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EXAM #43
ABSTRACT
The theory of non-carious cervical lesions (NCCLs) suggests that tooth
flexure arising from cyclic, eccentric occlusal forces causes their formation
and progression in vulnerable cervical regions of teeth. The etiology is still
controversial. Attrition, corrosion, abrasion and stress-corrosion might act alone
or in combination to initiate and perpetuate lesions. This review of the literature
provides the basis for the diagnosis that can be used in consideration of treatment
options.
Figure 2
Figure 1
T
D
A
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Seventy-five
percent of retention
failures of Class V
bonded composite
restorations have
been attributed to
bruxism and/or other
forms of stressful
occlusion.
N (normal force), angled at 45 degrees,
were applied to the teeth. Maximum
stress levels were measured along a
labial/buccal horizontal plane in both
intact teeth and teeth in which defects
of varying vertical heights were created
at the cervical DEJ. At normal chewing
loads of 100 N, even the smallest cervical
defects resulted in a dramatic increase
in MPS in cervical enamela defect
height of only 0.37 mm was found to
produce MPS levels that exceeded the
failure stress level for enamel (80 MPa)
in all tooth types. When intact teeth were
subjected to normal loads, MPS levels
were well below the critical failure stress
value. When 100 N was applied to an
93-1 Abfraction Lesions Where Do They Come From? A Review of the Literature
15
The pathogenesis of
NCCLs is considered
to be multifactorial,
with occlusal
loading, corrosion
and abrasion acting
synergistically rather
than in isolation.
isolation.37,44-46 Dental erosion, as defined
by Imfeld44 and Grippo,47 is the painless
loss of solid tooth surface primarily by
acid, without bacterial involvement. The
loss of substrate in erosion is a physical
process involving the flow of a substance
by a stream of liquid or gas, with or
without solid particles. As no forceful
stream of liquid occurs in the mouth to
produce enough friction to cause tooth
surface loss, Grippo et al.,48 subsequently
proposed deleting the term erosion from
the dental nomenclature in favor of the
more appropriate term corrosion to denote
the chemical dissolution of teeth. They
proposed several combined mechanisms
to explain tooth wear, which included
attrition-abfraction, abrasion-abfraction,
A recent study of
2,849 maxillary and
mandibular incisors,
canines, premolars
and molars reported
maxillary and
mandibular first
premolars most
frequently affected
by NCCLs.
Ages and 6,145 teeth from 238 modern
subjects.59 The most remarkable finding
was the absence of NCCLs in the large
sample of skeletons from prehistoric
and Medieval remains, compared with
a prevalence of 26% among modern
subjects from the same geographic area,
perhaps attributable to a much shorter life
span in prehistoric man.
The prevalence of NCCLs within the
dentition is well documented. A recent
study of 2,849 maxillary and mandibular
incisors, canines, premolars and molars
reported maxillary and mandibular first
premolars most frequently affected by
NCCLs.39 Maxillary and mandibular
93-1 Abfraction Lesions Where Do They Come From? A Review of the Literature
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8. Xhonga FA: Bruxism and its effect on the teeth. J Oral Rehab
1977;4(1): 65-76.
73. Smith WAJ, Marchan S, Rafeek RN: The prevalence and severity
of non-carious cervical lesions in a group of patients attending
a university hospital in Trinidad. J Oral Rehab 2008;35:128134.
74. Mayhew RB, Jessee SA, Martin RE: Association of occlusal,
periodontal, and dietary factors with the presence of non-carious
cervical dental lesions. Am J Dent 1998;11:29-32.
75. Brandini DA, Trevisan CL, Panzarini, SR et al.: Clinical
evaluation of the association between noncarious cervical lesions
and occlusal forces. JPD, 2012; 108(5):298-303.
93-1 Abfraction Lesions Where Do They Come From? A Review of the Literature
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