NON-CARIOUS CERVICAL LESIONS: INFLUENCE OF OCCLUSAL, BIOMECHANICAL, AND CHEMICAL FACTORS ON LESION PROGRESSION

Abstract

Non-carious cervical lesions (NCCLs) are characterized by the irreversible loss of mineralized tooth structure near the cementoenamel junction without bacterial decay involvement. This integrative review aimed to analyze the influence of occlusal, biomechanical, and chemical factors on the initiation, morphological patterns, and progression of NCCLs. The methodology involved searching and synthesizing evidence from clinical trials, observational studies, computer-simulated finite element analysis (in silico), laboratory biomechanical assays (3D-DIC and micro-CT), and high-resolution morphological examinations (OCT and stereomicroscopy). The results confirm the inherently multifactorial etiology of this condition, arising from the synergistic interaction between chemical biocorrosion/erosion, frictional mechanical wear (abrasion), and biomechanical stress concentrations from occlusal loads. Although computational and laboratory models demonstrate that eccentric or oblique forces generate high stress peaks in the cervical region and induce subsurface dentin microcracks — with highest susceptibility in premolars —, observational clinical studies indicate a lack of conclusive prospective evidence establishing a direct, isolated causal link between occlusal parameters and lesion formation. Given this clinical uncertainty, international consensus discourages using the term "abfraction" as an independent primary diagnosis. Chemical degradation from intrinsic and extrinsic acids reduces tissue microhardness, thereby accelerating secondary mechanical wear. It is concluded that NCCL management requires early diagnosis and preventive strategies focused on controlling underlying causes, reserving restorative intervention for cases presenting persistent dentin hypersensitivity, aesthetic compromise, or severe structural loss.