Noncarious Cervical Lesions and Cervical Dentin Hypersensitivity: Etiology, Diagnosis, and Treatment

Description

Cervical dentin hypersensitivity (CDH) and noncarious cervical lesions (NCCLs) are common findings in modern clinical practice. Although research has shown that NCCLs are a multifactorial condition involving the three mechanisms of stress, biocorrosion, and friction, few dentists know how to treat them effectively. Similarly, CDH has been an enigma for many years, and research has focused on etiology instead of treatment. In addition, little attention has been given to their mutual etiologic mechanisms of cervical stress concentration from occlusal loading and endogenous/exogenous biocorrosion. Therefore, this book approaches CDH and NCCLs together and outlines the history, mechanisms, and, most important, the clinical methods of treatment for these pathologies. It is about time we as dentists learn how to treat and prevent these conditions in clinical practice. This involves greater diagnostic effort and alteration of treatment protocols to (1) reduce dietary intake/exposure to acids, (2) manage reflux diseases, and (3) consider the significance of occlusal therapies. After reading this book, the student or clinician will be able to diagnose and treat clinical cases of NCCLs and CDH. Contents: Section I Introduction Chapter 01. History, Prevalence, and Etiology of NCCLs and CDH Chapter 02. Anatomical Considerations: Enamel, Dentin and Periodontium Section II Mechanisms of Action Chapter 03. Stress Chapter 04. Friction Chapter 05. Biocorrosion Section III Diagnosis and Treatment Chapter 06. Morphologic Characteristics of NCCLs Chapter 07. Clinical Analysis and Diagnosis of CDH and NCCLs Chapter 08. Nonrestorative Protocols: Occlusal, Chemical, and Laser Therapies Chapter 09. Restorative Protocols: Adhesive Bonding, Materials, and Techniques Chapter 10. Surgical Protocols: Periodontal Therapy and Root Coverage Cover Frontmatter Dedication Contents Forewords Preface List of Coauthors Section I: Introduction Chapter 1: History, Prevalence, and Etiology of NCCLs and CDH History of the Nomenclature and Etiology of NCCLs Prevalence of NCCLs History of the Nomenclature and Etiology of CDH Prevalence of CDH Etiology of NCCLs and CDH Friction Biocorrosion Stress Cervical Root Caries Conclusion References Chapter 2: Anatomical Considerations: Enamel, Dentin, and Periodontium Section II: Mechanisms of Action Chapter 3: Stress Stress-Strain Anatomical Considerations in the Cervical Region Abfractive Lesions and Occlusal Factors Occlusal Load Direction Levers Lesion morphology Other considerations Stress-Biocorrosion Biomechanical Behavior of Abfractive Lesions Restoration Orthodontic Treatment Periodontal Considerations Conclusion References Chapter 4: Friction Brushing Technique Toothbrushes Dentifrices Abrasivity Other considerations Whitening Toothpastes Cervical dentin hypersensitivity Interaction Between Etiologic Factors of NCCLs References Chapter 5: Biocorrosion Chemical Degradation Mechanismin Dental Structures Action of acids on enamel and dentin Stages of dental biocorrosion Chemical degradation of enamel Chemical degradation of dentin The Role of Saliva Importance of the acquired pellicle thickness and salivary flow Exogenous Sources of Acid Diet Fruits and fruit juices Other acidic foods Soft drinks and energy drinks Alcohol Nutritional habits Frequency Method of introduction to and retention in mouth Lifestyle Drug use Abusive effects of mouthrinses Medications Occupational hazards Athletes Swimmers. Winemakers and wine tasters Factory workers manufacturing acidic products Radiotherapy Chemical Parameters of Exogenous Acids Hydrogen potential (pH) Titratable acidity Buffering capacity Degree of saturation Clinical Aspects of NCCLs from Exogenous Biocorrosion Early stages Intermediate stages Severe stages Association of Exogenous Biocorrosion and Other Etiologic Factors Biocorrosion and abrasion Biocorrosion and stress (abfraction) Attrition, stress, and biocorrosion Endogenous Sources of Acid Gastroesophageal reflux disease Prevalence Clinical presentation Oral manifestations Diagnosis and treatment Bulimia nervosa Oral manifestations Diagnosis and treatment Other conditions Rumination syndrome Hyperthyroidism Pregnancy Enzymatic Action in the Progression of NCCLs Effect of endogenous acids and gastric enzymeson exposed dentin Prevention and Management of Biocorrosion Conclusion References Section III: Diagnosis and Treatment Chapter 6: Morphologic Characteristics of NCCLs Macromorphology Form/geometry Dimension (depth) Location Anatomical Clinical Micromorphology Composition Texture Relationship Between Etiologic Factors and Morphology Conclusion References Chapter 7: Clinical Analysis and Diagnosis of CDH and NCCLs Patient History and Complaint Clinical Examination and Diagnosis Clinical examination Extraoral examination Intraoral examination Periodontal examination Occlusal examination Other examinations Lesion analysis Morphology Location Diagnostic protocols for CDH Air indexing T-Scan occlusal analysis Case Report Reported history Clinical examination Diagnosis Conclusion References Chapter 8: Nonrestorative Protocols: Occlusal, Chemical, and Laser Therapies Occlusal Therapy Occlusal imbalance Muscular adaptation Indications for occlusal therapy Recording media for occlusal therapy Occlusal indicating papers Occlusal wax indicators Articulating foils Use of articulators T-Scan digital analysis Choices for occlusal therapy Additive therapy Subtractive therapy Selective occlusal adjustment 1. Occlusal adjustment in centric occlusion 2. Occlusal adjustment for lateral excursion prematurities 3. Occlusal adjustment in protrusion Conclusion Chemical Therapy Neural agents: Potassium At-home potassium Tubule-occluding agents Oxalates Strontium At-home strontium. Glutaraldehyde Varnishes Fluorides At-home fluoride. Sealants Selected calcium compounds Casein phosphopeptide–amorphous calcium phosphate (CPP–ACP). Bioglass. Arginine. Mixed agents Potassium oxalate At-home potassium oxalate. Potassium nitrate and NaF Conclusion Laser Therapy Literature review Low-power lasers High-power lasers Combined Protocol Considerations for Tooth Whitening Conclusion Acknowledgments References Chapter 9: Restorative Protocols: Adhesive Bonding, Materials, and Techniques Composition of Adhesive Systems Monomers Solvents Initiators Other components Evidence-Based Adhesive Bonding Protocols 1. Isolate the field 2. Do not perform cavity preparation 3. Select the appropriate adhesive system Etch-and-rinse adhesives Self-etch adhesives Universal adhesives 4. Adhesive application Use of a nonsimplified adhesive or a hydrophobicresin coating Multiple coats Extending application time prior to polymerization Vigorous adhesive application 5. Air drying the adhesive 6. Light curing Composition of Composite Resins Monomers Fillers Silane Other agents Classification Composites for NCCLs Hybrid composite resins Flowable composite resins Packable composite resins Bulk-fill composite resins Glass-Ionomer Cements Composition of Ceramics Glass-Ceramics Ceramic reinforced by leucite Ceramic reinforced by lithium disilicate Ceramic Fragments in NCCLs Light-Curing Units Direct Technique withComposite ResinRestorations Step-By-Step Direct Technique Case 1 Case 2 Newton Fahl’s Direct-Indirect Class V Technique with Composite Resins The Direct-Indirect Technique The Direct-Indirect Class VRestoration Access to difficult-to-reach areas Field control Composite handling Stress caused by polymerization shrinkage on the tooth Gingival margin finishing Restoration marginal adaptation Periodontal health Patient comfort Step-By-Step Direct-Indirect Technique Step 1: Composite selection Physical properties Shade and optical properties Step 2: Cavity preparation Step 3: Composite application Step 4: Light activation and restoration removal Step 5: Extraoral finishing and polishing Step 6: Precementation surface treatment of restoration Step 7: Precementation surface treatment of NCCL Step 8: Cementation of the Class V inlay Other Considerations for the Direct-Indirect Technique Indirect Technique Step-By-Step Indirect Technique Conclusion References Chapter 10: Surgical Protocols: Periodontal Therapy and Root Coverage Recession Defects and Root Coverage Treatment Approaches Single shallow defect: Modified envelope with SCTG Single moderate defect: Modified CAF orL-shaped CAF Single deep defect: Traditional CAF or laterally positioned flap Multiple defects: Envelope flaps with paramarginal incisions Root decontamination Case Reports of Root Coverage Associated with NCCLs or CDH Restored NCCLs CDH Conclusion References Appendix References References 2 Index