Dentoword : Today's Word is 'Dental Abfraction'.

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Today's word is "Dental Abfraction"

Dental Abfraction : 'The Main Culprit - Invisible Cracks'

Yesterday, we learned about dental abrasion, caused by excessive external forces. Today, we're exploring another non-carious lesion: dental abfraction. This condition results from excessive forces on the teeth during function, creating fine fracture lines at the gingival region that may develop into defects. Let's begin our discussion on dental abfraction without delay. 

Definition :

Eccentric occlusal forces exerted strongly on teeth cause microfractures at the cervical area, resulting in wedge-shaped defects. This condition is termed dental abfraction.

Etiology of dental abfraction: 

1.Weak teeth: 

Teeth that lack rigidity can deform under normal loading, leading to microfractures at the gingival line. 

2.Missing teeth: 

Reduced number of teeth can result in excessive force on the remaining teeth during chewing, contributing to microfractures. 

3.Poor oral habits: 

• Excessive clenching can impose additional loads on teeth, contributing to abfraction. 
  
  
  
• Biting on hard objects can cause microfractures that may develop into notched defects at the gingival line region.

4.Malocclusion:

 Poor alignment of teeth can create irregular biting forces, increasing the risk of microfractures. 

Clinical features of dental abfraction :

• Abfraction lesions are characterized by sharp notches or wedge-shaped defects at the cervical region of the tooth. 

• These lesions primarily affect the thin enamel region at the cementoenamel junction. 

• If cement restorations are placed near the gingival line without adequate support, they may become dislodged due to excessive forces.

•  Tooth sensitivity can occur due to exposed dentin caused by abfraction.

 

• Pulpal inflammation can also occur occasionally due to dentin flexure, which can alter fluid flow and lead to micro-leakage.

Diagnosis of Dental Abfraction :

1.Visual examination: 

Teeth affected by abfraction typically exhibit wedge-shaped notches at the cervical region.

2.Patient habit history: 

Ask the patient about habits such as teeth clenching, biting on hard objects, and their diet history.

3.Tactile assessment: 

Feel the tooth surface with a probe to detect roughness or irregular texture.

4.Radiographic diagnosis: Radiographs are used to visualize underlying changes in enamel and dentin that may not be visible during a regular visual examination.

5.Transillumination: Passing light through the tooth can reveal fine cracks or abnormalities that may not be apparent under normal dental chair lighting.

Prevention of Dental Abfraction :

1.Counseling patients about their habits and their harmful effects on teeth is crucial.

2.Practice good oral hygiene: 

Brush gently with a soft-bristled toothbrush using fluoride toothpaste.

3.Maintain a proper diet and avoid abrasive and hard foods daily.

4.Custom mouthguards: Prescribe custom mouthguards to patients with habits that can cause abfraction, preventing direct force on teeth and reducing its effects.

5.Regular dental check-ups are essential to detect this type of lesion early, preventing further complications.

Management of Dental Abfraction :

Management of dental abfraction involves several strategies aimed at addressing the structural loss and preventing further damage to affected teeth:

1.Restorative Treatment: 

If dental abfraction causes significant tooth structure loss, the following treatments are typically performed:

• Tooth-colored restorations are applied to fill the notched areas caused by abfraction.
• Resin-modified glass ionomer cement is commonly used as a filling material for abfraction lesions.
• In cases of severe tooth structure loss, crowns may be recommended to provide support and protect the affected tooth from direct forces.
• For patients with receding gums associated with abfraction, a combined approach of soft tissue grafting and cement restoration may be employed.

2.Management of Associated Issues:

Patients with additional problems such as temporomandibular joint disorders or malocclusion are referred to specialist doctors such as orthodontists or oral surgeons for further evaluation and treatment.

Conclusion :

Dental abfraction occurs when microfractures progress into notches if the underlying causes are not identified and addressed early. By understanding its causes, features, and preventive measures, you can preserve your teeth through regular dental check-ups and maintain your smile for years to come.

References :

Sturdevant’s Art and Science of Operative Dentistry (Second South Asia Edition-2019),Adaptation Editor,

V.Gopikrishna,Elsevier.