Tooth surface loss: causes, management, and prevention.

OBJECTIVES: Tooth wear, also referred to as tooth surface loss, occurs due to causes other than caries. This involves the loss of hard tissues, namely enamel, dentin, and/or cementum. Types of tooth wear/tooth surface loss are abrasion, abfraction, attrition, and erosion. These multifactorial conditions can be caused by factors such as lifestyle, diet, or even habits, and may not be symptomatic. The focus of this article is to provide clinicians with detailed examples and explanations of the causes of tooth loss to aid in early diagnosis. Through early identification, the preventive measures outlined can be implemented to avoid excessive tooth wear. The provision of a treatment flowchart and general treatment recommendations aims to help clinicians determine when to restore these lesions and the most appropriate treatment measures for the four types of wear. METHOD AND MATERIALS: The PubMed (MEDLINE) search engine was used to gather information on teeth restricted to a 5-year period (26 August 2018 to 25 July 2022). Only English-language studies and reviews with the best balance of sensitivity and specificity were considered. A Boolean search of the PubMed dataset was implemented to combine a range of keywords: ("tooth wear" OR tooth attrition OR tooth erosion OR tooth abrasion OR tooth abfraction). Additional articles were selected through Google Scholar. RESULTS: By this process, many articles and studies were obtained, and the 48 most relevant published studies were chosen and used in the current review. CONCLUSION: Tooth wear affects an increasing number of individuals and can have detrimental effects physically, mentally, and emotionally. It is important to stress early diagnosis and management of tooth wear through monitoring, prevention, and treatment where indicated.

Influence of cavity depth and restoration of non-carious cervical root lesions on strain distribution from various loading sites.

BACKGROUND: We aimed to investigate the load-induced strain variation in teeth with unrestored and resin-based composite restored non-carious cervical lesions (NCCLs). METHODS: Twelve extracted premolars were provided for measuring buccal-side root NCCLs. Strain gauges were fixed at four measuring sites of each tooth, two at the buccal surface and two at the lingual surface. NCCLs were prepared with occlusal margins at the cemento-enamel junction. A static 9-kg load was applied at seven occlusal loading points: buccal cusp tip (BC), inner inclination of the BC, lingual cusp tip (LC), inner inclination of the LC, center of the mesial marginal ridge or distal marginal ridge, and center of the central groove. The strain was detected at each site in teeth with NCCL depths of 0 (control), 0.5, 1.0, and 1.5 mm. Each NCCL was restored using an adhesive composite resin, and the strains were re-measured. RESULTS: The strains at the NCCL occlusal and gingival margins decreased with increasing defect depths, and the effect was significant when the depth of the defect was 1.5 mm. Loading on the buccal and lingual cusps induced prominent strain variation. The strains at all depth distribution recovered to nearly intact conditions when the NCCLs were restored. CONCLUSIONS: NCCLs at 1.5 mm depth are detrimental, but they can be restored using resin composites. CLINICAL SIGNIFICANCE: The existence of NCCLs should not be ignored. The depth of the NCCL may affect the progression of the lesion. Resin composite restoration is an appropriate method for preventing persistent NCCL deterioration.

Forage silica and water content control dental surface texture in guinea pigs and provide implications for dietary reconstruction.

Recent studies have shown that phytoliths are softer than dental enamel but still act as abrasive agents. Thus, phytolith content should be reflected in dental wear. Because native phytoliths show lower indentation hardness than phytoliths extracted by dry ashing, we propose that the hydration state of plant tissue will also affect dental abrasion. To assess this, we performed a controlled feeding experiment with 36 adult guinea pigs, fed exclusively with three different natural forages: lucerne, timothy grass, and bamboo with distinct phytolith/silica contents (lucerne < grass < bamboo). Each forage was fed in fresh or dried state for 3 weeks. We then performed 3D surface texture analysis (3DST) on the upper fourth premolar. Generally, enamel surface roughness increased with higher forage phytolith/silica content. Additionally, fresh and dry grass feeders displayed differences in wear patterns, with those of fresh grass feeders being similar to fresh and dry lucerne (phytolith-poor) feeders, supporting previous reports that "fresh grass grazers" show less abrasion than unspecialized grazers. Our results demonstrate that not only phytolith content but also properties such as water content can significantly affect plant abrasiveness, even to such an extent that wear patterns characteristic for dietary traits (browser-grazer differences) become indistinguishable.

A novel approach to treat gingival recession and non-caries cervical lesion combined defects: Restoration guided creeping attachment (RGCA) technique. A case report.

Gingival recessions have multifactorial etiology and are often associated with non-caries cervical lesions. Different surgical techniques have been proposed over the years for their treatment, according to the severity of the recession. A novel technique, called restoration guided creeping attachment (RGCA), for the treatment of combined gingival recession and non-caries cervical lesion is presented. RGCA aims at treating Miller class I and II recessions using a specifically designed composite restoration and a minimally invasive approach. A clinical case describing the technique and forming the basis for further studies is presented. Although the results obtained are encouraging, a wider number of patients and longer follow-ups are needed to assess the reliability of this technique.

Lesiones cervicales no cariosas / Non-carious cervical lesions

El objetivo de este trabajo consiste en describir las distintas lesiones cervicales no cariosas, la abrasión, la erosión y la abfracción. Se desarrollarán en detalle su etiología, localización y características clínicas. Se mencionarán los diferentes procedimientos a realizar para su prevención y los materiales a utilizar para su restauración.

This article describes the different types of non-cariouscervical lesions, for example abrasion, erosionand abfraction. We will discuss their etiology, location and clinical features in detail. We will describe the procedures to prevent them, aswell as the materials used for their restoration.

Ceramic laminate veneers: clinical procedures with a multidisciplinary approach.

Complex cases with high esthetic needs represent a challenge for clinicians. A multidisciplinary approach is vital to achieve the planned result. New technological devices are needed to facilitate the collaboration between the clinical team members and to develop a fluent and effective diagnostic and therapeutic pathway. This article describes a well-defined protocol for the treatment of complex esthetic cases with the use of ceramic laminate veneers. The protocol involves different branches of dentistry: periodontal therapy, mucogingival surgery, restorative dentistry, orthodontics, and prosthodontics. Each step of the protocol should be executed in a very strict order: intra- and extraoral esthetic analysis of the patient, with photographs; digital previsualization by means of Digital Smile Design (DSD); clinical previsualization by means of a mock-up; orthodontic, mucogingival, and endodontic treatments, if needed; minimally invasive tooth preparation, driven by a mock-up and silicone indices; manufacture of ceramic laminate veneers; try-in and adhesive cementation. In this article, this protocol is illustrated by a clinical case report in which all the above-mentioned steps were carried out. The finalization was obtained by means of state-of-the-art adhesive techniques and ceramic laminate veneers. The correct use of modern materials, in combination with rigorous adhesive procedures, allows for a minimally invasive and highly esthetic treatment, with adequate function and a perfect integration that is in harmony with the patient's face.

Nova abordagem no tratamento de recessões gengivais associadas à lesão cervical não cariosa / New approach in the treatment of gingival recessions associated with non-carious cervical lesion ­ case report

A recessão gengival está frequentemente associada à lesão cervical não cariosa (LCNC), originando uma lesão combinada que tem um prognóstico de tratamento diferente de quando as duas lesões se apresentam sozinhas. Tratamentos propostos possuem limitações, e o protocolo clínico ideal para o manejo dessas lesões ainda não foi estabelecido. Assim, o objetivo do presente relato de caso foi apresentar uma nova técnica cirúrgico-restauradora para o tratamento de recessões gengivais associadas à LCNC. Para tal, uma restauração parcial em resina composta foi realizada somente na parte coronal da lesão cervical. Em uma segunda sessão, o procedimento cirúrgico para recobrimento radicular com enxerto de tecido conjuntivo foi realizado. Seis meses após o procedimento, a paciente estava satisfeita com o resultado final alcançado, demonstrando que esse protocolo pode ser uma alternativa de tratamento aos protocolos existentes para o tratamento de recessões gengivais associadas à LCNC.

Gingival recession is often associated with non-carious cervical lesion (NCCL), resulting in a combined lesion which has a different treatment prognosis when the two lesions appear alone. Proposed treatments have limitations and the ideal clinical protocol for the management of these lesions has not been established. Thus, the aim of this case report is to present a new surgical-restorative technique for the treatment of gingival recessions associated with NCCL. For this, a composite resin partial restoration was performed only in the coronal part of the cervical lesion. In a second session, the surgical procedure for root coverage with connective tissue graft was performed. Six months after the procedure, the patient was satisfied with the final result achieved, demonstrating that this protocol may be an alternative to the existing protocols for the treatment of gingival recessions associated with NCCL.

[Teeth wedge-shaped defects in adults of different age groups: remark to prevention and treatment]. / Klinovidnye defekty zubov u vzroslykh liudei raznykh vozrastnykh grupp: remarki k profilaktike i lecheniiu.

The aim of the study was to assess the treatment of teeth wedge defects in different age groups. Records of 383 patients (125 males and 258 females aged 22-85 years) treated in outpatient dental facilities with different ownership forms. It is shown that the medical care of patients with wedge-shaped teeth defects routinely consists of remineralization therapy and restoration of anatomical teeth shape regardless of the form of ownership. The extensiveness of dental rehabilitation as well as the use of more modern technologies are typical for private clinics and 96-100% of patients finished their treatment there. In the state and departmental institutions complete rehabilitation of wedge-shaped defects was provided in 45.5-58.0% and 54.3-83.9, respectively. The paper also highlights the drawbacks of primary medical documentation identified in medical institutions of all forms of ownership.

[Sleep bruxism in children]. / Le bruxisme du sommeil chez l'enfant.

Bruxism is defined as repetitive activity of the masticatory muscles, characterized by clenching the teeth or teeth grinding and/or by tapping and swaying. This study investigated sleep bruxism. The etiology is multifactorial: mainly central (neuropathic disorder, anxiety) but also genetic and local (posture, mouth breathing). The diagnosis is based primarily on the anamnesis and examination of dental wear and progression over time (photos and dental castings). A diagnostic guide is proposed in this article. Frequently found in children, bruxism is not always considered pathological. The severity criteria relate intensity (number of dental attrition facets) as well as the context found in children: anxiety, ventilation disorders, and fragile dental structures. Management is multidisciplinary and depends on the etiologic diagnosis.

Abrasion: A Common Dental Problem Revisited.

Dental abrasion is most commonly seen at the cervical necks of teeth, but can occur in any area, even inter-dentally from vigorous and incorrect use of dental floss. Acid erosion has been implicated in the initiation and progress of the cervical lesion, while tooth-brush abrasion has long been held as the prime cause of cervical abrasion. Identification of the risk factors is clearly important in order to modify any habits and provide appropriate advice.

[Clinical observation on different kinds of laser on 60 molars with abrasion].

PURPOSE: To evaluate the clinical effect of different kinds of laser on 60 molars with abrasion. METHODS: Thirty patients with 60 abrasive molars were selected according to the inclusion criteria. Molars and premolars were divided into 2 groups randomly. Teeth in the experimental group were treated with Er,Cr:YSGG laser combined with AdperTM Easy One, while teeth in the control group were treated with Nd:YAG laser combined with AdperTM Easy One, composite resin Z350 was selected to restore the defect. The modified USPHS criteria was used to evaluate the treatment effects at recall periods.The data were analyzed using SPSS 13.0 software package. RESULTS: On retention, the B level rate of the experimental group was significantly lower than that of the control group(P<0.05) 12 months later. For success rate at 18 months，the difference between the experimental group and the control group was significant（P<0.05）. At the same time, sensitivity of tooth and overall response in the two groups had no significant difference (P>0.05). CONCLUSIONS: Although the overall response between the two groups had no significant difference,Er,Cr:YSGG laser shows better effect of retention, which is the preferred option for treatment of abrasive molars.

Lesiones cervicales no cariosas en pacientes del área de salud Eléctrico, municipio Arroyo Naranjo, 2015 / Non carious cervical lesions in patient of the area of health Electric, Arroyo Naranjo municipality, 2015

Introducción: las lesiones cervicales no cariosas son la pérdida patológica de la estructura dentaria localizada en el límite amelo-cementario, que no responden a un agente causal bacteriano. Teniendo en cuenta la incidencia de esta afección en la salud bucal, resulta una necesidad su estudio más detallado, que permita conocer mejor su comportamiento clínico-epidemiológico para favorecer su prevención y tratamiento de una forma más eficaz. Objetivo: determinar la distribución y características de lesiones cervicales no cariosas en pacientes pertenecientes al área de salud Eléctrico del municipio Arroyo Naranjo de la provincia La Habana. Métodos: se realizó una investigación descriptiva transversal en un total de 153 pacientes con lesiones cervicales no cariosas. Fue considerada una lesión cervical no cariosa cuando el paciente presentara alguna de las variantes erosión, abrasión y/o abfracción, o la combinación de estas. Se asumieron para la investigación otras variables como: sexo, edad, grupo de diente, localización y factores de riesgo. Se utilizó la prueba estadística de chi cuadrado para la asociación de variable. Resultados: predominaron el sexo masculino con 52,9 por ciento y el grupo de edad de 37 a 47 años con el 30,7 por ciento. Los premolares resultaron el grupo dentario más afectado con el 38,9 por ciento; se destacó al bruxismo y al cepillado traumático con el 43,8 por ciento y 35,3 por ciento respectivamente. Conclusiones: las lesiones cervicales no cariosas se manifestaron entre los 37 a 47 años, específicamente en los hombres, y afectaron fundamentalmente a los premolares superiores con un promedio de 4 dientes por paciente. El bruxismo y el cepillado traumático constituyeron los factores de riesgo que más se correspondieron con el desarrollo de este tipo de lesión no cariosa a nivel cervical del diente(AU)

Introduction: non-carious cervical lesions are the pathological loss of dental structure located in the amelocementum junction, which do not result from a bacterial causative agent. Given the incidence of this condition in the oral health, it is necessary to study it in detail in order to better know its clinical and epidemiological behavior and to prevent it and treat it more effectively. Objective: to determine the distribution and the characteristics of non-carious cervical lesions in patients from the Electrico health area in Arroyo Naranjo municipality in Havana province. Methods: a cross-sectional descriptive study was conducted on a sample of 153 patients with non-carious cervical lesions. The classification of a non-carious cervical lesion was considered when a patient presents with some of the variants called erosion, abrasion and/or abfraction, or their combination. Other variables were also taken for this study, that is, sex, age, tooth group, location and risk factors. The Chi square test was used for the association of variables. Results: in the study, males with 52.9 percent of the total number and the 37-47 year age group with 30.7 percent predominated. Premolars represented the most affected dental group with 38.9 percent; bruxism and harmful brushing were present in 43.8 percent and 35.3 percent of cases, respectively. Conclusions: non carious cervical lesions occur in the 37-47 age group, mainly in men and fundamentally affect upper premolars and 4 teeth per patient as average. Bruxism and harmful brushing were the most related risk factors to this type of non-carious lesion(AU)

Effects of Erosion Protocol Design on Erosion/Abrasion Study Outcome and on Active Agent (NaF and SnF2) Efficacy.

There is no standard for testing anti-erosive/anti-abrasive agents, making the assessment and comparison of study results difficult. Factors which are varied in study designs are amongst others the erosive medium regarding concentration and pH or movement type of acid. The present study therefore investigated the impact of these factors on dimension of tissue loss and on efficacy of active agents used as anti-erosive/anti-abrasive therapeutics. In 8 experiments, consisting of 8 groups each (n = 20 each), resulting in a total of 64 groups, enamel specimens were demineralised (10 days, 6 × 2 min/day) using different acids (1, 0.5 and 0.3% citric acid at native pH 2.3, 2.5 and 2.8, respectively, and 0.3% citric acid adjusted to pH 3.6) with two different movement types (jerky or smooth). Specimens were immersed (2 × 2 min/day) in slurries of 1,450 ppm F- toothpaste (NaF), 1,450 ppm F- and 3,436 ppm Sn2+ toothpaste (NaF/SnF2), 970 ppm F- and 3,000 ppm Sn2+ gel (SnF2) or placebo, or were additionally brushed during immersion (15 s, 200 g). All groups were in between stored in a mineral salt solution. Tissue loss was determined profilometrically. Movement type, pH and concentration of acid had a substantial impact on study outcome. The combination of jerky movement and concentrated acid masked, to some extent, differences between erosive and erosive-abrasive tissue loss. The acid at low concentration (0.3%), independent of pH, was too mild to produce any tissue loss. The model with the best ability to demonstrate effects of abrasive impacts and active agents used the 1% acid concentration combined with smooth acid movements.

Treatment of a case of serious occlusal instability associated with TMDs through a modern mini-invasive approach.

BACKGROUND: The latest trends in restorative dentistry are guided both by esthetic and mini-invasive procedures. New ceramic materials, such as lithium disilicate, allow the clinician to obtain invisible restorations with a minimum preparation thickness. SUMMARY: A young female patient presented at our practice with left temporomandibular closed locking and uncomfortable occlusal instability. After manual reduction, medical therapy, and reversible treatment with a stabilization splint, a mini-invasive lithium disilicate occlusal inferior posterior rehabilitation was conceived and performed. The esthetic integration of the onlay restorations was excellent, no fractures had occurred by the time of the 1-year follow-up, and the patient perceived the dental occlusion as comfortable. CONCLUSION: We strongly believe that a careful approach to esthetics is mandatory nowadays, including in the case of posterior teeth. New ceramic materials and the latest adhesive techniques make it possible to resort to mini-invasive and esthetic approaches, even in cases of restorations that are difficult in terms of functionality.

Effect of tooth brush abrasion and thermo-mechanical loading on direct and indirect veneer restorations.

OBJECTIVES: This study investigated toothbrush abrasion and in vitro aging on ceramic (indirect technique) and composite veneers (direct technique). MATERIALS AND METHODS: Identical composite and individual human incisors were restored with industrially preformed composite veneers, indirectly produced ceramic veneers, and direct composite restorations. Surface roughness was determined before and after tooth brushing. A 5-year period of oral service was simulated by thermal cycling and mechanical loading (TCML). After TCML, all specimens were examined with microscopy and scanning electron microscopy. Specimens without failures during TCML were loaded until failure. STATISTICS: analysis of variance; Bonferroni's post hoc analysis, Kaplan-Meier-Log Rank test (α = 0.05). RESULTS: Tooth brushing yielded a non-significant increase (p = 0.560) in roughness in all materials (industrial veneer, 0.12+/-0.07 µm, direct restoration, 0.18+/-0.14 µm, ceramic, 0.35+/-0.16 µm). No significant differences in roughness could be determined between the materials, neither before nor after testing (p < 0.001). After TCML of artificial teeth, direct and preformed composite veneers on composite teeth showed no failures or damages. Two ceramic veneers showed cracking in the labial area. After TCML of human teeth, transmission microscopy indicated a facial crack in a ceramic veneer and chipping in the cervical area of a preformed veneer. Two direct composite veneers lost retention. No significantly different survival rates were found between the three veneer groups. Fracture force on human teeth varied between 527.8+/-132.4 N (ceramic), 478.3+/-165.4 N (preformed composite), and 605.0+/-263.5 N (direct composite). CONCLUSION: All materials revealed comparable wear resistance. Indirect ceramic, direct restorative composite, and preformed composite veneers showed comparable failure rates and satisfying longevity. CLINICAL RELEVANCE: The results indicate similar longevity of the chosen materials for veneer restorations.

A "midline dilemma" in an adult mutilated dentition.

Orthodontic treatment for adult patients who have mutilated dentitions can be clinically challenging. A 58-year-old man with several occlusally abraded teeth, a congenitally missing maxillary lateral incisor, and prior implant placement sought orthodontic treatment and restoration. Prosthetic restoration would not be possible. The "dilemma" for this patient was whether to trephine and remove an existing implant and make space for a new lateral incisor implant, or to restore the maxillary canine as a lateral incisor.

Interactive treatment planning in toothwear: are we doing it right?

UNLABELLED: Toothwear is now common, especially in younger patients, with high demand for the restoration of the damaged teeth which is likely to increase further over time. Fixed prosthodontic options range from direct composite resin to conventional tooth preparation and cemented indirect restorations. This paper summarizes the views of a variety of clinicians on a plan delivered to a patient with toothwear in secondary care and explores the possible reasons for the variation in decision-making in the treatment of toothwear. CLINICAL RELEVANCE: With levels of toothwear increasing, the clinician needs to be aware of the different treatment modalities which are appropriate.

Minimal intervention dentistry: part 5. Ultra-conservative approach to the treatment of erosive and abrasive lesions.

The therapeutic management of tooth wear lesions does not require the removal of diseased tissue. Nevertheless, diverse etiological factors may be associated with the condition and they could be difficult to eliminate; this has to be considered when planning therapy. Interceptive procedures should be reserved for such situations while regular monitoring is recommended for other cases, in accordance with advice provided for using the Basic Erosive Wear Examination (BEWE). Direct and indirect adhesive procedures with composite resins allow treatment of most clinical situations, including even extensive restorations. The possibility of managing subsequent interventions should be considered when planning the initial therapeutic approach.

A survey of management strategies for noncarious cervical lesions.

Both causation and management of noncarious cervical lesions (NCCLs) (abfractions, wedge-shaped defects, stress-induced cervical lesions, and cervical erosion) remain debatable. A survey of clinicians' perceptions was therefore conducted at a recent professional meeting to determine optimal approaches to NCCL management. Examples of lesions differing in depth (1, 2, and 3 mm) were presented as being either sensitive or nonsensitive, and participants recorded their responses to the presented individual scenarios. This report provides information regarding correlations between increases in lesion depth, lesion sensitivity, and professionals' willingness to restore them. It was also noted that decisions to ensure mechanical retention positively influenced estimates for restoration longevity.