Tratamentul leziunilor dentare necarioase

Introduction

It is well known that oral health is one of the most important markers of body health. From the moment of their eruption on dental arcades to the moment of their loss, they are continually subjected to insults from both the external environment and those from our body. In addition to dental caries, we are often confronted with dental lesions of non-carious etiology, which may occur both physiologically and pathologically, but they all should be diagnosed and treated before complications occur or it is too late and lead to loss of the tooth⁽¹⁾.

With the emergence of new foods, different changes of dental tissues and the way the entire body adapts to various changes in the environment, dental lesions have increasingly diversified and require new treatment methods.

Non-carious lesions

Unfortunately, non-carious dental lesions often represent neglected dental lesions by both patients and dental practitioners – for example, dental abrasions or simple enamel fractures. The etiology is very diverse, so it is very important for patients to realize that some of these dental changes occur physiologically, but can be prevented or treated if they are already being installed. For example, the type of mastication, changes in occlusion or the various foods we consume every day  significantly contribute to the appearance of non-carious dental lesions and should be known and treated properly.

It is necessary to emphasize the importance of a correct approach of non-carious lesions by physicians and to avoid the complications that may result from them. These include dentin hypersensitivity, and various types of dental pulp inflammation which can lead to dental necrosis or even tooth avulsion in the case of severe trauma^(2,3).

Unfortunately, non-carious lesions may be the result of iatrogenic dentistry. Inattention, abnormal course of treatments, or various other causes may lead to dentin hypersensitivity, tooth discoloration, or even tooth fractures. The objective of a successful treatment also means avoiding these unpleasant consequences for our patients and equally for dentist⁽⁴⁾.

This paper reviews the particularities and the treatment of non-carious dental lesions in order to raise awareness among physicians about the frequency and effects of this type of lesions on oral health. In this regard, prevention should be more important than treatment, as always.

Non-carious dental lesions – whether with or without loss of hard dental substance – are a causal factor of aesthetic dysfunction, but to the same extent, with an important impact on mastication or phonation.

Depending on the volume of loss tooth substance, the non-carious lesions may be: non-carious lesions with no hard substance loss (dental discoloration, dental cracks) and carious lesions which involve loss of hard tissues, enamel and dentin.

Non-carious lesions with loss of dental hard tissues necessarily require a coronary restoration treatment due to the complications they may cause⁽⁵⁾.

Hard dental tissues are in direct contact with the oral cavity and once the teeth erupt on dental arcades they are immediately subjected to the action of chemical, physical or biological factors that lead to the apparition and development of non-carious lesions. The main types of non-carious lesions are:

• Dental attrition: wear of hard dental tissue due to direct tooth to tooth contacts, without interposition of food bowl or other factors.

• Dental abrasion: dental abrasion or tooth wear is a mechanical wear of dental hard tissues as a result of friction with an abrasive object, other than tooth to tooth contact. This type of wear can be the result of an incorrectly, excessive tooth brushing, or by using a very abrasive toothpaste.

• Abfraction: non-carious cervical lesions induced by occlusal stress. This type of substance loss occurs because enamel, especially at the cemento-enamel junction, undergoes large amounts of stress, causing micro fractures and tooth tissue loss, under the action of occlusive forces^(6,7). It is usually present in cervical buccal area of frontal teeth.

• Dental erosion: a shallow loss of dental substance (usually enamel) due to contact with chemicals (intrinsic and extrinsic acids), which produce dissolution.

• Traumatic lesions: most often we deal with the dental fracture, which is a traumatic lesion where the loss of dental hard substance is limited to enamel, or it also includes dentin or in some cases even dental cement. Fractures often involve frontal teeth, especially at their incisal angles. It can also cause oral mucosal lesions due to sharp edges, as well as aesthetics dysfunction.

Treatment of non-carious lesions

The treatment of non-carious dental lesions with hard dental substance loss is usually achieved by direct odontal restorations, often using resin composites.

For non-carious lesions which are limited to dental enamel, they can be simply restored by smoothing out sharp and irregular edges or, when substance loss is significant, by restoring tooth anatomy and morphology with specific dental materials, followed by monitoring.

For non-carious lesions that involve both enamel and dentin, dentinal protection is essential, possibly with calcium hydroxide-based materials to form a dentin protective barrier⁽⁸⁾. Coronal restoration is required with composite materials, compomers or oromocers. When the loss of hard dental substance is important, additional retention systems (dentin pins or prefabricated posts) are required for retention and stability of the coronal restorative material.

Another method for the treatment of non-carious dental lesions is direct composite veneers in the case of dental discoloration. Also, indirect composite or porcelain veneers are used.

The types of materials currently used for direct dental restorations of non-carious lesions are as follows:

• Resin composites (resin-based composites): aesthetic dental materials represent the first-choice materials for all types of modern direct restorations.

• Glass ionomer cements: physiognomic materials with a complex structure, used mainly in subgingival dental restorations due to their adhesion properties to the radicular cement.

• Compomers: hybrid materials derived from the association of composite resins and glass ionomer cement.

• Ceromers: they represent a modified composite resin-based material that incorporates ceramic particles in the inorganic filler, with good properties of bicompatibility and strength.

• Resin-modified ionomer cements: they are hybrid materials derived from classic glass ionomer cements with addition of polymerizable resins.

Non-carious dental lesions, with or without substance loss, can often lead to reversible or irreversible pulp tissue damage⁽⁹⁾. The main purpose of the treatment is to preserve the dental pulp vitality, but in advanced stages this is not always possible; in these cases, pulp extirpation is the only choice of treatment. Due to the fact that we cannot always institute conservative and restorative treatment in advanced non-carious lesions, the prophylaxis of this type of lesions is extremely important, by instructing the patient to prevent any dental injuries resulting in pulp damage, and also to have a proper tooth brushing, a rich, diversified diet, and mandatory visits to the dentist at regular check-ups⁽¹⁰⁾.

Acknowledgements: All the authors have equal contributions for this article.

Conflict of interests: The authors declare no conflict of interests.