1. NON-CARIOUS CERVICAL
LESION

2. :INTRODUCTION:
• Gradual loss of tooth structure is a physiologic process that
accurs throughout life.most often it so slow that is rarely
poses any problem to the patient.
• Loss of tooth structure from the cervical region of the teeth
accurs due to pathological processes like
erosion,abrasion & abfraction which may act
independently. This lesions are seen in half of the
population.prevelance increase with age.The incresing
popularity of adhesive restorative material like GIC &
composite resins.

3. :Non-carious cervical lesion are
associated with erosion, abrasion and
abfraction:
•Erosion: This is
the loss of tooth
substance by a
non-bacterial
chemical process.
•

4. ●Abrasion;
● Dental abrasion is
the pathological
wearing away of
teeth due to
abnormal process,
habits or abrasive
substances.

5. •Abfraction:
This is the pathologic
loss of tooth substance
due to bio-mechanical
loading forces that
result in flexure and
ultimate fatigue of
enamel and dentin at
a location away from
loading.

6. :Etiology of non-carious cervical
lesion:
EROSION
Extrinsic Intrinsic
1) dietary acids
Citrus fruits
Carbonated
Drinks
Pickled foods
1) gastric disorders
GIT ulcers
Hiatus hernia
Chronic alcoholism
2) Environmental erosion
wine tasting
metal plating
2) Eating disorders
Anorexia nervosa
bullimia nervosa
3) chronic vomiting
4) Pregnancy morning
sickness

7. ABRASION
1).Tooth brushing-
- Over vigorous brushing
- Use of hard tooth brush
- Improper brushing technique
2).Abnormal habits-
- Biting a pipe stem
- Biting finger nail
ABFRACTION
1)Excessive occlusal stresses
2)Para-functional habits-
- Bruxism
-Clenching

8. :SALIVA:
• The quantity and quality of saliva may also have role in
the development of non-carious cervical lesions. Drugs
and conditions which reduce salivary flow can
accelerated the loss of tooth structure in the cervical
region.
•
• Currently it is a accepted that non-carious cervical lesion
have a multifactorial etiology and are not related to any
one factor. A combination of erosion, abrasion and
abfraction may operate in the initiation and progression
of these lesions.

9. :Clinical Features:
Erosion Abrasion Abfraction
Location: Facial or lingual Facial Facial
Shape: Broad,shallow
Saucer shape
Wedge shape
V-shape
Wedge shape
Margins: Not well defined Sharp and well
defined
sharp
Enamel
Surface:
Smooth and
polished
Smooth may show
scratches
Rough,may show
grooves
Teeth
Affected:
Lingual surface of
maxillary anteriors
Facial surface of
maxillary
Canine to molar
region
Sub-gingival
location possible

10. :DIAGNOSIS:
)(.History:
• Note down any history of intrinsic or extrinsic
erosion. The dentist must try to identify
digestive problems like anorexia, gastric
regurgitation, etc..
• A diet diary is useful in detecting excessive
consumption citrus fruits, carbonated drinks, vit
C tablets, vinegar, etc.. which are the common
cause of dietary erosion.
• The dentist must also question about
abnormal habits like clenching, grinding, etc..
which may be factors responsible for abfraction.

11. )(.Clinical Examination:
•
•
• Tooth mobility
• Open contacts
• Tited or drifted teeth
• Atypical occlusal wear
• Overerupted teeth
• Cross bites,deep bites & open bites
• Fewer number of occluding teeth
•
)(.Radiograph:
• Altered lamina dura and periodontal space.
• Evidence of hyper-cementosis, resortptions.
• Pulpal calcification.

12. )(.Clinical Management:
•1). Tooth sensitivity: Exposure of dentin in the
cervical area may result in dentine hyper sensitivity.
•
•2). Compromise esthetics: Loss of tooth structure
in the cervical region of teeth may produce an un-
esthetic appearance especially in the anterior region.
•
•3). Risk of tooth fracture: Deep, wedge shaped
lesions in the cervical area of teeth can increase the
risk for tooth fracture due to lowered strength at this
critical regions.
•

13. • 4). Pulpal damage: Deep cervical lesions are also likely
to results in re- reversible pulpitis and pulpal
death.
•
5). Caries: Non-carious cervical lesions also favour plaque
accumulation which would eventually lead to the
development of
caries.
•

14. :TREATMENT OPTIONS:
•1) Dentin desensitization.
•
•2) Restorations.
•
•3) Endodontic therapy.
•
•4) Periodontal therapy.

15. :DENTIN DESENSITIZATION:
•This is a viable treatment option for those
situations where minimal amount of dentin is
exposed (less then 1mm) and the patient
experiences hyper sensitivity. This may be
managed by any of the methods suggested for
dentin desensitization such as:
•
I. Fluoride varnishes or fluoride iontophoresis.
II. Dentin bonding agents.
III. Use of desensitizing tooth pastes.

17. :RESTORATIVE TREATMENT:
• 1). Considerable loss of enamel and dentin.
• 2). Esthetics is compromised.
• 3). Deep lesions affecting the strength of the tooth
and pulpal intergritty.
• 4). Caries beginning in the cervical lesion.
• 5). Significant sensitivity of the exposed dentin.
•

18. :CHOICE OF RESTORATIVE MATERIAL:
• Class V non-carious lesions may be restored with any
of the permanent restorative materials presently
available. Amalgam, direct gold, cast gold inlays and
ceramic inlays are no longer preferred as they
require some amount of cavity preparation to make
the restoration retentive.
•
• Currently composite resins and GIC are more
popular to restore non-carious cervical lesions
primarily because they are adhesive and do not
require any extensive cavity preparations.

19. COMPOSITE
RESINS
GIC
Advantages:
-Superior esthetics.
-Excellent polishability.
-High bond strength.
-Good abrassion resistance.
Advantages:
-Adhesion to tooth structure
fluoride relese.
-Biocompatibility.
-Cofficient of thermal
expansion.
Disadvantages:
-Technique sensitivity
-Polimerization shrinkage may
open marginal gapes.
Disadvantages:
-Less esthetic
-Brittelness
-Sensitive to moisture
contamination

20. :ENDODONTIC THERAPY:
When cervical tooth is extensive
resulting is pulpal involvement,
endodontic therapy is necessary followed
by post placement and full coverage
restoration in the form of crown.

21. :PERIODONTAL THERAPY:
• Periodontal therapy is required when non-carious
cervical lesions are associated with considerable
gingival recession and mucogingival defects.
•
• Root coverage procedures using free gingival grafts
or connective tissue grafts.
•
• Root coverage using non-grafting procedures like
rotational and coronally advanced flaps or guided
tissue regeneration.

22. :REFERENCES:

23. ……THANK YOU…THANK YOU…