It was Grippo(1991) who coined the term abfraction to describe the pathological loss of enamel and dentine caused by biomechanical loading of teeth. He stated that the forces could be static, such as those produced by swallowing and clenching; or cyclic, as in those generated during chewing. He suggested that non-carious cervical abfractive lesions were caused by flexure and ultimate material fatigue of susceptible teeth at locations away from the point of loading. Grippo thought that the breakdown was dependent on the magnitude, duration, direction, frequency and location of the forces. (Grippo JO 1991 Abfraction: a new classification of hard tissue lesions of teeth. J Esth Dent, 3:14-8).
Examine the three figures given.
• Comment on the clinical picture. How would you diagnose an abfractive lesion? Can you see any in this case? If there were any, how would you treat them?
• Now examine the two SEM images. What are A, B & C? Comment on the differences between A, B & C in the two figures. What is happening here?
23 comments:
I thought I'll give it a go at answering some of the questions regarding abfraction in the blog. Some of these are ideas and might not be the best possible answer, so do help me out.
Abfraction lesions can be diagnosed clinically by the loss of enamel and dentine. These lesions can be followed up over a period of time to see if intervention has prevented further loss of these dental hard tissue, has stabilised or has progressed.
A possible abfraction lesion is seen mesially on 46 at the cervical margin with exposure of dentine (yellow) in this image.
This can be treated with a layer of Glass ionomer cement (GIC) which releases fluoride ions to help with remineralization. Fluoride ions also have both bacteriostatic and bacteriocidal effects which would prevent or minimise the possibility of carious activity at the lesion. On top of GIC, you could place Fuji IX and build it up. It may be necessary to prepare the lesion accordingly and remove any bacteria before placing these restorative materials.
I think the first Scanning electron micrograph (SEM) image ahos (A) Enamel, (B) Dentine, and (C) the Dentino-enamel junction, where the hard tissues are not subjected to any loading.
however, in the second SEM hard tissue has been subjected to biomechanical loading, which caused the fracture on enamel, disrupting the DEJ and exposing underlying dentine. Dentine looks irregular, and this may be possibly be secondary or reparative dentine.
Please do let me know if I my attempts are close to being correct :).
Cheers
Tharani
Is the breaking off bits of enamel? That must be what causes the abfraction. Are the micro images from the patient? If so, how did you do it?
I read the article by Grippo in the American Dental Journal (2004). Now I'm a bit confused. What is the difference between corrosion and erosion? They say we should not use erosion. Is this true?
It looks as though there may also be an abfraction lesion on 45. A tooth often subject to lateral extrusion. This seems to be the motion that stresses the CEJ area enamel the most (Rees 2002). Rees didn't seem to mention that although enamel is less mineralised and more poorly arranged the more apically located it is. It would seem to also be subject to more cantilever induced stress with a longer force arm. Perhaps this could also be a reason the CEJ area is more prone to abraftion lesions. Regan
Hello, I was reading some journal articles about the managment and prevention of dental erosion, but I couldnt find much about it regarding abfraction. Except for placing GIC what else could you do to prevent abfractive lesions.
Cheers Rajiv
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