non carious lesion and their managrment tooth structure loss can not be blamed

non carious lesion and their managrment tooth structure loss can not be blamed

1. NON CARIOUS LESIONS AND THEIR
MANAGEMENT
Dr. Ritika Chaudhary

2. INTRODUCTION
•Tooth structure loss can not be blamed entirely
to caries, many non carious destructive
processes that are an etiology to loss of tooth
structure include attrition abrasion, erosion
abfraction, demastication & resorption. Amongst
these lesion, abrasion erosion, abfraction,
attrition are the common ones, which are
responsible for non carious cervical lesions.

3. THE FOLLOWING ARE THE POSSIBLE NON
CARIOUS DESTRUCTIVE PROCESSES:

•Attrition
•Abrasion
•Erosion
•Abfraction

4. ABRASION LESIONS
•Wearing away of the tooth
substance because of grinding,
rubbing or scraping caused by
external mechanical means, like
in repeated contact of the teeth
with foreign objects or substances.
•Most common cause is faulty oral
hygiene practice like:
▫ horizontal brushing technique,
▫excessive frequency, time and
forces applied during brushing

5. EFFECT OF DENTIFRICES
•The role of dentifrices in abrading enamel and
dentin has been established.
•The amount of dentifrice applied, the degree of
salivary dilution, technique and force applied
during tooth brushing all influence abrasion.
•Tooth powder is generally five times more
abrasive than its dentifrice counterparts.

6. EROSION LESIONS
•These may be described as effects
arising because of dissolution of
tooth structure subsequent chemical
attack of either endogenous or
exogenous origin, or combined
chemico mechanical attack.
•Depending upon the source of
chemicals, usually acids, erosion
may be INTRINSIC or EXTRINSIC.

7. INTRINSIC VS EXTRINSIC EROSION
•INTRINSIC EROSION:
▫Recurrent vomiting:
Anorexia nervosa
Bulimia nervosa
▫Medical condition s
Gastrointestinal
disorders
Metabolic and
endocrine disorders
Neurological disorders
▫Gastro oesophagal reflux
disease
▫Rumination
•Extrinsic erosion:
▫frequently in the diet
consequence of exogenous
▫acids found as a
contaminant in the work
atmosphere (e.g. acid
battery factories)
▫ in professional swimmers
(chlorinated swimming
pools)
▫ in low pH medications like
iron tonics, aspirin,
hydrochloric acid
replacements, oral hygiene
products etc., and more
•The citrate ions are believed
to bind with calcium in
enamel and dentin forming
soluble calcium citrate.

8. MORPHOLOGY
•Erosion lesions are most of the times observed as broad shallow saucer shaped
excavations or depressions present in enamel and or dentin, but with no sharp
line angels and less well defined margins. At times, lesions may even be
grooved, wedge shaped or irregular.

9. Clinical features
•When the defect is only present on the palatal surfaces of upper teeth
Regurgitation of stomach acid can cause this condition
•Extrinsic erosion leads to dissolution of facial aspects of anterior and buccal
aspect of posterior teeth
•Cupped out areas on occlusal surface
•Exogenous acids produce a crescent or dish shaped appearance

10. ABFRACTION LESIONS
• These are described as wedge
shaped defects in the cervical
region of the tooth.
•They are as a result of tensile
stresses concentrated in this
area consequent to occlusal
forces in some areas.
• The term abfraction was first
coined by Grippo to distinguish
from abrasion and erosion.

11. MECHANISM FOR FORMATION OF
ABFRACTION LESIONS
•The masticatory system during function exposes the teeth to three types of stresses:
compressive,
tensile and
shear.
•As a general rule, both dentin and enamel have high compressive strengths but are relatively weak in tension.
•Intra oral forces range from 10 N to 430 N , 70 N is normal
•Enamel is 35 times stronger while dentin is 7 times stronger in compression than in tension. Even amongst
the two, dentin is substantially stronger then enamel in counteracting tensile stresses.
•The high resiliency and elasticity of the former enables it to withstand greater deformation without fracture.
Enamel is Brittle and liable to fracture at small deformation loads.

13. Attrition
•Attrition is the mechanical wear of the incisal or occlusal
surface as a result of functional and parafunctional
movements of the mandible
•Attrition also includes proximal surface wear at the contact
area due to physiological tooth movement
•Etiology:
Stress
Airway issues
Sleep apneoa

14. Clinical features
•In older patients, the enamel on the cusp tips is worn off,
cupped out areas because of exposed, softer dentin wears
faster than surrounding areas
•Presence of peripheral, sharp and ragged enamel edges
•Heavy occlusal loading from clenching may result in craze
lines

15. TREATMENT OF NON CARIOUS CERVICAL
LESIONS

16. LOCAL PREVENTIVE MEASURES
•Use of soft tooth brushes, low abrasive toothpastes,
vertical brushing technique, less force during brushing etc.
•Correction or avoidance of ill fitting metal clasps or
dentures.
•In cases of bruxism, use interdental splints at night and
treat the cause.
•Correct malocclusion
•Regulate frequency of consumption of acid foods and
beverages

17. •Restrict acidic food to main meals
•Finish meals with neutral foods like cheese.
•Drink only do not sip or swish acid beverages.
•Do not brush immediately following an acid intake.
•Use neutral pH fluoride mouth rinses on a daily basis.
•
•Relieve traumatic occlusion
•Prevent and cure periodontal disturbances.
•Enhance defense mechanisms of the body i.e. increase salivary flow e.g. by
chewing sugar free chewing gum.
•Enhance acid resistance, remineralization and re hardening of tooth surface
by topical fluoride agents.

18. RESTORATIVE ASPECT OF
TREATMENT
•A restoration in a non carious cervical lesion is indicated after
consideration is given to the following factors.
•Structural intergrity of the tooth: if the notched/ affected area is
very large deep, strength of the tooth at the cervix is lessened.
Placement of a bonded restoration is indicated to restore the lost
strength.
•Pulp protection: When the lesion is quite deep so as to endanger the
vitality of pulp or cause an exposure, a restoration should be carried
out.

19. •Sensitivity: when sensitivity continues to exist despite use of desensitizing
conservative treatments, lesions should be filled.
•Esthetics: if the notched area is in an esthetically critical position, the
patient may want the lesion restored with a tooth colored material.
•Gingival health: If the lesion seems to irritate the gingival tissue causing its
inflammation, gingival recession or plaque accumulation the defect should
be considered for restoration.
•Caries: If caries supervenes the lesions, it should be restored unless it is
incipient superficial and can be treated by preventive measures alone.
•Presence of removable partial denture: If the location of the lesion interferes
with the design of removable partial denture, restoration is indicated.

20. Role of Composites
•Restoration with composite resins offers the advantage of best
esthetics and excellent mechanical attachment to etched
enamel. Disadvantages include exacting and tedious
placement.
•No instrumentation is desired in the non carious
cervical lesion when restoring with composite . It is
demonstrated that V shaped cavities are preferable over box
shaped cavities as in the former the volume area ratio is less
and hence the amount of polymerization shrinkage.

21. Role of GIC
•Restoration with glass ionomer offers the advantage of adhesion to enamel
and dentin in wet environments and release of fluorides on a long term
bases.
•Disadvantages include long time required to achieve maturity and less than
adequate esthetics.
•Glass ionomers adhere to the tooth surface through hydrogen and ionic
bonding and hence mechanical retention is not required.

22. •Light cured glass ionomers are another possible
alternative for restoration of non carious cervical
lesions.
•They overcome the disadvantage of conventional
glass ionomers in that they show a rapid initial set
and hence are less sensitive to moisture
contamination.
•Polyacid modified composites i.e. compomers can
also be used for restoration of non carious cervical
lesions. Their restorations process is similar to that
for composite resins.

23. Role of adhesives
•Type of adhesive system used:
Glass ionomer cement
Two step SEA’s
Three step etch and rinse
One step SEA’s
•Whether or not the dentin is roughened:
Roughened dentin resulted in higher retention rate than
unprepared dentin
•GIC based materials and mild two step SEAs result in
excellent retention

24. THANK YOU