Treatments for hypersensitive noncarious cervical lesions

Clinical benefits of immediate dentin sealing: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The clinical complications, success, and survival rates of indirect restorations delivered with the immediate dentin sealing protocol are unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to find and collect evidence on the clinical complication, success, and survival rates of indirect restorations delivered with immediate dentin sealing.

MATERIAL AND METHODS

Electronic databases were searched for clinical studies on immediate dentin sealing up to December 2023, without language or time limitations. The records were included if they were clinical trials evaluating the clinical complication and survival rates of indirect restorations bonded to tooth substrate sealed immediately after preparation with suitable resin bonding. The extracted data were analyzed via Review Manager 5.4 for meta-analysis (α=.05).

RESULTS

A total of 11 studies were included in this review. The clinical complication rate was lower for immediately sealed dentin than for protocols without dentin sealing. The survival rate of restorations luted with the immediate dentin sealing protocol was higher (96.4% to 100%) than that of immediate dentin sealing (81.8% to 96.7%), negatively correlated with the observation time. The intensity and incidence of postoperative sensitivity were statistically significantly lower for restorations with immediate dentin sealing than for those without dentin sealing or conventionally cemented (P<.05).

CONCLUSIONS

Immediate dentin-sealed indirect restorations had fewer clinical complications and higher success and survival rates than those delivered without dentin sealing. To avoid postoperative sensitivity or reduce its intensity, dentin surfaces should be sealed immediately after preparation. More long-term randomized clinical trials are recommended to confirm these evidence-based conclusions.

A qualitative analysis of dentists' understanding and management of non-carious cervical lesions (NCCL)

INTRODUCTION

Non-carious cervical lesions (NCCLs) are considered to have a multi-factorial aetiology and their management is affected by a range of variables perhaps most importantly clinical judgement. The aim of this study was to elicit information from practicing dentists, using interviews, to explore their understanding of NCCL aetiology, the decision-making criteria of when to restore, and the restorative techniques used to restore NCCLs. This may help identify gaps or anomalies in our understanding to inform future research and clinical practice for the management of NCCLs.

METHODS

An interview guide was developed from a literature search which formed 2 domains framed around understanding and management of NCCLs based on: understanding of diagnosis and aetiology, and factors affecting decision making for management. Practicing dentists with more than 10 years of experience were purposively recruited to conduct in-depth, semi-structured interviews. Fifteen interviews were audio recorded and transcribed verbatim. A thematic content analysis was conducted and the results analysed.

RESULTS

From the thematic analysis, 2 domains were identified. In the domain of "diagnosis and aetiology", while participants have similar understanding and methods of diagnosing NCCL, most stated NCCLs in a patient were caused by a "main aetiology" such as "abrasion", "abfraction" while few described the inter-relationship of these aetiological factors. In the domain of "factors affecting decision making". "Patient reported symptoms" and "lesion dimension" were the main factors that affected participants' decision to provide restorative or non-restorative management. However, a "restorative threshold" was not able to be identified.

CONCLUSION

There was notable variety in participants' understanding of the aetiology, management, and treatment of NCCLs, particularly the restorative threshold of when to treat.

CLINICAL SIGNIFICANCE

The variability demonstrates the need to have a clearer understanding of the key elements that affect the management of NCCLs and better information to support the decision of when to treat.

The Cervical Abrasion Index of Treatment Needs (CAITN) Procedure for Population Groups and Individuals

Because of their complex epidemiology and etiology, cervical abrasions usually manifest with concealing symptoms. The buccolingual dimension of the sore is considered the most important metric to rank the damage and evaluate its long-term prognosis. In this piece, we will break this down and offer the Cervical Abrasion Index of Treatment Needs (CAITN), a simple grouping structure based on the clinical presentation of the sore that may be used to establish a basic, useful, treatment-based order. CAITN is the practical approach to routine screening and recording cervical abrasion lesions. The index provides epidemiologists, public health professionals, and practitioners with a practical means of assessing the treatment needs (TN) of cervical abrasion.

Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration

PURPOSE

To synthesize the literature regarding noncarious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated.

MATERIAL AND METHODS

A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration.

RESULTS

NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies, whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineralization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multistep and single-step adhesives have been used. Dentin etching should be increased to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion.

CONCLUSIONS

Noncarious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multistep or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators.

Assessment of Cervical Abrasion, Dentin Hypersensitivity, and Its Treatment Needs Using the Cervical Abrasion Index of Treatment Needs Probe

Objective This study was intended to compare the mean buccolingual measurement of abraded teeth with/without sensitivity. The hypothesis was that the suggested treatment approaches would be in agreement with that of the treatment needs (TN) elicited using the Cervical Abrasion Index of Treatment Needs (CAITN) probe and aid in the development of a prospective CAITN index for clinical/community studies of effective therapeutic measures. Materials and methods  A cross-sectional study was carried out on 30 individuals with a mean age of 48.4±12.54 years, comprising 840 teeth with/without cervical abrasion. The buccolingual measurement of each tooth was recorded using the CAITN probe. The response to air-blast was assessed by a short blast of one-second duration at a distance of 1 cm for each tooth. An endodontist was also asked to indicate the treatment methods used by him for the treatment of abrasions. His opinions regarding the TN were later compared with the data collected by an investigator. Results The mean buccolingual measurements of all the teeth were compared with the dentinal sensitivity using the independent t-test and were statistically highly significant. Furthermore, one-way analysis of variance disclosed that there was a statistically highly significant difference found for all the TN (p<0.01) such as none, preventive, basic, and advanced restorative TN followed by Tukey honestly significant difference post hoc tests for multiple pair-wise comparisons. The running receiver operator characteristic curve discloses the best cut-off value of the buccolingual measurement to predict the various categories of TN of each tooth. As the area under the curve is more close to 1 (noticed in the majority of the teeth in the sample), the model predicts the TN more precisely based on the buccolingual measurements. Conclusion The present study enables a correct diagnosis of cervical abrasions and determines the various TN with the most appropriate restorative material. These baseline data help to design clinical studies that test relevant treatment and diagnostic strategies.

ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry “Dentin Hypersensitivity,” based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

Association between cervical abrasion, oral hygiene practices and buccolingual dimension of tooth surfaces: A cross-sectional study

Background:

Cervical abrasion is a multifactorial process due to the use of abrasive dentifrices along with improper brushing patterns. An extensive lesion may cause loss of structural integrity of tooth and esthetically unacceptable. The purpose of the study was to assess the prevalence of cervical abrasion with age, gender, and oral hygiene practices among workers in a spinning mill, Kerala. The study also aimed to identify the buccolingual measurements of each abraded tooth using the Community Abrasion Index of Treatment Needs (CAITN) probe.

Materials and Methods:

A cross-sectional study where 366 subjects (257 males and 109 females) above 20 years of age were selected using a random sampling technique. Data was collected from the assessment form comprising demographic data and oral hygiene practices of the subjects. Clinical examination for abrasion and buccolingual measurements of abraded tooth recorded using CAITN probe. The statistical analysis was done using SPSS 26.0. for calculating descriptive statistics, Chi-square test, and binary logistic regression.

Results:

The overall prevalence of abrasion was 37.2% and 97.7% of subjects with abrasion had sensitive teeth and were statistically significant. Age, gender (males) and combined horizontal and vertical method of brushing technique were strongly associated with the cervical lesion (P < 0.001). Binary logistic regression analysis showed that age group, gender, combined horizontal and vertical method of brushing, and presence of sensitive tooth was associated with the abrasion.

Conclusion:

It is concluded that the severity of the abrasion is an age-related phenomenon associated with combined horizontal and vertical strokes of brushing and is common among the male population. Dentinal hypersensitivity is also more prevalent with cervical abrasion. The novel CAITN probe can be used as an effective tool to assess the cervical abrasion and its treatment needs.

Influence of cavity depth and restoration of non-carious cervical root lesions on strain distribution from various loading sites

Background

We aimed to investigate the load-induced strain variation in teeth with unrestored and resin-based composite restored non-carious cervical lesions (NCCLs).

Methods

Twelve extracted premolars were provided for measuring buccal-side root NCCLs. Strain gauges were fixed at four measuring sites of each tooth, two at the buccal surface and two at the lingual surface. NCCLs were prepared with occlusal margins at the cemento-enamel junction. A static 9-kg load was applied at seven occlusal loading points: buccal cusp tip (BC), inner inclination of the BC, lingual cusp tip (LC), inner inclination of the LC, center of the mesial marginal ridge or distal marginal ridge, and center of the central groove. The strain was detected at each site in teeth with NCCL depths of 0 (control), 0.5, 1.0, and 1.5 mm. Each NCCL was restored using an adhesive composite resin, and the strains were re-measured.

Results

The strains at the NCCL occlusal and gingival margins decreased with increasing defect depths, and the effect was significant when the depth of the defect was 1.5 mm. Loading on the buccal and lingual cusps induced prominent strain variation. The strains at all depth distribution recovered to nearly intact conditions when the NCCLs were restored.

Conclusions

NCCLs at 1.5 mm depth are detrimental, but they can be restored using resin composites.

Clinical significance

The existence of NCCLs should not be ignored. The depth of the NCCL may affect the progression of the lesion. Resin composite restoration is an appropriate method for preventing persistent NCCL deterioration.

Effect of the casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and photobiomodulation (PBM) on dental hypersensitivity: A randomized controlled clinical trial

Objective

This randomized controlled clinical trial aimed to evaluate the effect of the casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and photobiomodulation (PBM) in the treatment of dentin hypersensitivity (DH), and the impact of this on the health-related quality of life (HRQL).

Methods

Eighty teeth with DH were randomized into four groups and received three treatment sessions: PLACEBO = placebo + LASER application mimicking; CPP-ACPF = CPP-ACPF + LASER application mimicking; PBM = placebo + LASER active application; CPP-ACPF+PBM = CPP-ACPF + LASER active application. Tactile (exploratory probe) and evaporative (triple syringe) stimuli were used to measure DH and were recorded with the aid of a visual analogue scale (VAS) after the 1^st, 2^nd and 3^rd treatment sessions and one-month follow-up. The HRQL was recorded in the DH experience questionnaire (DHEQ).

Results

The intragroup comparison showed a significant reduction in DH (p < 0.05) with both stimuli after one-month follow-up. The intergroup comparison with the evaporative stimulus showed that CPP-ACPF+PBM significantly reduced DH when compared to the rest of treatments, after one-month follow-up. CPP-ACPF+PBM group statistically differed from the other treatment groups in the DHEQ evaluation after one-month follow-up.

Conclusion

After one-month follow-up, the association of CPP-ACPF with PBM was effective in the reduction of DH and promoted a positive impact on the HRQL of the participants of this study.

Management of dentin hypersensitivity by practitioners in The National Dental Practice-Based Research Network

BACKGROUND

Dentin hypersensitivity (DH) is a condition commonly encountered in clinical dental practice. The authors conduct a study to identify the treatments recommended to manage DH among dentists in the United States.

METHODS

The authors conducted a multicenter study of 1,862 patients with DH who received a diagnosis and were treated by 171 dentists with The National Dental Practice-Based Research Network.

RESULTS

The most common treatment recommended was desensitizing over-the-counter (OTC) potassium nitrate toothpaste (alone or in combination with other treatments) for 924 of 1,862 patients (50%). This was followed by an application of fluoride varnish (FV) for 516 patients (28%) and a prescription for fluoride toothpaste for 314 patients (17%). Restorative treatments were recommended to 151 patients (8%). The most common single treatment recommendation was desensitizing OTC potassium nitrate toothpaste, recommended to 335 patients (18%). The most frequent combination of 2 treatment modalities was FV and desensitizing OTC potassium nitrate toothpaste, recommended to 100 patients (5%). A total of 890 of 1,862 patients (48%) with DH received a recommendation for 1 treatment modality, and 644 of 1,862 patients (35%) received a recommendation for a combination of 2 treatment modalities, most frequently an application of FV along with desensitizing OTC potassium nitrate toothpaste (100/1,862; 5%).

CONCLUSIONS

Desensitizing OTC potassium nitrate toothpaste and fluoride products were the most widely recommended products to manage DH in the practice setting.

PRACTICAL IMPLICATIONS

Our results suggest that most network clinicians preferred noninvasive treatment modalities when treating DH.

Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiation of a clinical study on this topic

Background

Dentin hypersensitivity (DH) is a common problem encountered in clinical practice. The purpose of this study was to identify the management approaches for DH among United States dentists.

Methods

One hundred eighty five National Dental Practice-Based Research Network clinicians completed a questionnaire regarding their preferred methods to diagnose and manage DH in the practice setting, and their beliefs about DH predisposing factors.

Results

Almost all dentists (99%) reported using more than one method to diagnose DH. Most frequently, they reported using spontaneous patient reports coupled with excluding other causes of oral pain by direct clinical examination (48%); followed by applying an air blast (26%), applying cold water (12%), and obtaining patient reports after dentist’s query (6%). In managing DH, the most frequent first choice was desensitizing, over-the-counter (OTC), potassium nitrate toothpaste (48%), followed by fluorides (38%), and glutaraldehyde/HEMA (3%). A total of 86% of respondents reported using a combination of products when treating DH, most frequently using fluoride varnish and desensitizing OTC potassium nitrate toothpaste (70%). The most frequent predisposing factor leading to DH, as reported by the practitioners, was recessed gingiva (66%), followed by abrasion, erosion, abfraction/attrition lesions (59%) and bruxism (32%).

Conclusions

The majority of network practitioners use multiple methods to diagnose and manage DH. Desensitizing OTC potassium nitrate toothpaste and fluoride formulations are the most widely used products to manage DH in dental practice setting.

Non-surgical management of tooth hypersensitivity

Tooth sensitivity is a common complaint of patients in dental practices. Studies have demonstrated dentinal hypersensitivity to affect 10-30% of the population. There are various potential causes of tooth sensitivity and a variety of available treatment options. This narrative review will discuss the possible aetiology of this condition, as well as the treatment modalities available. A tailor-made treatment plan that starts with the most non-invasive treatment options and escalates only when those options have proven insufficient in alleviating symptoms should be provided for each patient. Only after all non- and less-invasive methods have failed to reduce the symptoms should more invasive treatment options, such as root-coverage, be considered.

Effectiveness of a resin-modified glass ionomer liner in reducing hypersensitivity in posterior restorations: a study from the practitioners engaged in applied research and learning network

BACKGROUND

The objectives of this randomized comparative effectiveness study conducted by members of the Practitioners Engaged in Applied Research and Learning (PEARL) Network were to determine whether using a resin-modified glass ionomer (RMGI) liner reduces postoperative hypersensitivity (POH) in dentin-bonded Class I and Class II resin-based composite (RBC) restorations, as well as to identify other factors (putative risk factors) associated with increased POH.

METHODS

PEARL Network practitioner-investigators (P-Is) (n = 28) were trained to assess sensitivity determination, enamel and dentin caries activity rankings, evaluation for sleep bruxism, and materials and techniques used. The P-Is enrolled 341 participants who had hypersensitive posterior lesions. Participants were randomly assigned to receive an RBC restoration with or without an RMGI liner before P-Is applied a one-step, self-etching bonding agent. P-Is conducted sensitivity evaluations at baseline, at one and four weeks after treatment, and at all visits according to patient-reported outcomes.

RESULTS

P-Is collected complete data regarding 347 restorations (339 participants) at baseline, with 341 (98 percent) (333 participants) recalled at four weeks. Treatment groups were balanced across baseline characteristics and measures. RBC restorations with or without an RMGI liner had the same one-week and four-week POH outcomes, as measured clinically (by means of cold or air stimulation) and according to patient-reported outcomes.

CONCLUSIONS

Use of an RMGI liner did not reduce clinically measured or patient-reported POH in moderate-depth Class I and Class II restorations. Cold and air clinical stimulation findings were similar between groups. Practical Implications. The time, effort and expense involved in placing an RMGI liner in these moderate-depth RBC restorations may be unnecessary, as the representative liner used did not improve hypersensitivity outcomes.