Overview
Noncarious Cervical Lesions (NCCLs) represent a common clinical challenge characterized by wear and structural changes on the tooth surface, particularly on the buccal aspects of premolars and canines. These lesions, often wedge-shaped or saucer-shaped, are multifactorial in origin, influenced by factors such as occlusal forces, abrasive toothbrushing, and dietary acids. Understanding the complex pathophysiology, epidemiology, and clinical presentation of NCCLs is crucial for effective management and prevention. This guideline aims to provide clinicians with a comprehensive framework for diagnosing, treating, and monitoring these lesions, emphasizing evidence-based practices and clinical reasoning derived from recent studies.
Pathophysiology
NCCLs exhibit a variety of morphological characteristics, including wear facets, occluded tubules, cracks, scratch marks, dimples, craters, structural loss, and dentin sclerosis, predominantly observed on the buccal surfaces of teeth [PMID:39059028]. The etiology of these lesions is multifaceted, with personal habits such as excessive horizontal toothbrushing and frequent consumption of acidic foods and beverages playing significant roles [PMID:35920595]. While occlusal factors have been proposed, their contribution remains controversial [PMID:35920595]. Advanced imaging techniques, such as scanning electron microscopy (SEM), have revealed 13 distinct ultrastructural features, underscoring the complexity of NCCL formation [PMID:20604754]. Notably, histopathological studies have failed to substantiate the theory of abfraction, instead highlighting acid wear, abrasion, and sclerotic dentin as primary contributors [PMID:19709108]. Additionally, research has shown no significant correlation between NCCL symmetry and occlusal wear patterns, challenging some traditional theories about their etiology [PMID:16919100]. These findings emphasize the need for a holistic approach in understanding and addressing NCCLs, considering both extrinsic factors and intrinsic tooth properties.
Epidemiology
The prevalence of NCCLs varies widely, ranging from 3.5% to 77.78%, with a notable predilection for premolars [PMID:39059028]. Studies indicate that the incidence can exceed 90% in certain populations, particularly among older individuals, where the lesions are frequently observed on the facial surfaces of maxillary premolars [PMID:35920595]. A comprehensive study involving 1108 Japanese adults aged 15 to 89 years reported an overall prevalence of 60.2%, with a marked increase observed across different age groups [PMID:34031732]. Gender disparities are also evident, with males exhibiting a significantly higher incidence (73%) compared to females (23%), and the mean age of patients with NCCLs being 50.3 years, indicating a higher prevalence in middle-aged individuals [PMID:19409158]. A weak positive correlation between age and NCCL presence (r=0.22, p=0.028) suggests that older patients may face a slightly elevated risk [PMID:19409158]. These epidemiological insights highlight the importance of age and gender in assessing risk and guiding preventive strategies.
Clinical Presentation
NCCLs typically manifest as wedge-shaped or saucer-shaped lesions, indicative of occlusal stress and multifactorial etiologies [PMID:39059028]. These lesions often affect the first premolars and canines, with asymmetric lesions being common, particularly in canines (69.0%) compared to premolars (44.5%) [PMID:16919100]. The clinical significance of NCCLs extends beyond aesthetics; they can lead to sensitivity, functional discomfort, and potential food impaction [PMID:35584331]. A classification system proposed by researchers categorizes NCCLs based on depth, width, and the angle between lesion walls, offering a structured approach to diagnosis and management [PMID:24784513]. This system aims to guide therapeutic decisions by quantifying lesion characteristics, thereby facilitating more targeted interventions. Additionally, studies have shown that while many patients with NCCLs do not experience sensitivity (74.7%), the presence of these lesions can still impact oral function and aesthetics, necessitating careful clinical assessment [PMID:19409158].
Diagnosis
Diagnosing NCCLs involves a combination of clinical observation and advanced imaging techniques to accurately assess wear facets, cracks, and structural changes [PMID:39059028]. Observational methods, including visual and tactile examinations, are foundational but may be complemented by scanning electron microscopy (SEM) for detailed morphological analysis [PMID:20604754]. SEM has proven particularly useful in distinguishing NCCLs from carious lesions by revealing specific ultrastructural features [PMID:20604754]. Histopathological assessments have further elucidated the role of sclerotic dentin in NCCLs, noting variations in dentinal tubule numbers and diameters due to intratubular dentin deposits, which are crucial for accurate diagnosis [PMID:19709108]. While laboratory bond strength data often fail to predict clinical success reliably [PMID:22192252], systematic approaches that quantify lesion dimensions and orientation can enhance diagnostic precision and monitoring of lesion progression [PMID:24784513]. These diagnostic tools and methods collectively support a comprehensive evaluation necessary for effective management.
Differential Diagnosis
Differentiating NCCLs from other dental conditions is essential for appropriate treatment planning. Unlike carious lesions, NCCLs lack signs of microbial infection and do not exhibit typical radiographic changes indicative of caries [PMID:19709108]. Studies have found no significant associations between NCCLs and factors such as brushing technique, frequency, or occlusal characteristics like wear facets, Angles classification, or canine guidance [PMID:19409158]. This suggests that while occlusal forces and brushing habits contribute to NCCL formation, they do not definitively distinguish these lesions from other non-carious conditions. Clinicians must rely on detailed clinical examination, including SEM and microscopic analysis, to rule out other potential causes such as abrasion from foreign objects or mechanical trauma, ensuring accurate diagnosis and tailored management strategies.
Management
The management of NCCLs emphasizes conservative approaches, focusing on preventive measures until restorative intervention becomes necessary due to symptoms like sensitivity, aesthetic concerns, or functional issues [PMID:35920595]. When restoration is required, composite resins remain the gold standard, with recommended techniques including texturing sclerotic dentin with fine instruments, beveling enamel for enhanced bonding, and employing acid etching for 30 seconds [PMID:35920595]. Recent advancements in adhesive technology, such as CUBQ (a fluoride-releasing universal adhesive), offer advantages like immediate light curing and reduced moisture interference, potentially improving adhesion and durability in cervical regions [PMID:37387551]. In vitro studies indicate that CUBQ demonstrates superior dentin bond stability over time when used in self-etch modes compared to etch-and-rinse methods [PMID:37387551]. Adjunctive procedures such as ethanol wet-bonding, extended adhesive application times, and the use of warm air to accelerate solvent evaporation can further enhance adhesion [PMID:22192252]. Clinical trials have shown that both resin composite (RC) and resin-modified glass ionomer cement (RMGIC) restorations effectively reduce microstrain, maintaining these benefits over six-month follow-ups [PMID:41759931]. Additionally, studies comparing different composite materials (e.g., Filtek Bulk Fill Posterior vs. Filtek Z350 XT) indicate no significant differences in clinical performance based on occlusogingival distance (OGD), suggesting flexibility in material selection [PMID:36763143]. Despite these advancements, the prognosis of restorations can vary, with some studies noting marginal discoloration and surface texture changes over time, though overall clinical outcomes remain favorable [PMID:36763143].
Prognosis & Follow-up
Predicting the long-term success of restorations for NCCLs remains challenging due to the variability in clinical outcomes compared to laboratory bond strength data [PMID:22192252]. However, clinical trials have demonstrated sustained benefits in reducing microstrain immediately post-restoration and at follow-up intervals, suggesting positive long-term prognoses [PMID:41759931]. A 30-month follow-up study indicated that while marginal discoloration and surface texture may deteriorate over time, there were no significant differences in clinical outcomes between different occlusogingival distances (OGD) [PMID:36763143]. Notably, restorations placed in the mandible and premolars showed slightly lower survival rates, highlighting the need for careful consideration of tooth location in prognosis [PMID:35584331]. Long-term follow-up is crucial, as evidenced by studies showing gradual changes in anatomic form, particularly more pronounced with compomer restorations compared to composites over extended periods [PMID:18435377]. Regular clinical assessments and patient feedback are essential to monitor these changes and ensure continued satisfaction and functionality.
Special Populations
In special populations, such as the elderly (60-69 years), the presence of erosive etiological factors significantly influences NCCL prevalence, indicating a specific risk profile for this demographic [PMID:34031732]. Additionally, a notable relationship exists between NCCL symmetry and root curvature in canines (48.1% with root curvature), though no such correlation was found in premolars (43.4% with root curvature) [PMID:16919100]. These findings underscore the importance of considering age-related and anatomical factors in managing NCCLs among older adults and those with specific dental anatomies. Tailored preventive strategies and more frequent monitoring may be warranted for these groups to mitigate the impact of NCCLs on oral health and function.
Key Recommendations
These recommendations aim to guide clinicians in effectively managing NCCLs, balancing preventive care with timely and appropriate restorative interventions.
References
1 Peumans M, Vandormael S, De Coster I, De Munck J, Van Meerbeek B. Three-year Clinical Performance of a Universal Adhesive in Non-Carious Cervical Lesions. The journal of adhesive dentistry 2023. link 2 Carvalho RM, Manso AP, Geraldeli S, Tay FR, Pashley DH. Durability of bonds and clinical success of adhesive restorations. Dental materials : official publication of the Academy of Dental Materials 2012. link 3 Yadav S, Rajasekaran P, Krishnamoorty S, Kishen A. Microstrain in Maxillary Premolars With Noncarious Cervical Lesions Before and After Restoration: A Randomized Clinical Trial. Operative dentistry 2026. link 4 Villamayor KGG, Codas-Duarte D, Ramirez I, Souza-Gabriel AE, Sousa-Neto MD, Candemil AP. Morphological characteristics of non-carious cervical lesions. A systematic review. Archives of oral biology 2024. link 5 Correia AMO, Jurema ALB, Bresciani E, Caneppele TMF. Effects of lesion size on the 30-month clinical performance of restorations with bulk fill and a regular nanofilled resin composite in noncarious cervical lesions. Clinical oral investigations 2023. link 6 Goodacre CJ, Eugene Roberts W, Munoz CA. Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration. Journal of prosthodontics : official journal of the American College of Prosthodontists 2023. link 7 Favetti M, Schroeder T, Montagner AF, Moraes RR, Pereira-Cenci T, Cenci MS. NaOCl Application after Acid Etching and Retention of Cervical Restorations: A 3-Year Randomized Clinical Trial. Operative dentistry 2022. link 8 Kitasako Y, Ikeda M, Takagaki T, Burrow MF, Tagami J. The prevalence of non-carious cervical lesions (NCCLs) with or without erosive etiological factors among adults of different ages in Tokyo. Clinical oral investigations 2021. link 9 Correia AMO, Tribst JPM, Matos FS, Platt JA, Caneppele TMF, Borges ALS. Polymerization shrinkage stresses in different restorative techniques for non-carious cervical lesions. Journal of dentistry 2018. link 10 Loomba K, Bains R, Bains VK, Loomba A. Proposal for clinical classification of multifactorial noncarious cervical lesions. General dentistry 2014. link 11 Santos MJ, Ari N, Steele S, Costella J, Banting D. Retention of tooth-colored restorations in non-carious cervical lesions--a systematic review. Clinical oral investigations 2014. link 12 Michael JA, Kaidonis JA, Townsend GC. Non-carious cervical lesions: a scanning electron microscopic study. Australian dental journal 2010. link 13 Daley TJ, Harbrow DJ, Kahler B, Young WG. The cervical wedge-shaped lesion in teeth: a light and electron microscopic study. Australian dental journal 2009. link 14 Ahmed H, Durr-E-Sadaf, Rahman M. Factors associated with Non-Carious Cervical Lesions (NCCLs) in teeth. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2009. link 15 Pollington S, van Noort R. A clinical evaluation of a resin composite and a compomer in non-carious Class V lesions. A 3-year follow-up. American journal of dentistry 2008. link 16 Maseki T, Tanaka H. Symmetry of non-carious cervical lesions in canines and premolars. Gerodontology 2006. link 17 Terry DA, McGuire MK, McLaren E, Fulton R, Swift EJ. Perioesthetic approach to the diagnosis and treatment of carious and noncarious cervical lesions: Part II. Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.] 2003. link
17 papers cited of 19 indexed.