The prevalence of non-carious cervical lesions in permanent dentition

A non-carious cervical lesion (NCCL) is the loss of hard dental tissue on the neck of the tooth, most frequently located on the vestibular plane. Causal agents are diverse and mutually interrelated. In the present study all vestibular NCCL were observed and recorded by the tooth wear index (TWI). The aim of the study was to determine the prevalence and severity of NCCL. For this purpose, 18555 teeth from the permanent dentition were examined in a population from the city of Rijeka, Croatia. Subjects were divided into six age groups. The teeth with most NCCL were the lower premolars, which also had the largest percentage of higher index levels, indicating the greater severity of the lesions. The most frequent index level was 1, and the prevalence and severity of the lesions increased with age.     

The anatomy of non-carious cervical lesions

Objective

The term “non-carious cervical lesion” (NCCL) describes a dental hard tissue defect of unknown origin. Two very distinct variations are known: wedge-shaped and saucer-shaped lesions. Reasons for occurrence of two forms might include different contributing factors.

Methods

Forty-two teeth, 19 wedge-shaped and 23 saucer-shaped lesions, were analysed by light and confocal laser scanning microscopy (CLSM) to investigate presence of calculus and organic matter, surface structure of the lesion, borders of the lesion, and potential fractures in the dental hard tissues.

Results

One hundred percent of the wedge-shaped teeth showed evidence of additional abrasion (incisal/occlusal surface) but only 70 % of the saucer-shaped teeth. In most teeth, the edge was rounded. Tiny grooves parallel to the cemento-enamel junction (CEJ) were present in 11 % of the wedge-shaped and in 39 % of the saucer-shaped lesions. Seventy-nine percent wedge-shaped and 52 % saucer-shaped lesions had some sort of apposition. Eighty-eight percent of all teeth had dead tracts, 62 % of which were located directly next to the defect (in the lesion). In 48 %, sclerotic dentin was present right next to the defect (in the lesion). Tertiary dentin was visible in 60 %. Not a single fracture was detected.

Conclusion

Different characteristics associated with each type of cervical lesion support the theory of different aetiology or at least of differing contributions from different factors that participate in the development of NCCLs.

Clinical relevance

Only knowledge of the correct aetiology of NCCLs will allow the best treatment and prevention for such lesions.     

The prevalence and severity of non-carious cervical lesions in a group of patients attending a university hospital in Trinidad

Non-carious cervical lesions (NCCLs) are often encountered in clinical practice and their aetiology attributed to toothbrush abrasion, erosion and tooth flexure. This paper aims to determine the prevalence and severity of NCCLs in a sample of patients attending a university clinic in Trinidad and to investigate the relationship with medical and dental histories, oral hygiene practices, dietary habits and occlusion. Data were collected via a questionnaire and clinical examination. Odds ratios were used to determine the association of the presence of lesions and the factors examined. One hundred and fifty-six patients with a mean age of 40.6 years were examined of whom 62.2% had one or more NCCLs. Forty five per cent of the lesions were sensitive to compressed air. Younger age groups had a significantly lower correlation with the presence of NCCLs than older age groups. Other significant factors included patients who reported heartburn, gastric reflux, headaches, bruxism, sensitive teeth and swimming or had a history of broken restorations in the last year. There was also significant correlation of NCCLs in patients who brushed more than once a day or used a medium or hard toothbrush. Patients with vegetarian diets and those who reported consuming citrus fruits, soft drinks, alcohol, yoghurt and vitamin C drinks were associated with the presence of lesions. Significant associations were also found in patients with group function, faceting, clicking joints or those who wore occlusal splints.     

Eight-year clinical evaluation of two types of resin composite in non-carious cervical lesions

Clinical Oral Investigations - In this clinical study, the 8-year clinical performances of a flowable resin composite was compared with that of a conventional resin composite. Ninety non-carious...     

The prevalence of non-carious cervical lesions (NCCLs) with or without erosive etiological factors among adults of different ages in Tokyo

Clinical Oral Investigations - To evaluate the prevalence of non-carious cervical lesions (NCCLs) on teeth with or without erosive etiological factors across a broad range of ages of Japanese...     

牙齿非龋性颈部缺损疾病的研究回顾

非龋性颈部缺损（non—carious cervical lesion,NCCL）是常见的唇颊侧釉牙骨质交界处牙体硬组织在某些非龋性因素长期作用下的逐渐丧失。早期的研究曾提出过度水平向刷牙是主要的病原因素。但更多的研究认为NCCL的产生是多因素的。内部碎裂和涉及的咬合力可能是存在的另一个病因,其产生的颈部应力疲劳使颈部表面易于酸蚀和磨耗。本文回顾了有关NCCL的病因学,非正常咬合对于NCCL影响,相关的力学研究方法及NCCL治疗的研究文献。     

Tooth morphology and characteristics of non-carious cervical lesions

OBJECTIVES: Two 3-dimensional models, one of a lower second premolar and one of a lower central incisor were used to investigate effects of load on the location and magnitude of cervical strains. METHODS: Point loads of 100 N were applied to the model premolar (at the cusp tip, parallel and 45 degrees to the long axis of the tooth) and incisor (at the mid-buccal point on incisal edge, parallel and 45 degrees to the long axis of the tooth). Outputs were presented in the form of tensile-strain contours and vector plots. RESULTS: Strains were concentrated near the cementoenamel junction (CEJ) regardless of load direction, and oblique loading showed higher tensile strains, opposite to the point of loading, than vertical loading for both models. For the premolar model, regardless of loading direction, strains were concentrated at the mid- buccal CEJ. In contrast, under vertical loading on the incisor model, tensile strains were concentrated at the line-angle of CEJ. From oblique loads, vector plots of both models showed tensile vectors in vertical directions while vertical loads showed tensile vectors in horizontal directions. CONCLUSION: Mechanisms of non-carious cervical lesions (NCCLs) may in part be due the changing orientation of tensile strains as well as their magnitude. Stress concentration at the CEJ related well to the common location of clinical NCCLs. The crown-root morphology may have an influence on the initial location of non-carious cervical lesions.     

Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review

ObjectivesThe aim of this systematic review was to evaluate the clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions (NCCLs) in terms of restoration retention as a function of time.MethodsMedline Ovid and IADR abstracts were reviewed for NCCLs clinical trials from 1950 to 2013. The reference list of all eligible trials and relevant review articles was checked to find additional studies. The review did not have any language restrictions. Only randomized controlled clinical trials that evaluated at least two adhesives for a follow-up period of at least 18 months were included. Materials with adhesive potential were categorized into 6 main classes: 3-step etch&rinse adhesives (3E&Ra's), 2-step etch&rinse adhesives (2E&Ra's), 2-step self-etch adhesives (2SEa's), 1-step self-etch adhesives (1SEa's), glass-ionomers (GI's) and self-adhesive composites (SAC's). The first four can bond restorative composite to tooth tissue. Both 2SEa and 1SEa were further sub-divided in ‘mild’ and ‘intermediately strong (1/2SEa_m), with a pH ≥ 1.5, and ‘strong’ (1/2SEa_s), with a pH < 1.5. From the restoration retention rates as a function of time the average annual failure rate (AFR) per adhesive and adhesive class was calculated.ResultsThe lowest AFR scores [mean (SD)] were recorded for GI [2.0 (1.4)] shortly followed by 2SEa_m [2.5 (1.5)], 3E&Ra [3.1 (2)] and 1SEa_m [3.6 (4.3)] (Tukey Contrasts: p > 0.05). Significantly higher AFR scores were recorded for 1SEa_s [5.4 (4.8)], 2E&R [5.8 (4.9)], and 2SEa_s [8.4 (7.9)] (p > 0.05). In addition, significant differences in AFR were noticed between adhesives of the same class (Kruskal–Wallis sum test: p > 0.05), except for GI (p = 0.7) and 2SEa_m (p = 0.1). Finally, selective enamel etching did not significantly influence the retention rate of SEa (AFR SEa_etch = 0.43 (0.49), AFR SEa_non-etch = 1.43 (1.77).SignificanceThe adhesive approach significantly influences the clinical effectiveness of adhesives in NCCLs. Within each class, except for GI, there was a wide variation in clinical bonding effectiveness.     

广州市中高收入人群楔状缺损调查分析

目的调查广州市部分中高收入人群的牙颈部楔状缺损患病率、病变特征及病因,为制定楔状缺损防治措施提供依据。方法对885名中高收入人员楔状缺损状况进行调查,以楔状缺损牙数、缺损形状、好发牙位、刷牙方式等情况作为统计指标,对所得数据进行统计学分析。结果该人群楔状缺损患病率为76.61%,男女差异无统计学意义(P>0.05);70.17%的楔状缺损为V形,主要发生在上颌后牙,以上颌第一前磨牙最常见,患病率为34.29%。年龄越大、习惯横向刷牙及爱吃硬食的人,楔状缺损患病率更高。调查人群中楔状缺损的就诊率为20.64%。结论广州市部分中高收入人群的楔状缺损患病率较高,有喜欢吃硬食、横向刷牙等不良习惯的人群患病率更高。     

One-year clinical evaluation of tooth-colored materials in non-carious cervical lesions

The purpose of this study was to assess the clinical performance of bonded composite (Excite/Tetric Ceram - Vivadent) versus a resin-modified glass ionomer cement (Vitremer - 3M) for restoring non-carious cervical lesions. A total of 70 restorations (thirty-five per material) were placed in 30 patients, 18-50 aged, by one operator. Rubber dam was employed in all cases, lesions were pumiced, enamel margins were not beveled, and no mechanical retention was placed. The restorations were directly assessed by two independent evaluators using modified-USPHS criteria for six clinical categories. The ratings for clinical acceptability restorations (alfa plus bravo) were as follows (Tetric Ceram/Vitremer): retention (86%/100%), marginal integrity (100%/100%), marginal discoloration (100%/100%), wear (97%/100%), postoperative sensitivity (100%/100%) and recurrent caries (100%/100%). Statistical analysis was completed with Fisher's exact or Pearson Chi-square tests at a significance level of 5% (P<0.05). Results showed that almost all restorations were clinically satisfactory with no significant differences between materials groups. Five restorations of Excite/Tetric Ceram failed. No restorations of Vitremer have yet failed.     

Investigation of non-carious cervical lesions of populations in Guangzhou area

目的 调查广州市部分中高收入人群的牙颈部楔状缺损患病率、病变特征及病因,为制定楔状缺损防治措施提供依据.方法 对885名中高收入人员楔状缺损状况进行调查,以楔状缺损牙数、缺损形状、好发牙位、刷牙方式等情况作为统计指标,对所得数据进行统计学分析.结果 该人群楔状缺损患病率为76.61％,男女差异无统计学意义(P＞0.05);70.17％的楔状缺损为V形,主要发生在上颌后牙,以上颌第一前磨牙最常见,患病率为34.29％.年龄越大、习惯横向刷牙及爱吃硬食的人,楔状缺损患病率更高.调查人群中楔状缺损的就诊率为20.64％.结论 广州市部分中高收入人群的楔状缺损患病率较高,有喜欢吃硬食、横向刷牙等不良习惯的人群患病率更高.     

Chemical profile of the dentin substrate in non-carious cervical lesions

ObjectiveThe molecular structural nature of the dentin substrate in non-carious cervical lesions (NCCLs) is poorly understood. This investigation characterized the chemical structure including inhomogeneities, composition, mineral crystallinity, collagen organization of normal dentin and affected dentin substrates within NCCLs using Raman microspectroscopic mapping/imaging.Materials and methodsThree extracted human pre-molars affected with NCCLs were selected and cavities matching the natural lesion with respect to size and location were prepared on the lingual/palatal surface of each tooth to serve as controls. The specimens were sectioned to expose the gingival and occlusal margins of the NCCLs and the control cavities. Micro-Raman spectra and imaging were acquired at 1.5 μm spatial resolution at positions perpendicular to the lesion surfaces.ResultsThe Raman spectra and imaging comparisons showed the distinct compositional and structural alterations in mineral and matrix components of NCCL affected dentin. A heterogeneous hyper-mineralized layer, with characteristic features such as high phosphate/low carbonate content, high degree of crystallinity and partially denatured collagen were revealed in affected dentin substrate of NCCLs.SignificanceGenerating Raman images based on different strategies from the same data set provides a powerful means to study the structural alterations within heterogeneous dental tissues. Direct overlay of the images indicated that the changes in chemical structure and composition are synchronized. Further studies are required to understand the role that these alterations play in response to acid etching and bonding to these clinically relevant substrates.     

Two-year clinical evaluation of composite resins in non-carious cervical lesions

Objective

The purpose of this double-blind, randomised trial was to compare the clinical performance of a hybrid composite (Clearfil AP-X, Kuraray, Tokyo) and a nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN) over a period of 2 years in non-carious class V lesions using a modified US Public Health Service (USPHS) system.

Methods

Forty-six patients with at least one pair of equivalent non-carious cervical lesions under occlusion and a mean age of 44.1 years (range 27–66 years; median 45 years) were enrolled in this study. A total of 116 restorations (58 with each material) were placed according to manufacturer's instructions by two calibrated operators. The restorations were evaluated at baseline and at 6, 12 and 24 months after placement using the USPHS criteria for retention, colour match, marginal discolouration, marginal adaptation, anatomic form, surface texture and secondary caries. Statistical analysis was conducted using the Cochran and the McNemar tests at a significance level of 5 % (P?<?0.05).

Results

No surface texture changes or secondary caries were detected in association with any restorations. The retention rates for Clearfil AP-X (100 %) and for Filtek Z350 (91.38 %) did not differ significantly (P?>?0.05). Two Z350 restorations were completely lost after 2 years. No significant differences were observed in the colour match, marginal discolouration, marginal adaptation or anatomic form.

Conclusions

There were no significant differences in the clinical performances between the materials.

Clinical relevance

Both restorative materials exhibited acceptable clinical performance in class V non-carious lesions 2 years post-restoration.     

排龈术在龈下楔状缺损修复中的临床应用

选择楔状缺损颈部边缘位于龈下0～2 mm 内、较难充填的活髓患牙120颗,分3组（n ＝40）：I 组：排龈线排龈;II 组：排龈膏排龈;III 组：对照组,直接充填。充填后1、2年复查,以改良的 USPHS 直接临床评价系统评估疗效。修复1年及2年后实验组和对照组成功率差异均有显著性,实验组之间成功率差异无显著性。