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Title Resin-modified Glass Ionomer Restorations Are An Adequate Treatment for NCCLs, but Coronal Advancement Flaps Should Be Considered in the Treatment Plan
Clinical Question In a patient with non-carious cervical lesions will resin-modified glass ionomer restorations or coronal advancement flaps provide a better treatment for gingival recession associated with NCCLs?
Clinical Bottom Line Non-carious cervical lesions have several treatment options, but in many cases a combined restorative/periodontal approach at the restoration will provide the best esthetic and functional result for the patient.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12948216Terry/20034 Case Studies on Adults PatientsReview
Key resultsPart I of this review looks at the factors that contribute to non-carious cervical lesions. In the past, dentists have traditionally treated NCCLs with restorative methods, but in many cases, a periodontal or a combined restorative/periodontal approach provides a better result. The authors concluded by the examples of their case reports that “often a periodontal rather than an operative approach should be considered when gingival recession is associated with a cervical lesion.”
#2) 14620659Terry/2003Case Study on 68 year old femaleReview
Key resultsIn Part II of this review, several classes of tooth-colored materials are discussed. It is mentioned that it is the “ultimate challenge” of the dentist to keep up with new materials, and maintain an interdisciplinary perspective when restoring lesions. The report gives a blueprint for the proper sequence of treatment and restorative therapy for NCCLs, and defines the best approach to transition the therapy into a periodontal surgical approach.
#3) 19419445Santamaria/200916 Adults (26-58 years old)RCT
Key resultsThis study evaluated the treatments of CAF alone vs. CAF+Restoration. The change observed in relative gingival recession (RGR) after 2 years was 1.31±0.37 for CAF+R and 1.36±0.41mm for CAF (p>0.05). A change in the position of the gingival margin provided a comparable percentage of cervical lesion height (CLH) coverage: 51.57±17.2% for CAF+R and 53.87±12.6% for CAF (p>0.05). The clinical attachment level (CAL) increase by 1.2±0.72mm for CAF and by 1.31±0.6mm for CAF+R. It was concluded that the presence a restoration on the cervical area would not prevent the ensuing soft tissue coverage by the CAF. The results show that CAF alone and the combination of CAF and restoration using a glass ionomer can provide stable results after 2 years.
Evidence Search ("Gingival Recession"[Mesh] AND ("Glass Ionomer Cements"[Mesh] OR "Fuji glass-ionomer lining cement"[Supplementary Concept] OR "glass ionomer"[Supplementary Concept])) AND ("Free Tissue Flaps"[Mesh] OR "Surgical Flaps"[Mesh]) AND Randomized Controlled Trial[ptyp]
Comments on
The Evidence
Terry in his 2003 Part I and Part II articles reported a review that evaluated the different restorative techniques and the benefits of transitioning to periodontal surgery. The two articles reviewed 5 case studies on 5 adult patients. There was no comprehensive, detailed search for relevant trials, and a meta-analysis was not done. Santamaria in his 2009 article reported a RCT that showed the effects of CAF alone and CAF with a restoration for treatment of patients with gingival recession and NCCLs. This trial was a not a double-blind experiment with similar groups at the start that had an >80% completion rate. The groups were treated the same, had adequate followups, and acceptable compliance. In this study, recall bias was unlikely, and there was not a statement of competing interest.
Applicability The articles evaluated adult patients who would represent the age of patients seen in either general practice clinics or periodontal specialty clinics. All subjects were otherwise systemically healthy adults with no contraindications for periodontal surgery, no active periodontal disease, and no medications known to interfere with periodontal tissue health and healing. The risks associated with periodontal surgery apply to the patient. The potential benefits of the surgery (reduced dentin sensitivity/better esthetics) coincide with patient expectations.
Specialty/Discipline (General Dentistry) (Periodontics) (Restorative Dentistry)
Keywords Gingival Recession, NCCLs, Glass Ionomer, Cervical Advancement Flaps
ID# 2438
Date of submission: 03/01/2013spacer
E-mail lewisch@livemail.uthscsa.edu
Author Christopher Lewis
Co-author(s) e-mail
Faculty mentor/Co-author William Rose, DDS
Faculty mentor/Co-author e-mail rosew@uthscsa.edu
Basic Science Rationale
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