Presence of Gingival Recession or Noncarious Cervical Lesions on Teeth under Occlusal Trauma: A Systematic Review

The goal of this research was to carry out a systematic review to verify the possible influence of occlusal factors on the occurrence of gingival recession and noncarious cervical lesions. To answer the specific research question—whether gingival recession or noncarious cervical lesions on teeth are present under occlusal trauma—a bibliographic search was conducted at MEDLINE/PubMed, Web of Science, and Gray Literature databases focusing on articles published, following strict inclusion criteria based on randomized clinical trials, controlled clinical studies, and case series, with restricted language (English) and publication date between March 2010 and March 2020, considering patients with occlusal trauma and gingival recession/noncarious cervical injuries. Questionnaires, animal or laboratory studies, case reports, and interviews were excluded. First, the title and/or abstract of the articles obtained were analyzed and, finally, a full-text reading was performed. Given the amount and diversity of the final studies, a qualitative analysis was made. Based on the established criteria, it was possible to obtain an initial 757 articles. After screening, five articles were included, and then qualitative analysis was performed. The results described in the articles were different, given the heterogeneity of the articles subjected to analysis. A few studies were published in the past 10 years, suggesting that the traumatic occlusion seems to be associated with the occurrence of the noncarious cervical lesion while it is not possible to arrive at a conclusion with regard to the association of gingival recession and occlusal trauma. Key Message Even though many professionals have categorically affirmed that there is a relation between trauma occlusal and gingival recession/noncarious cervical lesion, this systematic review found the absence of strong literature to really prove it. Once defined, it allows the therapeutic focus to centre on the causal or contributing factors and preventing or reducing future recurrence.

Resolution of Abfraction-Associated Gingival Fenestration Utilizing Connective Tissue Grafting

Introduction. Gingival fenestration (GF) is a distinct clinical entity of uncertain etiology that is seldom documented in the literature. It has been associated mainly with submucosal mechanical irritants such as calculus that subsequently create an opening in the oral soft tissue, usually at facial anterior sites. Surgical correction may be indicated to address functional and/or esthetic concerns. Case Presentation. The patient, a 74-year-old male, presented to the clinic with a chief complaint of “something is poking through my gum.” Clinical exam revealed a gingival fenestration on the facial of tooth #11, associated with what appeared to be a pronounced noncarious cervical lesion (NCCL). Surgical treatment consisted of a connective tissue graft and odontoplasty of the sharp protruding edge of the root surface. Healing was uneventful with excellent closure of the fenestration and no evidence of recurrence after 18 months of follow-up. Conclusion. GF is a perforation of the mucosa typically associated with underlying sharp mechanical etiology. This report describes a fenestration that developed from a probable abfractive lesion, which later was successfully closed and exhibits long-term stability.

Evaluation of Three Esthetic Restorative Materials Used for Carious or Noncarious Cervical Lesion Restoration

Background: Cervical lesions appear on the cervical surface of the lingual or buccal side of the tooth and are classified into carious and non-carious lesions. Aim: The present study evaluates the performance of three different types of aesthetic restorative materials, used for the restoration of carious or non-carious cervical lesions. Materials and methods: The study comprised 195 cervical lesions in 45 patients. The restorations were carried out for non-carious cervical lesions in 34.62% of the cases, for primary carious lesions in 40.00% of the cases, and to replace a previous restoration in 25.38% of the cases. The restorations were evaluated at 2 weeks (the reference line), and then at 1 and 2 years after placement. The following have been assessed: restoration retention, color harmonization, surface texture, margin discoloration, anatomical contour, margin integrity, and the presence of secondary caries. The characteristics were registered in conformity with the modified USPHS criteria. Results: At the one-year evaluation, we noticed the loss of 12 restorations, and after 2 years, the loss of 19 restorations. The results showed significant differences between restorative materials regarding color, margin adaptation, margin coloration, surface texture, as well as criteria regarding the anatomical contour (p <0.05). Conclusions: The evaluation of the success of restorative material retention must consider the location of the cervical lesion. A successful treatment depends particularly on a full understanding of the factors that caused the lesions and on the method of their treatment.

Effect of Restorative System and Thermal Cycling on the Tooth-Restoration Interface – OCT Evaluation

SUMMARY The present study evaluated the tooth/noncarious cervical lesion restoration interface when using different adhesive systems and resin composites, submitted to thermal cycling (TC), using optical coherence tomography (OCT). Noncarious cervical lesion (NCCL) preparations (0.7 mm depth × 2 mm diameter) were performed on 60 human third molars and randomly divided into six groups, according to the adhesive system and resin composite used: group 1 = Adper Single Bond 2 (SB2) + Aelite LS Posterior (AP); group 2 = SB2 + Venus Diamond (VD); group = SB2 + Filtek Z250XT (Z250); group 4 = Clearfil SE Bond (CSE) + AP; group 5 = CSE + VD; group 6 = CSE + Z250. Selective enamel etching was performed for 30 seconds on groups 4, 5, and 6, while groups 1, 2, and 3 were etched for 30 seconds in enamel and 15 seconds in dentin. All groups were evaluated using OCT before and after TC (n=10). Images were analyzed using Image J software; enamel and dentin margins were separately evaluated. Data from OCT were submitted to PROC MIXED for repeated measurements and Tukey Kramer test (α = 0.05). No marginal gaps were observed in etched enamel, either before or after TC, for all adhesive and resin composite systems. A significant interaction was found between adhesive system and TC for the dentin groups; after TC, restorations with CSE showed smaller gaps at the dentin/restoration interface compared with SB2 for all resin composites. Increased gap percentages were noticed after TC compared with the gaps before TC for all groups. In conclusion, TC affected marginal integrity only in dentin margins, whereas etched enamel margins remained stable even after TC. Dentin margins restored with CSE adhesive system showed better marginal adaptation than those restored with SB2. Resin composites did not influence marginal integrity of NCCL restorations.

Clinical Implications of Regressive Alterations of Teeth and their Management

ABSTRACT Regressive alteration is a multifactorial condition causing loss of enamel and dentine. The cause is generally erosion, abrasion, abfraction, attrition and resorption or a combination of these lesions. Progression of regressive changes is found to be slow with periods of activity and inactivity. Although restorations are indicated, prevention remains the prime strategy in maintaining the longevity of a tooth. A thorough knowledge of the etiology, signs and symptoms of these lesions is of utmost importance in the diagnosis and management. Conclusion and clinical implications This article describes the etiological factors and assists the readers in reaching a diagnosis on the type of lesion and their appropriate management. Abbreviations NCCL: Noncarious cervical lesion; VDO: Vertical dimension at occlusion; RMGIC: Resin-modified glass ionomer cement.