Abfraction lesions: etiology, diagnosis, and treatment options

Clinical, Cosmetic and Investigational Dentistry Dovepress open access to scientific and medical research Review Clinical, Cosmetic and Investigational Dentistry downloaded from https://www.dovepress.com/ by 54.37.117.73 on 12-Jul-2018 For personal use only. Open Access Full Text Article Abfraction lesions: etiology, diagnosis, and treatment options This article was published in the following Dove Press journal: Clinical, Cosmetic and Investigational Dentistry 3 May 2016 Number of times this article has been viewed Marcelle M Nascimento 1 Deborah A Dilbone 1 Patricia NR Pereira 1 Wagner R Duarte 2,3 Saulo Geraldeli 1 Alex J Delgado 1 Department of Restorative Dental Sciences, Division of Operative Dentistry, 2Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA; 3Private Practice, Brasilia, DF, Brazil 1 Abstract: Abfraction is a type of noncarious cervical lesion (NCCL) characterized by loss of tooth tissues with different clinical appearances. Evidence supports that abfraction lesions, as any NCCLs, have a multifactorial etiology. Particularly, the cervical wear of abfraction can occur as a result of normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The interaction between chemical, biological, and behavioral factors is critical and helps to explain why some individuals exhibit more than one type of cervical wear mechanism than others. In an era of personalized dentistry, patient risk factors for NCCLs must be identified and addressed before any treatment is performed. Marked variations exist in dental practice concerning the diagnosis and management of these lesions. The lack of understanding about the prognosis of these lesions with or without intervention may be a major contributor to variations in dentists’ management decisions. This review focuses on the current knowledge and available treatment strategies for abfraction lesions. By recognizing that progressive changes in the cervical area of the tooth are part of a physiologically dynamic process that occurs with aging, premature and unnecessary intervention can be avoided. In cases of asymptomatic teeth, where tooth vitality and function are not compromised, abfraction lesions should be monitored for at least 6 months before any invasive procedure is planned. In cases of abfraction associated with gingival recession, a combined restorative-surgical approach may be performed. Restorative intervention and occlusal adjustment are not indicated as treatment options to prevent further tooth loss or progression of abfraction. The clinical decision to restore abfraction lesions may be based on the need to replace form and function or to relieve hypersensitivity of severely compromised teeth or for esthetic reasons. Keywords: abfraction, tooth wear, noncarious cervical lesions, tooth restoration Introduction Correspondence: Marcelle M Nascimento Department of Restorative Dental Sciences, Division of Operative Dentistry, University of Florida, 1395 Center Drive, Room D9-6, PO Box 100415, Gainesville, FL 32610-0415, USA Tel +1 352 273 5858 Fax +1 352 846 1643 Email 79 submit your manuscript | www.dovepress.com Clinical, Cosmetic and Investigational Dentistry 2016:8 79–87 Dovepress © 2016 Nascimento et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/ terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/CCIDE.S63465 Powered by TCPDF (www.tcpdf.org) Noncarious cervical lesions (NCCLs) develop as a result of normal and abnormal or pathological wear and cause abfraction, abrasion, and erosion or chemical degradation of dental tissues.1 Clinical appearance of NCCLs can vary depending on the type and severity of the etiological factors involved.2 Of all possible etiological factors for NCCLs, occlusal stress forces have received maximum attention over the years. Tensile stress from malocclusion and masticatory forces was initially proposed as the primary factor in NCCLs;3 shortly thereafter, these lesions were termed as abfraction lesions.4 Despite many efforts to demonstrate that occlusal forces are the main cause of abfraction, its etiology remains poorly understood and controversial.5 Nowadays, it is generally incorrect to designate only one mechanism to be the cause of any type of NCCLs.6 Instead, current evidence supports a multifactorial etiology for all NCCLs Dovepress Clinical, Cosmetic and Investigational Dentistry downloaded from https://www.dovepress.com/ by 54.37.117.73 on 12-Jul-2018 For personal use only. Nascimento et al with patient factors being responsible for the various degrees of tooth loss.7–10 Figure 1 shows the scheme of pathodynamic mechanisms responsible for initiation and perpetuation of NCCLs, as proposed by Grippo et al.6 NCCLs are relatively common clinical conditions that can adversely affect structural integrity, retention of dental plaque, tooth sensitivity, pulpal vitality, and esthetics.5,9,11 The incidence of NCCLs is expected to increase as the population ages and teeth are retained longer; however, marked variations exist in dental practice concerning the diagnosis and management of these lesions.12 Treatment planning is primarily based on dentists’ beliefs about the effectiveness of restorative or alternative interventions in terms of longevity and minimization of further tooth loss.13 A dental practicebased study revealed that NCCLs are the main reason other than caries for placement of restorations on previously unrestored permanent tooth surfaces.14 Nonetheless, the limited longevity of NCCL restorations is a continuing issue in dentistry,15 and unfortunately, no evidence-based guidelines are available in the literature to assist dentists regarding when and how these tooth defects should be restored. Noticeably, clinicians have long been misled by articles that proposed treatment recommendations for abfraction without credible scientific data. This review aims to provide insights on where abfraction lesions stand in research and clinical practice today by presenting the current knowledge and treatment options for these lesions. Theory of abfraction Abfraction means “to break away”, a term derived from the Latin words “ab”, or “away” and “fractio”.4 The theory of abfraction sustains that tooth flexure in the cervical area is caused due to occlusal compressive forces and tensile stresses, resulting in microfractu (...truncated)