Aim
To identify the best available evidence for the effect of toothbrushing on the initiation and progression of gingival recession and non-carious cervical lesions (NCCLs).

Methods
A protocol was developed for the questions: Does traumatic toothbrushing, compared to normal toothbrushing, lead to an increased prevalence of non-inflammatory gingival recession? [FQ1] and NCCLs? [FQ2]. The search covered four electronic databases. Bibliographies of review articles, relevant texts, World and European Workshops were screened. Hand searches were performed of the Journals of Clinical Periodontology, Periodontology, Periodontal Research and IADR abstracts.

Results
A meta-analysis included 159 subjects and showed that subjects who used MTBs (manual toothbrush) had greater gingival recession after 12 months when compared with those using PTBs (powered toothbrush). Thirteen cross-sectional studies identified the most frequent toothbrushing factors associated with gingival recession as being toothbrushing frequency, a horizontal or scrub toothbrushing method, bristle hardness, toothbrushing duration and the frequency of changing a toothbrush. The principal toothbrushing factors associated with NCCLs were toothbrushing method and frequency.

Conclusion
The data to support or refute the association between toothbrushing and gingival recession and NCCLs remain largely inconclusive.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jcpe.12330

Evidence for the occurrence of gingival recession and non‐carious cervical lesions as a consequence of traumatic toothbrushing

The Effects of Endodontic Access Cavity Preparation Design on the Fracture Strength of Endodontically Treated Teeth: Traditional Versus Conservative Preparation.

Relationship between noncarious cervical lesions, cervical dentin hypersensitivity, gingival recession, and associated risk factors: A cross-sectional study.

Non-carious cervical lesions (NCCLs) are a group of lesions that affect the cervical area of the teeth. Different aetiological factors have been reported, among them tooth brushing force, erosive agents and occlusal forces. The aim of this study was to ascertain, by means of a systematic review, the association between NCCLs and occlusion. A search was performed in the MEDLINE database, retrieving a total of 286 articles. After title and abstract screening, the clinical investigations were read in full to select those that evaluated the occlusal aspects of NCCL aetiology. This systematic review describes the results of three prospective and 25 cross-sectional studies. As there is an extreme heterogeneity in design, diagnostic criteria, forms of analysis and associated factors, a meta-analysis was not possible. The wide variety of classification and diagnostic criteria reflects a high range of reported prevalence. An extensive heterogeneity of independent variables was noted, even in occlusal analysis, which helps to mask any conclusion about the role of occlusion in NCCL aetiology. The literature reveals that studies on this topic are subject to a substantial amount of bias, such as evaluation (use of non-blinded examiners) and confounding bias (no control of others aetiological factors). Up to now, it has been impossible to associate NCCLs with any specific causal agent, and the role of occlusion in the pathogenesis of non-carious cervical lesions seems as yet undetermined. Therefore, additional studies, properly designed to diminish bias, are warranted.

Non-carious cervical lesions and occlusion: a systematic review of clinical studies.

Over the last century, humans from industrialized societies have witnessed a radical increase in some dental diseases. A severe problem concerns the loss of dental materials (enamel and dentine) at the buccal cervical region of the tooth. This “modern-day” pathology, called non-carious cervical lesions (NCCLs), is ubiquitous and worldwide spread, but is very sporadic in modern humans from pre-industrialized societies. Scholars believe that several factors are involved, but the real dynamics behind this pathology are far from being understood. Here we use an engineering approach, finite element analysis (FEA), to suggest that the lack of dental wear, characteristic of industrialized societies, might be a major factor leading to NCCLs. Occlusal loads were applied to high resolution finite element models of lower second premolars (P2) to demonstrate that slightly worn P2s envisage high tensile stresses in the buccal cervical region, but when worn down artificially in the laboratory the pattern of stress distribution changes and the tensile stresses decrease, matching the results obtained in naturally worn P2s. In the modern industrialized world, individuals at advanced ages show very moderate dental wear when compared to past societies, and teeth are exposed to high tensile stresses at the buccal cervical region for decades longer. This is the most likely mechanism explaining enamel loss in the cervical region, and may favor the activity of other disruptive processes such as biocorrosion. Because of the lack of dental abrasion, our masticatory apparatus faces new challenges that can only be understood in an evolutionary perspective.

/pdf/the-evolutionary-paradox-of-tooth-wear-simply-destruction-or-4s5hy0ytf6.pdf

The evolutionary paradox of tooth wear: Simply destruction or inevitable adaptation?

Objective: To determine factors associated with Non-Carious Cervical Lesions (NCCLs) and the teeth most commonly involved in such lesions. Study Design: Cross-sectional study. Place and Duration of Study: Department of Operative Dentistry, Section of Dentistry at Aga Khan University Hospital, Karachi, Pakistan, from December 2005 to January 2006. Methodology: A total number of 95 patients with 671 teeth were evaluated using a pre-coded questionnaire. Subject of evaluation was teeth. Patients with symptomatic or asymptomatic NCCLs and permanent dentition were included. Patients exhibiting active, untreatable periodontal disease, rampant uncontrolled caries, xerostomia, primary dentition, patients undergoing orthodontic treatment or bleaching procedure were excluded from the study. Data analysis was done using Spearman’s correlation, Mann Whitney test and Kruskal-Wallis test. Results: Mean age of patients was 50.3 years (r=0.22, p=0.028); males (73%) had more NCCLs than females (23%). Majority (45.3%) of them brushed their teeth twice a day, with medium type of brush (48.4%) and horizontal (73.7%) brushing technique. Most of the patients were non-bruxists (90.5%), with Angles Class 1 occlusion (48.4%) and canine guidance (50.5%). Majority (74.7%) of the patients did not have sensitivity. Conclusion: First premolars in all the quadrants were the most frequently involved teeth in NCCLs. More males had NCCLs. Middle aged patients were more involved. A weak positive correlation was found between age and NCCLs. No association was observed between hand used and site of NCCLs, between wear facets and NCCL, Excursive guidance and NCCL, Angles classification and NCCL.

/pdf/factors-associated-with-non-carious-cervical-lesions-nccls-51d0vx787x.pdf

Factors Associated with Non-Carious Cervical Lesions (NCCLs) in Teeth

Objective: To determine the distribution and pattern of carious teeth involvement in permanent teeth requiring endodontic treatment. Study Design: Cross-sectional study.

/pdf/frequency-and-distribution-of-endodontically-treated-teeth-4630x9fgdx.pdf

Frequency and distribution of endodontically treated teeth.

Aim of the Study: Aim of endodontic therapy is to restore the natural tooth functionally as well as esthetically. The success of the treatment depends predominantly on the reduction or complete eradication of pathogens and their byproducts (mechanically and chemically) along with adequate seal. Studies have concluded that chemo mechanical instrumentation alone will only render 50-70% of infected canals free of microorganisms therefore, an effective antimicrobial agent as intracanal medication should be used to improve treatment outcome. Moreover Improper apical seal has been reported as most common cause of endodontic treatment failure in different studies Therefore it is essential to know the effect of most commonly used intracanal medicament Ca (OH) 2 on apical seal, in order to reduce the chances of endodontic failure. The aim of this study is to evaluate the effect of intracanal medicament on apical seal. 
Study Design: Quasi Experimental study. 
Place of the Study: The samples were prepared at Ziauddin University and was analyzed at Karachi University. 
Methodology: Mandibular premolars were prepared using step back technique and were divided into two groups.  In Group A, no intracanal medicament was placed and in Group B intracanal medicament was placed. Samples were placed in Indian ink dye for 7 days and were then cleaned in running water before sectioning up to 5 mm (1 mm each) using Microtome and analyzed under stereomicroscope. Shapiro-Wilks test and Mann Whitney U test was used for data analysis. 
Results: Group with intracanal medicament showed least amount of dye penetration with mean value 2.30±1.832 as compared to non-medicated group mean value (2.96 ±1.69) but the results were not statically significant p value 0.072. 
Conclusion: The results of this study concluded that there is no statistically significant difference in leakage between group A and group B (non-medicated and medicated group).

Influence of Calcium Hydroxide as an Intracanal Medicament on Apical Seal

Aesthetic dentistry continues to evolve via advances in bonding agents, restorative materials, and conservative preparation methods. Alternatives to dental amalgam and gold include ceramic dental restorative materials. The lifespan of ceramic inlay repairs is still up for debate. When it comes to durability, colour matching, and anatomical shape stability, ceramic inlay restorations top the list of options. More predictable long-term performance may be achieved by strategically placing ceramic inlays in teeth that are not subjected to significant occlusal stress. Preparation design for ceramic inlay materials is necessary to avoid flexure. This case report discusses the ceramic inlay practice for functional and aesthetic restoration in a patient.

/pdf/ceramic-inlays-a-case-report-1usopib9.pdf

Ceramic Inlays: A Case Report

Objective  An early identification of patients who are at an obvious increased risk of osteoporosis and subsequent high risk of pathological bone fractures is important to prevent morbidity and its subsequent impact on the quality of life of the affected patients. Dental professionals have a chance of identifying such cases in their very initial stages through routinely prescribed dental radiographs. The aim of this study was to assess the influence of gender and age on different parameters of alveolar bone loss using orthopantomograph (OPG) as an aid to identify patients with low bone mineral density (BMD). Materials and Methods  This study included eighty subjects in whom after taking OPGs, mandibular cortical index (MCI), mandibular cortical width (MCW), and panoramic mandibular index were assessed, while the results obtained were subjected to statistical analysis. One-way analysis of variance followed by Tukey's test was used to compare the means, while p -value less than 0.05 was considered statistically significant. Results  The findings of this study revealed a significant association between MCI and age for females, with C2 and C3 categories being more common with advancing age. Also, a significant difference could be seen in relation to gender ( p -value = 0.0315) for MCW with a concomitant decrease in the values of MCW in females over 60 years of age. Conclusion  Panoramic radiographic measurements could provide valuable information and help in screening patients with low BMD.

http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0042-1751009.pdf

Hina Ahmed

Papers

Factors Associated with Non-Carious Cervical Lesions (NCCLs) in Teeth

Frequency and distribution of endodontically treated teeth.

Influence of Calcium Hydroxide as an Intracanal Medicament on Apical Seal

Ceramic Inlays: A Case Report

Panoramic Indices: An Aid to Early Detection of Patients with Low Bone Mineral Density