Lack of evidence to support an association between occlusal risk factors and non-carious cervical lesions

shutterstock_52040509 - Rusty cogs

Loss of tooth surface in the cervical areas of the tooth unrelated to caries, or non-carious cervical lesions (NCCL) have been reported to occur in prevalences of between 5-85%.  These lesions can be the result of attrition, abrasion or erosion. The potential of occlusal stress to be a factor leading to abfraction has also been proposed.  The aim of this review was to assess the evidence for an association between NCCL and occlusal risk factors (ORF).

The Pubmed, Web of Science, Cochrane, Lilacs, Clinical Trials, National Research Register and National Institute for Health databases were searched with out language restriction. Cross-sectional studies, case- control studies, cohort studies and clinical trials conducted in humans evaluating the presence of NCCL associated with occlusal risk factors were included. Study selection and data abstraction was conducted independently by two reviewers.  The Newcastle-Ottawa Scale was used to assess quality.

  •  Six cross-sectional studies, two case-control studies, and one clinical trial were included. Five studies used a comparative group that was classified as a control group.
  • Three of the nine studies found associations between NCCL and some variables (occlusal contact area, right canine guidance, premature contacts in centric relation and working side) (p<0.05).

The authors concluded

The available scientific evidence could not confirm an association between occlusal factors and NCCL. Further prospective studies with standardised methods are vital to strengthen the evidence.


An earlier review by Senna et al  which looked at the same question but only searched one database included 3 prospective studies and 25 cross-sectional studies.  Both that review and this one note wide heterogeneity in design, diagnostic criteria, forms of analysis and associated factors.


Silva AG, Martins CC, Zina LG, Moreira AN, Paiva SM, Pordeus IA, Magalhães CS. The association between occlusal factors and noncarious cervical lesions: A systematic review. J Dent. 2012 Nov 8. doi:pii: S0300-5712(12)00302-8. 10.1016/j.jdent.2012.10.018. [Epub ahead of print] PubMed PMID: 23142094

Senna P, Del Bel Cury A, Rösing C. Non-carious cervical lesions and occlusion: a systematic review of clinical studies. J Oral Rehabil. 2012 Jun;39(6):450-62. doi: 10.1111/j.1365-2842.2012.02290.x. Epub 2012 Mar 21. Review. PubMed PMID: 22435539.








Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+