2 Cervical lesionsClass V lesions are those carious and non carious defects found in the gingival third of the facial and lingual tooth surfaces.
3 - well-defined margins - hard smooth surfaces Abrasion- well-defined margins- hard smooth surfaces- normally free of plaque• Abrasion lesions are worsened in an acidic oral environment→ the abrasive object can more readily remove tooth mineral that is softened by acidAbrasion: Treatment• Identify the cause• Modify habits (oral hygiene, diet)• Fluoride, especially if the oral cavity is acidic (active)• Consider restoration of lesions
4 Erosion. these cases the oral lesions generally present a rounded-cupped out defects Erosion in enamel– Obvious loss of enamel– Dentine not exposedErosion in dentine– Dentine involved:
5 Erosion: Simple advice for patients Drink water (or milk) ! Avoid/limit intake of veryacidic drinks and foodFinish meals with neutralfood, e.g. cheeseUse a straw, do not rinsemouth with acidic drinksDo not brush teeth rightafter acidic drinks/food,rinse with water beforebrushingUse a soft toothbrush andtoothpaste with lowabrasive effectRegular local F-treatment(↑ F-conc. if active,sensitive lesions)
6 (Abfraction) • Cervical lesions caused by abnormal occlusal loading leading to mechanical andchemical wear• Under large occlusal forces or offaxisloading of tooth cusps, the teethexperience microscopic levels ofbending at the CEJ, leading toconcentration of stress and microcrackformation• These areas are more susceptible tomineral loss in connection withabrasion and erosion• Clinicalfeatures– Wedge-shaped non-carious defectsthat look like abrasion lesionsAbfraction: Consequences• Sensitivity• Weakening of the tooth• Reduced lifetime ofrestorations (GIC, ceramics)• PossibleTMD(temporomandibular dysfunction)• Tooth fracture and wear• Residual endo/perio lesions
7 Note same notch - Proof it is the same tooth. Half of the notch is below the gum level.It would be impossible for toothbrushingto cause this abfraction.
8 Treatment – General guidelines Non-carious lesions should be considered for restorationwhen the lesions are:• carious• deep enough that tooth integrity or pulp are in danger• sensitive (conservative desensititizing methods do not help)• aesthetically unacceptable• involved in a partial prosthesis design
10 Restorative materials used in class V restorations: 1-Non esthetic materials.2-Esthetic materials:-Resin composite.-Resin composite with glass-ionomer base GIC(sandwitch technique.)-Flowable resin composite.-Glass ionomer cement.-Porcelain inlay(not widely used).
11 Sandwich technique (laminated technique): This technique is useful combining the advantages of both GIC and composite resin. GIC, is used as intermediate layer between dentin and resin composite, it replaces the missing dentin and reduce micro leakage and increase retention.This technique could be open or closed ,open technique in which the GIC at the gingival margin is exposed to oral cavity, while in closed technique the GIC is completely covered by resin composite to enhance esthetic and polishability and increase abrasion resistance of the restoration.
12 Dentinal sensitivity: It is a problem often associated with gingival recession and non-carious cervical lesions.Treatment:Dentinal hypersensitivity secondary to gingival recession is best treated surgically.-Treatment or prevention of hypersensitivity is accomplished by the use of some method to occlude the open dentinal tubules by1-Dentin adhesives.2-Oxalate solutions.3-Stanous fluoride.4-Potassium nitrate available in dentifrices or as agel for application in the dental office.