management

of
non-carious lesionS
 • Introduction.
• Classification of non-carious lesions.
• Management of -Attrition.
CONTENTS

-Abrasion.
-Erosion.
-Abfraction.
• Management of developmental lesions-
- Amelogenesis imperfect
- Dentinogenesis imperfect
-Localized non- hereditary enamel hypoplasia.
 -Localized non- hereditary enamel hypocalcification.
-Localized non- hereditary dentin hypoplasia.
CONTENTS

-Localized non- hereditary dentin hypocalcification.

• Conclusion.
• References.
 INTRODUCTION

• The primary cause of tooth substance loss is dental caries but

according to marzouk 25% of tooth destruction doesn't originate
from a carious process.

•Zsigmondy in 1894 described cervical tooth substance loss as

wedge shaped defects

•Smith and Knight in 1984, proposed the term tooth wear for
non-carious lesions.
Over the years non-carious lesions have been termed differently
as-
Wasting disease of teeth.

regressive alterations of the teeth.

wedge shaped defects.

cervical incisions.
•‘Tooth surface loss’ or 'tooth wear' refers to the pathological loss of
tooth tissue by a disease process other than dental caries.
(Eccles, 1982)

•Non-carious cervical lesions (cervical wear) are defined as the loss of

tooth substance at the cemento-enamel junction.
(Mair, 1992)
 PREVALENCE OF NON-
CARIOUS CERVICAL
LESIONS
The reported prevalence regardless of form and
etiology is shown to vary from 5-85%.

BUCCAL surface is affected more than lingual

surface-

CANINE &PREMOLARS are affected mostly

because of their prominence in the arch.
Prevalence and severity are known to increase with AGE
(appearance and progression of gingival recession increases
with age)

MALES> females( dietary habits, force applied)

MAXILLA> mandible.
 HUME –tooth disease classification.JOCDH 1997:22(4):224-247

non-carious tooth lesions

• Attrition
DEVELOPMENTAL ACQUIRED • Abrasion
• Abfraction
TOOTH • Erosion
WEAR
NON-HERIDITARY
HERIDITARY Extrinsic
Localized non-hereditary DISCOLORATION
Amelogenesis Enamel hypoplasia Intrinsic
imperfecta Localized non-hereditary
External
Dentinogenesis enamel hypocalcification
RESORPTIONS
imperfecta Localized non-hereditary Internal
dentin hypoplasia
Malformations
Localized non-hereditary
TRAUMA
dentin hypocalcification
 morphological non-carious lesion classification

SHALLOW CONCAVE WEDGE NOTCHED IRREGULAR

SHAPED

• Flat shallow • Angular irregular

• Curved shallow • Curved irregular
• Angular and curved
irregular

JA Michael et al. Australian Dental journal 2010:55:138-142

 ATTRITION

Derived from latin verb attritum which describes the action of

rubbing against something.

Attrition is defined as the mechanical wear of incisal and

occlusal surfaces as a result of functional or parafunctional
movements of mandible (Tooth-to tooth contact).
 Definition:

It is defined as physiological wearing away of tooth as a result of tooth to tooth

contact as in mastication. -Shafer

It may be defined as surface tooth structure loss resulting from direct frictional
forces between contacting teeth.
-Marzouk
ETIOLOGY:

• Parafunctional habits (bruxism,

clenching).
• Pre-mature contacts
• Hard and abrasive diet.
• Certain occupations
A) Proximal surface attrition (proximal surface facets)

 Results from surface tooth structure loss and flattening ,widening of the
proximal contact areas.

 Mesiodistal dimension of the teeth is decreased, leading to drifting, with

the possibility of overall reduction in the dental arch.

 Surface area proximally increases in dimension, which is susceptible to

decay.
B) Occluding surface attrition (OCCLUSAL WEAR)

It is the loss, flattening, faceting or reverse cusping of the occluding

elements.
It leads to loss of vertical dimension of the tooth .
a) If the LOSS IS SEVERE & accomplished in a relatively short time

 there would be no chance for the alveolar bone to erupt occlusally

 compensate for the occlusal tooth loss, & therefore the vertical loss
might be imparted to the face

 overclosure during mandibular functional movements & strain areas on

stomato-gnathic system.

15
CLINICAL FEATURES:

• can occur in both deciduous & permanent

dentition.
• large, flat, smooth and shiny wear facets with
tooth sensitivity.
• can cause loss of vertical dimension and
shortening of arch length.
• caries can superimpose at the attritional area.
• In severe cases:
“a reverse cusp” situation might be created in place
of the cusp tips and inclined planes.
• Excessive occlusal wear can result in –
i. pulpal pathology.
ii. impaired function.
iii. occlusal disharmony.
iv. esthetic disfigurement.
v. Cheek or tongue biting
vi. Tooth sensitivity.
vii. Deficient masticatory capabilities.
 MANAGEMENT OF ATTRITION
•In developing a treatment plan the dentist should consider
the following factors:

Whether the wear is localised or generalised.

Factors affecting the patient’s speech, function and
orofacial aesthetics.
The behavioural, psychological, anatomical, developmental
and physiological limitations of the patient.
Observation and palliative strategies.
Sequence of treatment:
1. Pulpally involved teeth: undergo endodontic therapy or extraction
(based on restorability).
2. Parafunctional activities should be controlled with the proper
disocluding-protecting occlusal splints.
3. Occlusal equilibration should be performed after all notable
symptoms are relieved.
- selective grinding of tooth surfaces.
- rounding and smoothing the peripheries of the occlusal tables

Operative dentistry-modern theory and practice; M.A.Marzouk.

4. Exposed sensitive dentinal areas should be protected using
fluoride.
5. Carious lesions should be obliterated by a proper temporary
restoration.
6. Lost tooth structure due to attrition is at high stress conc. areas
so metallic restorations should be preferred.
Restoration therapy is needed in cases where there is loss of
vertical dimension, decay or cavitation lesion or endodontically
treated teeth.
Operative dentistry-modern theory and practice; M.A.Marzouk.
Treatment modalities

• Depends on degree of attrition-

Mild Attrition
• Instructions for oral hygiene.
• Fluoride application.
• Use of temporary restorations.

Moderate Attrition
Severe Attrition

• Restoration of vertical dimension to

improve function and esthetics.
or
 extraction of affected teeth.
 replacement with conventional dentures,
overdentures and overlay prosthesis, etc.
Treatment depends upon the following categories:
Category I: (Appearance is satisfactory)
A. Counselling- in patients with parafunctional habits.
Habit breaking appliance should be given in patients with bruxism or
clenching.
B. Conventional Restorative Treatment
• Exposed pits are filled .

• Occlusal disharmony is corrected.

• crown lengthening procedure.

Category II: (Appearance is unsatisfactory but there is no need to raise
the vertical height).

• Teeth are restored with all ceramic crowns or laminates.

• Occlusal guard for protecting against nocturnal clenching like bleaching

trays, etc.
Category III: (Appearance is unsatisfactory and there is a need to
raise the vertical height)

• Generalized increase in vertical height is required.

• Orthodontic tooth movement can be used for over-eruption of
posterior teeth creating space for the anterior teeth.
• Space has to be utilized in retruded cusp position (RCP) and
intercuspal position (ICP).
Modes of increasing the vertical dimension:
• Crowning or composite build up incrementally till patient can
accommodate the increase physiologically.

• Orthodontic extrusion / use of Dahl appliance

-attached to the palatal surface of anteriors.
-creates a space in posteriors so the posterior teeth
erupt occlusally to fill the space and come to
occlusion thus creating a space in the anteriors.
• Canine raising: material is added on the canine only to
disocclude it thus creating space.
QUESTION AND ANSWERS
Q) Which occupations can cause attrition?
• Tailors
• Cobblers
• Carpenters
• Musicians playing wind instruments
• Labourers and weight lifters.
Topical fluoride application and fluoride
content?
• Topical fluoride application can be done by :
• 2% Sodium Fluoride (9200 ppm)
• 8% Stannous fluoride (19500 ppm)
• 1.23% APF (12300ppm)
Q) Fluoride varnish?
• Developed by Schimdt in 1964
• Fluoride is incorporated in varnish like coating material to increase the
contact time between enamel surface and topical fluoride agents
• eg: Durphat – 22600 ppm
• Fluorprotector 7000 ppm
 Q) Which cast metal restorations are used and
how to do you get retention?
• Cast restorations provide a durable, non-abrasive occluding surface.
• In view of its strength and minimal space requirements, cast metal is
an effective material. Appropriate metals include gold (which may be
heat treated, oxidized or tin plated to aid bonding) and non-precious
alloys such as nickel chromium.
• The castings are commonly retained by a dual-affinity resin such as a
4-META adhesive.
• extended onto the incisal edges to ease location and increase the
surface area available for bonding.
Watson ML, Trevor Burke FJ. Investigation and treatment of patients with teeth affected by tooth
substance loss: a review. Dental update. 2000 May 2;27(4):175-83.
Q)What is biocorrosion?
• Biocorrosion is the chemical, biochemical and electrochemical
degradation of tooth substance caused by endogenous/ exogenous
acid, proteolytic agents as well as the piezoelectric effect.
• It is regarded as one of the three major mechanism for the
development of non carious cervical lesions apart from stress and
friction.
• It is the interplay of these mechanisms along with the modifying
factors such as saliva, tongue action and tooth form etc. that cause non
carious lesions.
 ABRASION

•Derived from latin word abrasum (to scrape off)

•Abnormal tooth surface loss resulting from direct frictional forces between
the teeth and external objects or from frictional forces between contacting
teeth components in the presence of abrasive medium. (Sturdevant 5th
edition)
 ETIOLOGY:
I. Improper brushing habit: Factors influencing the role of tooth brushing in
abrasion are:
i. Brushing technique.
ii. Brushing force.
iii. Bristle stiffness.
iv. Time.
v. Frequency.
II. Oral hygiene products: toothbrush and dentrifices.
III. Habits: such as holding a pipe stem between teeth, vigorous use of tooth
picks .
IV. Iatrogenic: such as denture with porcelain teeth opposing natural teeth, Ill-
fitting clasps.
V. Tobacco chewing: can create a generalized occluding surface abrasion.
VI. Pica-syndrome- due to habit of chewing clay has a specific occlusal
abrasion pattern & other systemic disease.
 CLINICAL FEATURES:

• Sharply defined margins and hard smooth surfaces

with burnished appearance.
• Occasionally, the surface may exhibit scratches.
• The surrounding walls tend to make a V shape ,by meeting at an acute
angle axially.
• Hypersensitivity may be present which can be intermittent in nature.
• Usually generalized.
• Most commonly seen on facial surfaces of maxillary teeth.
• Canines and premolars exhibit highest frequency.
 Management of abrasion

1. Diagnose the cause of presented abrasion: There is no use in treating

and restoring the teeth if the cause of abrasion is still in action.
2. Treat the cause: break the habit.
3. If the habit cannot be broken , the restorative treatment can by-pass the
effect of habit.
The objective of the restoration should be to prevent further
destruction of tooth.
Abrasions at non-occluding surfaces:
a) If lesions are multiple, shallow and wide (shallow - not greater than 0.5mm)
Restoration not necessary.

b) If lesions are in enamel or cementum only Restoration not necessary.

4. If involved tooth very sensitive, desensitize first and then restore.

Desensitization by F-solution (NaF/SnF 8-30% for 4-8 min) or iontophoresis.
Restorative treatment
Abrasion

Anterior tooth (or) Inconspicuous area

Facially conspicuous in posterior tooth
area of posterior tooth

Metallic
restoration

but if cavity preparation

Adhesive tooth
of metallic restoration
colored
would compromise the
materials
pulp dentin organ vitality
 VARIOUS RESTORATIVE MATERIALS
• GIC- presents several characteristics to make them a good choice-
i. biocompatibility.
ii. adhesion to calcified substrates.
iii. elastic modulus similar to dentin.
iv. GIC, RMGIC, a GIC/RMGIC liner base laminated with a resin
composite in combination are all restorative options
• COMPOSITE RESINS-
--lesion should be restored with microfilled resin composite or flowable
resin that has low modulus of elasticity as it will flex with the tooth & not
compromise retention.
 EROSION

• Derived from latin verb erosum (to corrode).

• Defined as loss of tooth structure resulting from chemico mechanical acts
in the absence of specific microorganisms. (Marzouk)

• In erosion, progressive and irreversible loss of hard dental tissues is seen

due to a chemical process i.e., dissolution from acids not involving
bacteria.
 ETIOLOGY: EROSION

INTRINSIC EROSION EXTRINSIC EROSION IDIOPATHIC EROSION

I. RECURRENT VOMITING I. OCCUPATIONAL Result of contact with

A. EATING DISORDERS- FACTORS: Professional acids of unknown
• anorexia nervosa wine tasters & swimmers. origin.
• bulimia nervosa
B. MEDICAL CONDITIONS II. DIET: Citrus fruit juices,
• GI disorders-peptic ulcer, hernia, intestinal acidic beverages &
obstructions. carbonated beverages.
• Metabolic & endocrine disorders.
II. REGURGITATION III. MEDICAMENTS: Aspirin
• GERD (gastroesophageal reflux disease) & ascorbic acid (vitamin C).
III. RUMINATION
syndrome consisting of repetitive, effortless IV. LIFESTYLE
regurgitation of undigested food in minutes after
meal.
 CLINICAL FEATURES
• Extensive loss of buccal and occlusal tooth structure.

• Raised amalgam restorations .

• Occlusal surfaces exhibit concave dentin depressions surrounded by elevated

rims of enamel
• Caries is an uncommon occurrence because eroded teeth do not tend to retain
plaque.
• lesion surface is glazed.
• Tooth sensitivity to physical, chemical and mechanical stimuli is always evident
& the main complaint of the patient.
Management of Erosion
 Complete analysis of diet, occlusion,
habits, environmental factors.
Treatment of
etiology  Every attempt to correlate to a cause.

 Try to eliminate the probable cause.

Preventive
measures  Patient education, Counselling,
Physician consultation.

 Use of sugarless chewing gum.

Restorative
treatment  Pilocarpine.

 Do not rush to restoration.

 Desensitisation by using fluoride rinses, gels, and varnishes as
well as high-fluoride toothpastes and remineralizing toothpastes.

 Tooth coloured filling material.

 FULL COVERAGE RESTORATIONS.

 Endodontic intervention, if required.

 FULL MOUTH REHABILITATION

 ABFRACTION

• Abfraction is the microstructural loss of tooth

substance in areas of stress concentration.
(JADA 2004)

• Derived from the Latin words “ab”, or “away” and “fractio” or

‘breaking’ by Grippo in 1994.

• Acc to sturdevant, strong eccentric occlusal force result in

microfractures at the cervical area of the tooth causing wedge-shaped
defects is termed as abfraction.
 ETIOLOGY
• due to tooth flexure in patients with abnormal occlusal interactions.
• The theory of abfraction sustains that tooth flexure in the cervical area is
caused due to occlusal compressive forces and tensile stresses, resulting in
micro fractures of the hydroxyapatite crystals of the enamel and dentin with
further fatigue and deformation of the tooth structure.
MECHANISM OF ABFRACTION
Tooth flexure during abnormal occlusal interaction

Lateral or axial bending of the tooth

Tensile and compressive stresses generated in the cervical region

Strain leading to microfractures in cervical enamel and tooth loss

Notch shaped abfraction lesions

 CLINICAL FEATURES

• Wedge shaped lesion with sharp line angles. local factors may
modify the lesion.
• Size of lesion is determined by the magnitude & frequency of
applied tensile force.
• Mostly seen on buccal surfaces of mandibular teeth.
Management of Abfraction

Treat the cause before restoring

Occlusal loading on the tooth can be tested in

centric occlusion and in excursive
movements with occlusal marking paper.

Restorative treatment
1. Monitoring abfraction lesions
When Abfraction lesions are not causing clinical consequences and or they are
only shallow in depth (less than 1 mm)
simply monitor them at regular intervals (e.g., six-monthly).

2. Restoration of abfraction lesions

• should be restored when clinical consequences (e.g. dentin hypersensitivity)
have developed or are likely to develop in the near future.
•Glass ionomer cements (GICs), resin-modified GICs (RMGICs),a GIC⁄
RMGIC liner⁄ base laminated with a resin composite, and resin composite in
combination with a dentin bonding agent are all restorative options.
3. Occlusal adjustment : occlusal adjustment has been advocated to
prevent their initiation and progression and to minimize failure of cervical
restorations.

4. Occlusal splints : aimed at reducing the amount of nocturnal bruxism

and non-axial tooth forces, have been recommended to prevent the initiation
and progression of abfraction lesions.
DEVELOPMENTAL
DISTURBANCES
 AMELOGENESIS IMPERFECTA

• Characterized by abnormal enamel formation.

Etiology-
Due to malfunction of protein amelogenin which is principle protein
in developing enamel.

• Classified into 3 main types-

Hypoplastic.
Hypomaturation.
Hypocalcified.
 • Defect in formative stage.
1.Hypoplastic • Enamel not formed to full
thickness on newly erupted
teeth.
• Enamel is very thin but hard &
translucent.
 • Defect in calcification.
• Normal thickness but extremly
2.Hypocalcification brittle.
• Enamel is so soft it can be
removed by an instrument.
 • Defect in maturation.
• Enamel is less hard & are
3.Hypomaturation prone to rapid wear.
• Enamel can be pierced by an
explorer under firm pressure.
 Management of Amelogenesis imperfecta

Treatment of Hypoplastic Amelogenesis Imperfecta:-

•Composite resin or porcelain veneers can be bonded to the

anterior teeth when the incisor shape, size and/or color require
modification.

•Orthodontic therapy may be used to partially close the interdental

spaces prior to restoration.

•However, if the enamel is extremely thin and malformed the teeth

can require full coverage with crowns.
Treatment of Hypomaturation & Hypocalcified types:
•Enamel is not severely involved-Conventional Bonded restorations.

•Enamel is severely hypomineralized and of insufficient strength to retain bonded or

intracoronal restorations - full coverage restorations.

•In cases of severely hypomineralized enamel - stainless steel crowns are indicated
in the primary and early permanent dentitions.

•Resin crowns can be placed on permanent incisors soon after they begin to erupt
during the mixed dentition (about age 7 - 10 years).
DENTINOGENESIS IMPERFECTA
• Autosomal dominant disorder with variable expressivity
• Primary teeth are normally more severely affected than permanent teeth .

Classification : (Witkop)
• Type I : Dentinogenesis imperfecta, which occurs in patients
afflicted with Osteogenesis Imperfecta.

• Type II : Dentinogenesis Imperfecta, which is not associated with

Osteogenesis Imperfecta.

• Type III : Dentinogenesis Imperfecta Type III or the “Brandywine

type” is a rare condition and is inherited as an autosomal dominant trait.
61
• Dentitions have blue to brown
discoloration, with a distinctive
translucence.

• The enamel can be easily separated from

the underlying dentin often demonstrates
significantly accelerated attrition.

• The pulp is usually obliterated by the

excess dentin production, some of the teeth
may show the normal sized pulp (shell
tooth).
 Management of Dentinogenesis Imperfecta
In the primary dentition-

• STAINLESS STEEL CROWNS on the molars, to prevent tooth wear and to

maintain the occlusal vertical dimension.

• Esthetics may be improved using composite facing or composite strip crowns.

Permanent dentition-

•Cast occlusal onlays on the first permanent molars .

•Until growth is complete, the treatment of choice for the

replacement of missing teeth is dentures.

•Dental implants may be considered when growth is

complete at about 18 years of age.
 LOCALIZED NON- HEREDITARY ENAMEL
HYPOPLASIA

Ameloblasts forming the enamel are injured.

i t s to
t e d p ar
l a i n e
Iso read l
s p
e
wi defects
d Enamel matrix will not be formed.

Formation of Hypoplastic or hypo mineralized enamel.

 Management of Localized non- hereditary enamel hypoplasia

• Defects are narrow lines or isolated pits or narrow depression – selective

odontomy/ esthetic reshaping is performed.

• If selective odontomy/ esthetic reshaping does not produce results- direct

tooth colored resinous material is inserted.

• Defect at occluding or contacting area- resort to metallic or cast

restorations.
• If lesions -discolored & veneering procedures are not planned- vital bleaching
can be attempted after odontomy.

• Disfiguring lesion, not in occlusion- laminated tooth- colored resinous or

ceramic veneer are treatment choice.
 LOCALIZED NON- HEREDITARY
ENAMEL HYPOCALCIFICATION

• Hypomineralized enamel results when normal amount of enamel

matrix fails to achieve full mineralization.

• Affected areas- appear chalky and soft to indentation and will be

stainable.

• Shades- chalky to yellow, to brown, dark brown and or greyish.

Management of Localized non- hereditary enamel hypocalcification
Management can be done using-
• Fluoride application.
when the enamel
• Fluoride iontophoresis.
matrix is still
• Strict prevention of plaque accumulation. intact & the areas
• Vital bleaching. are localized,
• Laminated veneer. small &
• Composite veneering. unstained.
• Porcelain fused to metal.
• Cast ceramic restoration.
 LOCALIZED NON- HEREDITARY DENTIN
HYPOPLASIA

Disturbance in odontoblasts function causes deficient or complete

absence of dentin matrix deposition.

Cause:

It appears to be a hereditary disease, transmitted as an autosomal

dominant characteristics
CLINICAL PRESENTATION

 There would be NO apparent destruction to be diagnosed or treated ,till the

time the lesion is covered with enamel.
 During tooth preparation for a restoration , these defects may get exposed

Treatment-
Various intermediary bases can be used-
Zinc oxide eugenol, calcium hydroxide, zinc phosphate cement,
polycarboxylate cement can be used.
TRAUMATIC INJURIES
 TRAUMATIC INJURIES

ELLIS CLASS I FRACTURE:

• RECONTOURING-eliminates the sharp enamel

edges associated with minor injuries & prevents
laceration of tongue, lips & oral mucosa.

• COMPOSITE RESIN RESTORATION- missing tooth

structure can be restored.
ELLIS CLASS II FRACTURE

• INDIRECT PULP CAPING AND COMPOSITE RESIN

BUILD UP

• REATTACHMENT OF THE FRACTURED SEGMENT-

the fractured fragment can be esthetically and
concurrently attached to the tooth using composite
resins.
ELLIS CLASS III FRACTURES

• A) Teeth with immature root apices and vital pulp exposures:

• Pulp capping
• Partial pulpotomy or pulpotomy
• B) Fractured crown with mature apex:
• Vital Pulp therapy
 ELLIS CLASS IV FRACTURES

TEETH WITH INCOMPLETE/OPEN APEX:

• Apexification with calcium hydroxide, MTA, biodentine etc
• Revascularization of the pulp- the necrotic infected pulp may act as
scaffold for the ingrowth of new tissue from the periapical area.

TEETH WITH MATURE APEX:

• Pulpectomy.
• Reattachment of fragment.
 ELLIS CLASS V FRACTURES

• Extraoral time-shorter-better prognosis.

• Replant the tooth as soon as possible after avulsion
• If not possible to reinsert the tooth, place it in a suitable transport
medium.
• In case the avulsed tooth cannot be located
-Removable partial denture
-Autotransplantation.
 ELLIS CLASS VI FRACTURES

Horizontal fractures-
• Immediate reduction of the fractured segments and complete
immobilization of coronal segment.
• Splinting is not needed in cases of apical third fractures.
• Endodontic treatment- if pulp necrosis develops, root canal
treatment of the coronal tooth segment to the fracture line is
indicated to preserve the tooth.
• In case of coronal third fractures where the coronal fragment is lost
-Orthodontic extrusion of root.
-Intra alveolar reimplantation of fractured tooth can be done.
vertical fractures-
• Bonding the fragments.
• Hemisection of multirooted tooth.
• Extraction.
 ELLIS CLASS VII FRACTURES-

SUBLUXATION-
• Occlusal relief & soft diet.

• Immobilization with flexible wire &composite splint for 2 weeks.

EXTRUSIVE LUXATION-

1. Reposition the tooth by gently re-inserting it into the socket.

2. Stabilize the tooth for 2 wks using a flexible splint.
3. Orthodontic intrusion may also be carried out by fixed
appliance therapy.
4. Endodontic treatment is certain in cases of significant
extrusion.
5. Crown discolorations may be treated with non-vital
bleaching, veneer or full coverage crown.
6. In cases of incomplete root formation-apexification.
INTRUSION-

• Surgical reduction(immediate repositioning).

• Repositioning with traction (active repositioning).
• Waiting for the tooth to return to its pre-injury
position(passive repositioning).
LATERAL LUXATION-

• An inflammatory , analgesic and antibiotic prescribed.

• Repositioning after local anesthesia & applying semi-rigid splint
for 4 wks.
• Stabilize the tooth for 4 wks using flexible splints.
• If pulp becomes necrotic, root canal treatment is indicated to
prevent root resorption.
• In immature developing teeth, revascularization can be a
possibility.
 ELLIS CLASS VIII FRACTURES-

Reattachment- fractures fragment is cemented to the coronal

portion of the fiber post by using self cure resin cement.

ELLIS CLASS IX FRACTURES

complicated crown fractures-
• Teeth with immature apex preserve the vitality by pulp capping or
pulpotomy.
crown-root fractures- rct or extraction.
• Root fracture-if not mobile- Monitor
If mobility present –Extraction

• Alveolar fracture-
reposition any displaced segment and then splint.
Teeth with fracture line are monitored for loss of vitality.
 CONCLUSION

•Non-carious lesions are commonly encountered in clinical practice

and present in a variety of forms.

•Hence, as a restorative dentist, knowledge of the etiology of these

lesions is important for preventing further lesions, halting the
progression of lesions already present, and determining appropriate
treatment.
 REFERENCES
Sturdevant’s art and science of operative dentistry: 5th edition.

 Textbook of operative dentistry by vimal k sikri :second edition.

 Operative dentistry-modern theory and practice; M.A.Marzouk.

Sarode GS, Sarode SC. Abfraction: a review. Journal of oral and maxillofacial pathology: JOMFP. 2013
May;17(2):222.

Nascimento MM, Dilbone DA, Pereira PN, Duarte WR, Geraldeli S, Delgado AJ. Abfraction lesions: etiology,
diagnosis, and treatment options. Clinical, cosmetic and investigational dentistry. 2016;8:79.

Grippo JO, Simring M, Schreiner S. Attrition, abrasion, corrosion and abfraction revisited. J Am Dent Assoc
2004;135:1109-1118.

Watson ML, Trevor Burke FJ. Investigation and treatment of patients with teeth affected by tooth substance loss: a
review. Dental update. 2000 May 2;27(4):175-83.