Treating Noncarious Class V Lesions With Composite Bonding
A proactive approach to improve esthetics and protect tooth structure from future damage
Marc Geissberger, DDS, MA
Long-term exposure to abrasion from toothbrushing, acidic foods and drinks, and occlusal forces can contribute to the development of noncarious Class V lesions. In addition, when compared with patients with a thick gingival biotype, those with a thin gingival biotype are much more susceptible to developing noncarious Class V lesions.1 With patients retaining their teeth much longer today than they did in the past, these cervical lesions have become more common among the older adult population; therefore, the maintenance and protection of teeth and tooth structure is more important now than ever before.
There are several approaches that clinicians can take in response to the presentation of noncarious Class V lesions. Although many decide to merely monitor the areas affected, a more proactive approach may provide the opportunity to improve the function, longevity, and esthetics of the patient's teeth. Treatment options to be considered include prescribing desensitizing toothpaste, sealing any exposed dentin, performing soft-tissue grafting procedures, and restoring the lesion with composite resin. This article presents a case in which the patient accepted a treatment plan involving composite resin bonding.
A 43-year-old female patient presented to the practice with the chief complaint that she experienced excessive temperature sensitivity when eating cold food items, which resulted in pain associated with her maxillary left cuspid and first bicuspid. Clinical thermal testing confirmed her complaint, and noncarious Class V lesions were observed on the affected teeth. Upon further examination of the lesions, a loss of tooth structure was noted apical to the cementoenamel junction (CEJ) of both teeth. The cause of the lesions was likely the co-contribution of abrasion from overly aggressive brushing, chemical erosion from acidic foods and drinks, and occlusal wear from grinding. Several treatment options were discussed with the patient, including using desensitizing toothpaste, applying products designed to seal the exposed dentin, grafting, and placing composite resin. Ultimately, the patient elected to undergo a composite resin bonding protocol to protect the CEJ from future damage. After the teeth were prepared, an adhesive was applied using a selective-etch technique, two layers of a flowable composite restorative material were placed on each of the damaged tooth surfaces, and contouring and polishing were performed on the restorations to establish natural shapes and esthetics. The final results demonstrated excellent margins for which it was virtually impossible to see were the restorations ended and the teeth began.
About the Author
Marc Geissberger, DDS, MA
1. Cortellini P, Bissada N. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018;89(Suppl l):S204-S213.
2. Peumans M, De Munck J, Van Landuyt KL, et al. Eight-year clinical evaluation of a 2-step self-etch adhesive with and without selective enamel etching. Dent Mater. 2010;26(12)1176-1184.