening of the dentin surface and / or preparation of a fine groove led to higher long - term survival Restorations placed without any dentin preparation had the highest loss rate at 7.7 years ❖Beveling of the enamel is recommended It increases the bonding area , provides a better etching substrate , and improves the esthetic result ❖Composite should be preferred over GIC. ❖GIC had higher retention rates than composite but were worse in surface roughness and color match  conclusion ❖ THE ERTIOLOGY OF NCCLS IS MULTIFACTORIAL AND INCLUDES OCCLUSAL FACTOR, CLENCHING, MENTAL HEALTH, ORAL HGIENE, NUTRITION, HABITS. ❖ ITS IMPORTANT TO UNDERSTAND AND ADDRESS THE MOST FACTORS IN ACH PATIENTS OTHERWISE DESTRUCTION WILL CONTINUE AND EVEN THE BEST RESTORATIVE APPROACH WILL NOT LAST Reference any Q