Restorative Rehabilitation of a Patient with Generalized Non-Carious Cervical Lesions: Case Report

Restorative Rehabilitation of a Patient with Generalized Non-Carious Cervical Lesions: Case Report Rehabilitación restaurativa de un paciente con lesiones cervicales no-cariosas generalizadas: Reporte de un caso Roberto Zúñiga-Castañeda DDS, MSc¹; Mariné Ortiz-Magdaleno DDS, MSc, PhD¹; Roberto Carlos Uribe-Trancoso DDS¹; María del Pilar GoldaracenaAzuara DDS, MSc¹; Gabriel Fernando Romo-Ramírez DDS, MSc¹ 1. Specialty in Aesthetic, Cosmetic, Restorative, and Implantological Dentistry, Faculty of Stomatology, Autonomous University of San Luis Potosí, S.L.P. México. Correspondence to: Dr. Gabriel Fernando Romo-Ramírez Received: 20-XI-2018 Accepted: 22-II-2019 Published Online First: 27-II-2019 DOI: 10.15517/IJDS.V0I0.36347 ABSTRACT Non-Carious Cervical Lesions (NCCL) are a current problem of multifactorial origin that is associated with the loss of vertical occlusal dimension, hypersensitivity, loss of teeth, fractures, and many other pathologies that affect the masticatory function of the oral cavity. Identification of the etiological factors of NCCL comprises a key piece for the solution of the problem. Based on clinical scientific evidence related with the diagnosis, a restorative treatment must be planned according to the loss of dental structure in order to return function and aesthetics. The purpose of this case report was to describe a 54-year-old male patient who was diagnosed with generalized NCCL combined with occlusal vertical dimension loss. The protocol of the treatment process is described. KEYWORDS Non-Carious Cervical Lesions; Ceramics; Abrasion; Erosion; Abfraction; Attrition. RESUMEN Las lesiones cervicales no cariosas (LCNC) son una problemática actual de origen multifactorial, la cual se ve asociada a la pérdida de dimensión vertical oclusal, hipersensibilidad, pérdida de dientes, fracturas y muchas otras patologías que afectan la función masticatoria de la cavidad bucal. La identificación de los factores etiológicos de las LCNC son piezas claves para la solución del problema. Basados en la evidencia científica clínica relacionado con el diagnóstico, se debe planificar un plan de tratamiento restaurativo que depende de la pérdida de la estructura dentaria para devolver la función y estética. El objetivo de este reporte de caso es describir a un paciente masculino de 54 años a quien se le diagnosticó LCNC generalizadas combinado con una pérdida de dimensión vertical oclusal. El protocolo de plan de tratamiento es descrito paso a paso. PALABRAS CLAVES Lesiones cervicales no cariosas; Cerámicas; Abrasión; Erosión; Abfracciones; Atrición. INTRODUCTION Non-Carious Cervical Lesions (NCCL) are characterized by the loss of tooth structure in the cement-enamel junction without being related to an active pathological process of caries. These lesions have been classified as abrasion, erosion, abfraction, attrition, and their possible combinations (1,2). It is considered that the etiology of NCCL is complex and multifactorial. Dietary habits and social lifestyles are part of the many risk factors that have given rise to an increase in the degree of dental wear, therefore to the presence of NCCL. This type of lesion is slow progressing, progressive, and, in the majority of cases, the dental organ forms dentin and achieves isolation from the external environment (3). Abrasion is a deterioration of the pathological etiology of the tooth structure caused by abnormal mechanical processes, which in turn is caused by foreign objects that, when in contact with the teeth, generate the loss and wear of hard tissues at the level of the cementoenamel junction (4). Erosion or bio-corrosion is the chemical dissolution of dental tissues that does not involve the presence of caries and dental plaque; its etiological factors include acid or chelating agents of intrinsic or extrinsic origin (5). Attrition is the wearing down of dental tissue due to the contact of the teeth during normal or parafunctional activity (6). Another type of wear described by McCoy (1982) is abfraction, derived from the Latin "as a fracture"; the morphology of this type of injury is wedgeshaped in the cement- enamel junction and is caused by eccentric occlusal forces that lead to dental flexion (7-10). The integral restorative treatment of a patient with an aesthetic demand can represent a great challenge when the patient presents dentition with generalized NCCL, since the ideal is to propose a minimally invasive one. The treatment of each tooth depends on the type of NCCL and the degree of wear that the tissue presents and whether or not it involves the dentin-pulp complex (11). Treatment planning by segment in the oral cavity of a patient with generalized NCCL in case of loss of vertical dimension, allows us to maintain stable occlusion with provisional restorations that protect the dental organs from mandibular movements (12,13). The objective of this case report was to show and describe the aesthetic restorative rehabilitation of a patient diagnosed with generalized NCCL with ceramic restorations to restore the aesthetics and stable occlusion, describing step-by-step the treatment executed. CASE REPORT Male patient, 54 years of age, who is referred to the Specialty in Aesthetic Dentistry, Cosmetic, Restorative, and Implantology of the Faculty of Stomatology, Autonomous University of San Luis Potosí, Mexico, with spontaneous pain in the upper teeth along with NCCL in the upper and lower teeth, compromising the aesthetics and functions of the dentition. His clinical history reports the high and continuous intake of carbonated and acidic beverages, as well as the prolonged consumption of medications during 15 years due to a vehicular accident. Signed informed consent was obtained from the patient to publish his case. INTRAORAL EXAMINATION Clinical examination revealed NCCL, anterior cross bite right side and edge-to-edge bite perspective, thick periodontal biotype, middle line deviated to the right, provisional crowns with microfiltration at the cervical level, multiple microfiltered amalgam restorations. The patient was diagnosed with generalized NCCL combined with a loss of the vertical occlusal dimension (Figures 1A, 1B, and 1C). The diagnosis and treatment procedure of each teeth according to the degree of destruction of the dental tissue is shown in Table 1. PERIODONTAL REHABILITATION Periodontal phase was performed in the maxilla, which consisted of the extraction of tooth #16 due to an endodontic perforation, and of teeth #25 and #27 due to root caries; tooth #14 was treated endodontically and a fiberglass post was placed for the degree of destruction. Teeth #15, #17 and #26 were treated endodontically by hypersensitivity, and provisional fixed acrylic restorations were placed in the posterior-superior sector for the post-extraction ovoid pontic formation in the zone of teeth #16 and #25 (Figure 1D). Periodontal phase was performed in the lower arch, as well as the removal of amalgam (...truncated)