Noncarious cervical lesions in adults: prevalence and occlusal aspects

BACKGROUND: The factors that induce the formation of noncarious lesions are not understood fully, particularly those that are related to occlusal aspects. The authors conducted a study to evaluate the prevalence of noncarious cervical lesions in adults and their association with occlusal aspects. METHODS: The authors examined 70 people (35 men and 35 women) aged 25 to 45 years to determine the presence and type of noncarious cervical lesions, wear facets, tooth contacts in maximal intercuspal position, and lateral and protrusive movements. The assessment involved a questionnaire and clinical examination. RESULTS: Among the teeth the authors evaluated, 17.23 percent had cervical lesions, 80.28 percent of which had wear facets (P < .01). The authors found a significant difference between the prevalence of noncarious lesions and the presence of wear facets (P = .0484). CONCLUSIONS: The authors found that cervical lesions were related significantly to wear facets. These findings strengthen evidence for the role of occlusal forces as an etiologic factor for noncarious lesions. CLINICAL IMPLICATIONS: The presence of wear facets should be considered in the treatment of noncarious cervical lesions.     

Clinical features and factors associated with non‐carious cervical lesions and dentin hypersensitivity

Determining the factors associated with NCCLs and DH in populations could guide the implementation of specific preventive measures. This study evaluated the clinical features and factors associated with non‐carious cervical lesions (NCCLs) and dentin hypersensitivity (DH) in a Brazilian population. The participants were 118 patients at the Dentistry Clinic of our dental school. They completed an interview to obtain personal information and determine the possible factors associated with NCCLs and DH. Clinical examination was undertaken to record the NCCLs, shape of the lesion and certain occlusal factors. DH was diagnosed by air and probe tests. Data were analysed with the multilevel Poisson regression and prevalence ratios, and the respective 95% confidence intervals were calculated. The prevalence of NCCLs and DH among patients was 67·8% and 51·7%, respectively. Of a total number of 2902 teeth examined, 9·65% had NCCLs and 5·82% were sensitive to air. The most affected teeth for both conditions were the premolars. Most of the NCCLs were wedge‐shaped and located in the maxilla. The factors associated with NCCLs and DH were age and presence of premature occlusal contacts. NCCLs were also significantly associated with consumption of wine and alcoholic beverages, and DH with consumption of acidic fruits and juices. NCCLs were a common finding, with higher frequency in more advanced age groups, the maxilla and premolars. A significant association occurred between NCCLs, premature contacts and consumption of wine and alcoholic beverages. DH was associated with NCCLs, premature contacts and with the consumption of acidic fruits and juices.     

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。     

干扰(牙合)对特发性牙颈部病损临床疗效影响的研究

目的:研究干扰(牙合)对特发性牙颈部病损临床治疗效果的影响.方法:第一部分:纳入该院口腔科特发性牙颈部病损就诊患者83例,患牙295颗;临床检查存在干扰142颗作为治疗1组,无干扰(牙合)153颗作为治疗2组,分别行纳米树脂治疗.随访2年.评价疗效,卡方检验.第二部分:治疗l组失败患牙60颗,随机分为实验组和对照组,各30颗.实验组纳米树脂充填治疗特发性牙颈部病损后精确去除咬合干扰因素,对照组仅纳米树脂充填治疗.治疗2组失败患牙29颗,随机分为实验组14颗和对照组15颗.实验组降低咬合,对照组仅纳米树脂充填治疗.随访1年,评价效疗,卡方检验.结果:第一部分:治疗1组和2组牙颈部病损治疗成功率分别为57.75％和81.05％ (P ＜0.05).第二部分:治疗1组失败患牙60颗,实验组和对照组成功率分别为83.33％和56.67％ (P ＜0.05).治疗2组失败患牙29颗,实验组和对照组成功率分别为85.72％和40％ (P ＜0.05).结论:充填治疗时配合精确去除咬合干扰因素治疗,可提高特发性牙颈部病损的临床疗效.     

Application of a dental adhesive using the self-etch and etch-and-rinse approaches: an 18-month clinical evaluation

BACKGROUND: Laboratory investigations have demonstrated that the application of multiple adhesive coats can increase adhesive infiltration, thereby increasing bond strength values. The authors conducted an 18-month, randomized, controlled prospective study to evaluate the clinical performance of a self-etch and an etch-and-rinse adhesive in noncarious cervical lesions. METHODS: Twenty-nine patients with at least two pairs of similarly sized lesions participated in this study. The authors placed 116 restorations in one of four groups: OS2 (phosphoric acid and dental adhesive [One-Step Plus, Bisco, Schaumburg, Ill.], following the manufacturer's recommendation [two coats]); OS4 (phosphoric acid and One-Step Plus, with four coats); TY2 (Tyrian SPE [Bisco] and One-Step Plus, following the manufacturer's recommendation [two coats]); and TY4 (Tyrian SPE and One-Step Plus, with four coats). The authors evaluated the restorations at baseline and at six, 12 and 18 months, according to modified U.S. Public Health Service criteria. (Eight of the 116 restorations were unavailable for follow-up.) RESULTS: The retention rate for the TY2 group (55.5 percent) was statistically lower than that for the TY4 (77.8 percent) and OS4 (88.9 percent) groups. Only teeth in OS4 exhibited a retention rate at 18 months that was similar to that observed at baseline. Marginal discoloration occurred in all groups, and it was statistically significantly worse in TY2. CONCLUSIONS: Multiple adhesive coats significantly improved retention rates. CLINICAL IMPLICATIONS: Applying multiple coats of adhesive with the etch-and-rinse or self-etch approach can improve retention rates of Class V resin-based composite restorations, although not to the level of the American Dental Association's guidelines for dentin and adhesive materials.     

Three-year clinical effectiveness of a two-step self-etch adhesive in cervical lesions

A 3-yr randomized, controlled prospective study evaluated the clinical effectiveness of a mild two-step self-etch adhesive, Clearfil SE, in Class-V non-carious lesions. The hypothesis tested was that prior selective etching of enamel with phosphoric acid does not affect the 3-yr clinical performance of this adhesive. A total of 100 lesions in 29 patients were randomly restored in one or two pairs, according to two experimental protocols: (i) application of Clearfil SE according to the instructions of the manufacturer (C-SE non-etch); and (ii) similar application of Clearfil SE with prior etching of enamel cavity margins with phosphoric acid (C-SE etch). Clearfil AP-X was used as a restorative material. At 3 yr, 90% of the restorations were examined for retention, marginal integrity, marginal discoloration, caries recurrence, postoperative sensitivity, and preservation of tooth vitality. An excellent retention rate (100%) was noted after 3 yr of clinical functioning. Only one restoration of the C-SE etch group was clinically unacceptable owing to the presence of a severe cervical marginal defect. A pairwise comparison between both groups showed a significant difference only in the number of small marginal defects at the enamel side, which was higher in the C-SE non-etch group. These incisal defects were small and clinically irrelevant. Superficial marginal discoloration increased slightly in the C-SE non-etch group and was related to the higher frequency of small incisal marginal defects. In this latter group, localized marginal discoloration was observed significantly more in smokers. In conclusion, the clinical performance of the mild two-step self-etch adhesive, Clearfil SE, remained excellent after 3 yr of clinical functioning. Additional etching of the enamel cavity margins was not critical for its clinical performance.     

A cross‐sectional study: non‐carious cervical lesions,cervical dentine hypersensitivity and related risk factors

The present survey aims to study the prevalence and clinical characteristics of non‐carious cervical lesions (NCCLs) and cervical dentine hypersensitivity (CDH), as well as their possible risk factors in a general population in China. A total of 1023 subjects were included in the present study. Each subject completed a structured interview, and all teeth of each subject were examined by a practitioner to determine NCCLs and CDH. Teeth with NCCLs and CDH were diagnosed according to the tooth wear index and by a blast of air from a triple syringe, respectively. Binary logistic regression was completed by analysing the association of risk factors with the occurrence of NCCLs and CDH. Loss of attachment (LOA) and gingival recession (GR) of teeth with NCCLs and/or CDH were measured using Williams periodontal probe. The diagnoses of NCCLs and CDH established following a clinical assessment yielded an overall prevalence of 61·7% and 27·1%, respectively. The 60–69 age group had the greatest proportion of subjects with NCCLs or CDH. The pre‐molars were the most commonly affected teeth type with NCCLs or CDH. The proportion of teeth with CDH associated with NCCLs increased significantly with age, but the proportion of teeth with CDH only associated with LOA or GR decreased slowly with age. The single variables and interactive effects of variables associated with the occurrence of NCCLs include the following: age group, occupation type, method of toothbrushing, frequency and method of toothbrushing, and method of toothbrushing and duration of a toothbrush used. Gender, age group, occupation type and frequency of toothbrushing were associated with the occurrence of CDH. The current study presented higher prevalence of NCCLs and CDH in a general Chinese population. Both diseases were closely associated with age and periodontal status. The portion of the population with NCCLs or CDH had different risk factors.     

不同排龈方法修复龈下楔状缺损临床疗效观察

目的:评估不同排龈方法修复龈下楔状缺损(楔缺)的临床疗效。方法:选择颈部边缘位于龈下0～2 mm内较难充填的楔缺,分3组:I组:龈边缘位于龈下0～1 mm的楔缺40个,使用排龈线排龈;II组:龈边缘位于龈下0～1 mm的楔缺40个,使用推龈器排龈;III组:龈边缘位于龈下1～2 mm的楔缺20个,使用推龈器排龈;IV组:龈边缘位于龈上的楔缺40个,直接充填,作为对照。各组均使用可乐丽菲露自酸蚀粘接剂粘接,3M Z250树脂进行充填。治疗后1年随访,以改良的USPHS直接临床评价系统评估疗效。数据行卡方检验。结果:I-III组病例修复体均无脱落,对照组有2个脱落。楔缺修复1年后4组成功率差异无显著性;在充填体脱落、边缘适合性、继发龋、边缘着色、新发缺损、牙龈反应及牙髓反应7个方面,4组间差异均无显著性(P>0.05);对于任何一组,基线与1年后复查的差异均无显著性(P>0.05)。结论:在采用有效排龈方法的前提下,龈下楔状缺损的修复可取得满意疗效,颈部边缘于龈下的深度并不影响治疗效果;推龈器的使用对于龈下楔状缺损的治疗有较大帮助。     

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.     

中老年人群牙颈部非龋性缺损与（牙合）面磨损的临床分析

目的：调查中老年人群牙颈部非龋性缺损（NCCL）与（牙合）面磨损发生情况,并对两者的发病因素和相互关系进行探讨。方法：对568名45岁及以上机关干部,使用Smith和Knight牙齿磨损指数（TWI）进行牙颈部非龋性缺损与（牙合）面磨损的患病情况调查。结果：该研究人群NCCL的患病率为73．24％,（牙合）面磨损患病率为87．50％。NCCL和（牙合）面磨损的患病率和严重程度与性别和年龄相关,发生（牙合）面磨损的患牙更易发生NCCL,反之亦然（P〈0．05）。该人群的磨牙症史、饮食习惯及刷牙方法与NCCL和（牙合）面磨损的发生没有明显相关性。结论：牙颈部非龋性缺损与（牙合）面磨损在中老年人中较常见,两者的发生有一定的联系,（牙合）力、机械摩擦和时间为其发生的共同因素,但加重原因不尽相同。     

Two-year clinical evaluation of one-step self-etch systems in non-carious cervical lesions

Objectives

This randomized controlled clinical trial evaluated the 2-year clinical performance of S³ Bond (S3) and G-Bond (GB) in 108 non-carious cervical lesions.

Methods

Twenty-three patients, 12 male and 11 female (mean age: 61.8 years, range: 30–79 years) regularly visiting the Nagasaki University Hospital of Medicine and Dentistry, participated in the study. Each patient received both materials randomly. All restorations (53 restorations for S3 and 55 restorations for GB) were placed by one dentist. The restorations were blindly evaluated by two examiners at baseline, 6 months, 1 and 2 years using modified USPHS criteria. The data were statistically analyzed using the Cochran Q test and Fisher's exact test.

Results

One restoration of each material was lost during 2 years. The only minor clinical problem was the integrity of the enamel margin. Slight marginal staining occurred adjacent to 11 restorations of both S3 and GB. There was no significant difference in the clinical performance between S3 and GB for each variable.

Conclusions

Under the protocol used in this study, S3 and GB have demonstrated an acceptable clinical performance up to 2 years.     

A practice-based evaluation of the prevalence and predisposing etiology of white spot lesions

ObjectiveTo use an alumni-centered, practice-based research network to evaluate white spot lesions (WSLs) among treated orthodontic patients.Materials and Methods:An initial survey was conducted to ascertain whether orthodontic alumni from Texas A&M University Baylor College of Dentistry were willing to participate. Twenty randomly selected alumni participated, providing 158 treated cases. Each alumnus (1) obtained internal review board consent; (2) submitted pre- and posttreatment photographs of 10 consecutively finished cases; (3) completed a treatment survey; and (4) had the patient/parent complete the American Dental Association (ADA) Caries Risk Assessment.Results:Almost 90% of the alumni surveyed were willing to participate in the practice-based research, primarily because a fellow alumnus asked them to. Approximately 28% of the patients developed WSLs. The average patient developed 2.4 white spots, affecting 12.7% of the teeth examined. WSLs were significantly (P < .001) more (2.3−3.2 times) likely for patients who were identified on the ADA Caries Risk Assessment. The risk of developing WSLs during treatment was also increased for those with fair (2.7 times) or poor (3.5 times) oral hygiene, poor gingival health (2.3 times), and extended treatment times (2.1 times).Conclusions:There is a substantial risk of developing WSLs among private practice patients, depending partially on the length of treatment. Patients at greatest risk can be identified prior to treatment based on the ADA Caries Risk Assessment, oral hygiene, and gingival health.     

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.     

The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia

The purpose of the present study was to evaluate the prevalence of oral mucosal lesions and conditions in a population in Ljubljana, capital of Slovenia. A total 1609 subjects represented the study population in the survey about the periodontal treatment needs in a population in Ljubljana, conducted from 1983 to 1987. Ten years later the same 1609 subjects were invited to the second examination. Altogether, 555 (34.5%) of the invited subjects in the age range 25-75 years came for an interview and clinical examination at the Department of Oral Medicine and Periodontology of the Dental Clinic in Ljubljana. Oral mucosal lesions and conditions were evaluated according to the WHO Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases and Conditions. The results showed the presence of one or more mucosal lesions in 61.6% of the population. Fordyce's condition was observed the most frequently (49.7%) followed by: fissured tongue (21.1%), varices (16.2%), history of herpes labialis (16.0%), history of recurrent aphthae (9.7%), denture stomatitis (4.3%), leukoplakia (3.1%), cheek biting (2.7%), lichen planus (2.3%), frictional keratosis (2.2%), geographic tongue (2.2%), geographic and fissured tongue together (1.1%), mucocele (0.9%), smoker's palate (0.5%) and angular chelitis (0.4%). In the population examined, no oral malignancies were observed. Mucosal lesions like whitish lesions, denture related lesions, fissured tongue, varices and mucocele were more prevalent with increasing age. Tobacco-related lesions (leukoplakia and smoker's palate together) were significantly more prevalent among men than among women (P<0.05), while lichen planus, denture stomatitis and herpes labialis occurred more frequently in the female population.     

Three-year clinical evaluation of a flowable and a hybrid resin composite in non-carious cervical lesions

Objectives

This randomized controlled clinical trial evaluated the 3-year clinical performance of a hybrid (Clearfil AP-X; AP) and a flowable (Clearfil Flow FX; FX) resin composite in 98 non-carious cervical lesions.

Methods

Twenty-two patients, 11 males and 11 females (mean age: 61.9 years, range: 29–78 years) regularly visiting the Nagasaki University Hospital, participated in the study. Each patient received both materials randomly. All restorations (48 restorations for AP and 50 restorations for FX) were placed in conjunction with an all-in-one system (Clearfil S³ Bond) by one dentist. The restorations were blindly evaluated by two examiners at baseline, 6 months, 1, 2 and 3 years using modified USPHS criteria. The data were statistically analyzed using the Cochran's Q-test and Fisher's exact test.

Results

All the patients were examined at each recall. However, five restorations could not be evaluated at 3-year recall as two teeth had been extracted and three restorations had been lost. The only minor problem was the integrity of the enamel margin. The incidence and extent of marginal staining increased with time, but it was still superficial. Marginal staining occurred adjacent to 11 restorations for AP and 12 restorations for FX after 3 years. Neither lesion size nor depth had influence on marginal staining adjacent to each type of resin composite. There were no significant differences in the clinical performances between AP and FX for each variable.

Conclusions

Under the protocol used in this study, both types of resin composite in conjunction with S³ Bond demonstrated an acceptable clinical performance up to 3 years.     

Effectiveness of a new one-step self-etch adhesive in the restoration of non-carious cervical lesions: 2-Year results of a randomized controlled practice-based study

Objectives

The purpose of this practice-based randomized controlled trial was to evaluate the effectiveness of a new one-step self-etch adhesive to restore non-carious cervical lesions following CONSORT guidelines and to test the hypothesis that this adhesive is equally effective with or without beforehand selective etching of enamel.

Methods

Twenty-eight patients each received two restorations randomly assigned to the control or the experimental group. In the control group, the adhesive (Bond Force, Tokuyama) was applied without beforehand enamel phosphoric-acid-etching, whereas the latter was applied first in the experimental group. The restorative composites used for all restorations were Estelite Flow Quick followed by Estelite Sigma (Tokuyama). The clinical effectiveness was assessed at baseline, 6 months, 1 year and 2 years in terms of retention, marginal staining, restoration staining, and post-operative sensitivity.

Results

One restoration loss occurred in the control group before the 6-month recall. At the two-year recall, only 2 secondary endpoints showed significant differences between groups: marginal staining at the enamel occurred more often in the control group (29% vs. 5%) (hierarchical linear regression: p = 0.011) and ‘minor marginal defects’ were significantly more frequent in the control group (29% vs. 0%) (hierarchical linear regression: p = 0.009).

Significance

Although in a practice setting, the effectiveness of this new adhesive was very good after 2 years of clinical service. More minor defects and restoration staining at the enamel margin were noticed when enamel had not been selectively acid-etched. Selective enamel acid-etching might enhance the adhesive properties of this new one-step self-etch adhesive.