Cervical Lesions: Choosing the Material
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Direct answer
Two cervical defects that look identical can deserve entirely different materials, because the choice follows aetiology, location and moisture control. Non-carious cervical lesions — the wedges of abfraction, abrasion and erosion — are treated on sensitivity, depth and position: shallow sensitive lesions get desensitising adhesive treatment alone, root-surface and moisture-difficult lesions get glass ionomer, and aesthetic or load-bearing cervical margins get composite. Carious Class V lesions follow the same logic with the caries risk added. The technical rules that decide success are three: bevel enamel only, never cementum; respect how sclerotic dentine resists bonding; and treat the cause — an unfixed occlusal habit or abrasive brushing returns every restoration.
What you must remember
- Aetiology triad (viva favourite): abrasion (mechanical, hard brushing with notched defects and recession), erosion (chemical, dietary or gastric acid with shallow cupping), and abfraction (occlusal stress flexure at the cervical fulcrum) — one defect often combines all three.
- Sensitivity-first option: a shallow lesion whose only complaint is sharp pain to cold and touch may need no restoration — dentine adhesives and desensitising agents (glutaraldehyde-HEMA, fluoride varnishes, potassium salts) occlude tubules.
- GIC's claim: chemical bond to cementum and dentine via carboxyl-calcium chelation, fluoride release, and setting tolerance to moisture — the material of choice for root-surface lesions and moisture-difficult fields.
- Composite's claim: superior aesthetics and wear resistance for visible or function-loaded cervical margins, demanding dry isolation and proper conditioning of both enamel and dentine.
- Bevel rule: bevel the enamel margin (about 0.25-0.5 mm) to widen the prism ends for etching; never bevel cementum, which lacks prisms and gains nothing from a bevel.
- Sclerotic dentine problem: hypermineralised, acid-resistant tubules bond poorly — extended etching, air abrasion or roughening, and sometimes glass ionomer's chemical bond succeed where a simple etch-and-rinse adhesive fails.
- Cause management: occlusal equilibration or a night guard for abfraction, a brushing-technique correction for abrasion, and dietary or reflux advice for erosion — without which restoration failure recurs.
Choosing materials across three cervical lesions
A 45-year-old presents with three cervical problems. First, a shallow wedge defect on 24 with sharp sensitivity to the air test and no cavitation — the answer is no restoration: etch-and-rinse adhesive or a dedicated desensitiser is applied, the brushing habit is corrected to a soft brush and sulcular technique, and the lesion is reviewed. Second, a deep notch on 36 below the gingival margin where rubber dam isolation will be imperfect and the base is root dentine: resin-modified glass ionomer, placed without bevel, fluoride-releasing, forgiving of the marginal seepage that composite cannot survive there. Third, a broad defect on the upper canine visible in the smile, margin partly on enamel: composite, with the enamel edge bevelled for etching, the sclerotic floor roughened with a diamond and given a longer etch, layered in two shades for cervical depth. Each choice is written with its reason in the notes — sensitivity treated conservatively, GIC where moisture and substrate demand it, composite where aesthetics and isolation allow — because the examiner's follow-up question is never "what did you use?" but "why not the other one?".
Where students slip
The reflex error is restoring every NCCL: a shallow, sensitive notch treated with a restoration manages the symptom and ignores the cause, and the defect often recurs beside or beneath the filling within a few years. The viva trap is the bevel question — students bevel everything, and the marks go to whoever states that cementum gains nothing from bevel because it is non-prismatic. Another standard confusion is sclerotic dentine: "etch and bond" fails silently on hypermineralised surfaces, and the expected escalation is roughening with a bur or air abrasion, prolonged etching, or a glass ionomer's chemical bond. The aetiology question rounds out the vivas — distinguishing abrasion's notched, brush-driven defect from erosion's cupped one is a two-mark staple.
Frequently asked questions
Why is glass ionomer preferred for root-surface cervical lesions?
It bonds chemically to cementum and dentine, releases fluoride, and tolerates the marginal moisture that cervical restorations rarely escape.
When is a non-carious cervical lesion treated without restoration?
When the lesion is shallow and the complaint is only sensitivity — tubule-occluding adhesives and desensitising agents treat the symptom while the cause is corrected.
Which margins should be bevelled in Class V preparations?
Only enamel margins, bevelled about 0.25-0.5 mm to expose prism ends for etching; cementum margins are left unbevelled as cementum is non-prismatic.
Why does bonding to sclerotic dentine fail predictably?
Hypermineralised, acid-resistant tubules prevent proper hybrid layer formation, so roughening, extended etching or chemically bonding glass ionomer is used instead.
How do abrasion, erosion and abfraction differ clinically?
Abrasion notches correlate with traumatic brushing, erosion cups correlate with acid exposure, and abfraction wedges correlate with occlusal stress — often combined in one lesion.