Hands On

Etiology, diagnosis, and treatment of abfraction lesions

Background

Multiple factors are seen as contributing to the development of noncarious cervical lesions (NCCLs). The term abfraction is applied to these lesions in relation to their causation. Clinically these lesions have different presentations, depending on the type and severity of the etiologic factors at work. Patient factors are responsible for the various degrees of tooth loss. NCCLs can adversely affect structural integrity, dental plaque retention, tooth sensitivity, pulp vitality, and esthetics.

Etiology

The theory of abfraction is that tooth flexure in the cervical area results from occlusal compressive forces and tensile stresses. In response, microfractures of the hydroxyapatite crystals of the enamel and dentin occur, producing further fatigue and deformation of the tooth structure. Although many attempts have been made to reproduce the phenomenon in the laboratory, few have confirmed that there is a relationship between occlusal stress and abfraction lesions. There is a weak association

Diagnosis

Proper management of abfraction lesions requires accurate diagnosis. Diagnosis is accomplished through a careful medical history and detailed clinical examination. Identifying any possible interactions between chemical, biological, and behavioral factors is essential. This includes noting whether the patient has had gastroesophageal reflux disease, eating disorders, or a poor diet. Other patient factors can also contribute to the development of the disease and help the clinician in determining

Treatment

Treatment planning approaches vary widely among dentists, with lack of information about the prognosis of these lesions with and without intervention serving as a major contributing factor to these variations. Preventive interventions can include counseling for changing the patient’s behavior, use of protective night guards, use of chewing gum to increase salivary flow if needed, and therapy or medical care for underlying physiological or mental conditions.

The primary treatment options are