OHDE Articles

Oral Health and Dentistry
ISSN: 2573-4989

Editorial Article Volume 7 Issue 1
Perio-Resto Management of Non-Carious Cervical Lesions- An Update
Salvatore Luca La Terra DDS, MSc, PgCert, PgDip1* and Faisal Alzahrani BDS, MSc2
    1Periodontist, Implantologist, Oral Surgeon. Periodontology Department at the College of Medicine and Dentistry, Ulster University, with practices in Rome and Ragusa, Italy
    2Oral Surgeon, Oral Surgery department, College of Medicine and Dentistry, Ulster University, United Kingdom, Birmingham, United Kingdom
*Corresponding Author: Salvatore Luca La Terra, DDS, MSc, PgCert, PgDip, Periodontist, Implantologist, Oral Surgeon. Periodontology Department, College of Medicine and Dentistry, Ulster University. Birmingham B4 6BN, United Kingdom.Private Practice in Rome 00100 and Ragusa 97100, Italy.
Received: May 01, 2024;   Published: May 20, 2024.
Abbreviations: GR: Gingival Recession; CEJ: Cementoenamel Junction; DH: Dentin Hypersensitivity; NCCL: Non-Carious Cervical Lesion; OH: Oral Hygiene; RC: Root Coverage.
Keywords: Gingival Recession; Cementoenamel Junction; Dentin Hypersensitivity; Non-Carious Cervical Lesion; Oral Hygiene; Root Coverage; Toothbrush Trauma; Perio-Resto
The exposure of the tooth crown and the cervical zone of root surface to the oral cavity [1,2] is a consequence of gingival recession (GR) which is defined as the apical shift of the soft tissue margin in relation to the cementoenamel junction (CEJ) [3,4].
Certain clinical conditions such as plaque-induced inflammation, toothbrush trauma, tooth alignment, alveolar bone dehiscence, high muscle attachment, frenal pull, iatrogenic factors, orthodontics, and restorative procedures [5] may determine GR and absence of root surface protection with possible unfavourable events, such as aesthetic complaints, dentin hypersensitivity (DH), root caries and cervical wear [6].
Conversely, a clinical scenario closely linked to GR is the non-carious cervical lesion (NCCL) [7] which is defined as a pathological dental wear of the tooth substance at the level of the gingival one-third of the tooth due to reasons other than dental caries [8,9,10].
The lack of adequate gingival protection and the effect of oral hygiene (OH) over the time along with the alteration of anatomy determined by the non-bacterial acid action cause a progressive destruction of hard tissue [11].
A study by Que., et al. (2013) investigating NCCLs showed a percentage of 61,9% with at least one NCCL, including 27,1% with cervical tooth hypersensitivity over a total of 1023 patients. Moreover, in agreement with Jaeggi and Lussi (2006) NCCLs mostly affect the vestibular surfaces of the maxillary premolars and canines with a prevalence increasing with age in people with high level of OH in advanced countries [12,11].
With regard to aetiology and treatment Chelani., et al. and Toffenetti., et al. respectively evidenced that NCCLs and GRs are closely linked as the two clinical conditions are often present on the same tooth with a percentage of approximately 50% and this combined defect (GR + NCCL) requires a specific therapy [13,14] as confirmed by Santamaria., et al. [15,16].
Mainly, when aesthetic issues, DH [17], root caries/demineralization [18] and bacterial plaque accumulation are present, the treatment of the combined defect is indicated [10]. However, from a prognostic standpoint, root coverage (RC) procedures may result different when compared to intact roots [15,19,20] in case of NCCL + GR. In presence of combined GR and NCCL, unsuccessful aesthetic outcomes following the surgical or restorative treatments may occur, particularly for those defects extending apically [23]. Also, traditional mucogingival surgical procedures alone without any restorative therapy might led to inadequate RC [24]. Moreover, although NCCLs and GRs are two clinical conditions closely linked, treatments are often focused on hard tissue reconstruction, and a restorative approach alone (i.e., composite restoration) is considered in most of cases [21], disregarding GR presence or the final aesthetic result [22].
The decision-making process should be based on a deep knowledge of the periodontal and restorative aspects of the therapy [25]. Therefore, optimal functional and aesthetic results as well as successful outcomes in the long term are obtainable through a combined periodontal and restorative approach [26]. That said, periodontal and restorative components of the treatment should be carefully analysed during the decision-making process [25], and a combined periodontal and restorative approach is essential for optimal functional and aesthetic outcomes over the long term [26].
Conclusion
To summarize, management of GRs may be negatively influenced by the presence of a NCCL and deciding the optimal treatment approach for combined GRs + NCCLs may result challenging. While a GR on an intact root may be successfully treated through RC procedure, the presence of NCCL/GR combined defects needs a thorough evaluation of the clinical features and mutual spatial relationships of both hard and soft tissue defects [18]. From a restorative and surgical aspect, proper finishing and polishing of the restorations before surgery and lesion configuration analysis of the defect configuration including the appropriate surgical technique options are essential phases for successful outcomes in agreement with several authors [26,27,10,25]. In light of this, the assessment of the efficacy of the combined technique compared to the surgical technique alone as well as the choice of the optimal restorative material should be further investigated.
Conflict of Interest:
Authors declare that does not any financial interest or any conflict of interest exists.
References
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Citation: Salvatore Luca La Terra and Faisal Alzahrani. “Perio-Resto Management of Non-Carious Cervical Lesions- An Update”. Oral Health and Dentistry 7.1 (2024): 09-11.
Copyright: © 2024 Salvatore Luca La Terra and Faisal Alzahrani. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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