The last seven years brought clearer evidence about what truly causes these defects and what actually works to stop, desensitize, and restore them—often with minimally invasive options that preserve pulp vitality and enamel.
This guide distills that literature into an actionable chairside strategy you can use today.
1) Scope & Etiology—what we know (and what we don’t)
★ Erosion (chemical)
Dietary acids, gastric reflux, and low salivary buffering drive surface softening and bulk tissue loss. Prevention-first care and active monitoring are now strongly emphasized.
★ Abrasion (mechanical)
Toothbrush force, abrasive pastes (high RDA), and habits (e.g., gritty powders) accelerate loss on previously softened surfaces.
★ Attrition (tooth–tooth)
Parafunction and bruxism concentrate wear; protect with occlusal splints when indicated.
★ NCCLs (cervical)
Best explained by multifactorial synergy—erosion + abrasion dominate; the abfraction hypothesis remains controversial and, at most, a co-factor. Manage causes before margins.
2) Diagnose & Risk-stratify—simple tools that change outcomes
★ History & risks
Acids (dietary/GERD), xerostomia, medications, brushing force/technique, abrasives, parafunction. Photograph and chart baseline.
★ Monitoring
Adopt routine wear screening (e.g., BEWE for erosion), periodic photos, and—when available—serial intraoral scans to visualize progression and educate.
★ Pain phenotype
If sharp, short pain to thermal/evaporative stimuli = dentin hypersensitivity (DH); treat stepwise (home → office) and reassess before drilling.
3) Prevention & Desensitization—treat the causes first
★ Diet/biochemistry
Reduce frequency of acids; time brushing ≥60 min after acidic exposures; manage GERD with the patient’s physician.
Prefer stannous-fluoride formulations (or Sn-containing rinses): polyvalent ions form acid-resistant layers that slow erosive wear.
★ Toothbrushing & pastes
Use soft brushes and low-to-moderate RDA pastes; teach non-scrubbing technique.
★ Dentin hypersensitivity (step-care)
1. Home: Twice-daily desensitizing toothpaste (e.g., stannous fluoride, arginine-based, potassium nitrate).
2. Office: Varnishes, calcium-phosphate systems, oxalates, or resin sealants/adhesives for tubule occlusion.
3. Adjuncts: Diode lasers show promise alone or combined with NaF varnish for DH reduction. Reassess before restoring.
★ Protection
Nightguard for parafunction; sports mouthguards as needed.
4) Micro-invasive Esthetics—when “camouflage” beats drilling
Resin infiltration (Icon) for white-spot lesions and selected early non-carious enamel lesions: consistent color blending and lesion stabilization at 1–24 months; in-vitro data show deep penetration into demineralized enamel.
Great for post-orthodontic WSLs and mild buccal defects.
5) Restorative Decisions—adhesive strategies that last
★ When to restore an NCCL or wear facet
Persistent DH after prevention/sealants; clear progression on photos/scans; esthetic demand; or compromised cleansability/gingival recession planning. Do etiology control first, then restore.
★ Material selection (mid-2020s data)
Glass-ionomer cements (GIC/RMGIC) vs resin composites (RC): A recent 48-month clinical comparison found no significant difference in medium-term performance for NCCL restorations—so pick based on moisture control, cervical dentin sclerotic level, and patient factors.
Technique pearls
- Prefer mild self-etch or selective-enamel-etch adhesives on sclerotic dentin.
- Bevel enamel; lightly roughen glossy sclerotic dentin; consider dentin pretreatments per manufacturer IFU.
- Aim for cervical margins that facilitate hygiene and avoid over-contouring to reduce plaque and recession risk. (Contemporary restorative reviews support conservative adhesive approaches.)
★ Combined perio-restorative approach
For NCCLs with Miller/Cairo recession, coordinate CEJ reconstruction + coronally advanced flap; emerging digital guides help position the restorative CEJ and flap precisely with good 1-year stability.
6) Full-mouth Wear—additive rehabilitation first
For generalized erosive/attritional wear, guidelines emphasize prevention, risk control, and additive direct techniques (e.g., Dahl concept, bonded composites) before irreversible crown preparations, reserving ceramic coverage for selected, stable cases.
7) Chairside Flow (print & pin)
1. History + photos + BEWE/indices → classify risk.
2. Stabilize causes: diet/GERD, saliva, brushing & paste, nightguard. Start desensitizing toothpaste.
3. Reassess DH (2–6 weeks): if persists, apply varnish/oxalate/adhesive seal; consider diode laser adjunct.
4. Micro-invasive esthetics: Icon for indicated enamel lesions/WSLs.
5. Restore NCCLs only if pain/esthetics/progression remain*: choose GIC/RMGIC (moisture/challenge) or RC (superior esthetics), with selective-etch on enamel and careful dentin strategy.
6. Perio-restorative plan for lesions with recession; digital CEJ guides can aid precision.
7. Maintenance: 6–12-month wear review with photos (and scans where available); reinforce at-home regimen.
Clinical FAQs (2025)
★ Is abfraction “real”?
Evidence still favors multifactorial cervical loss (erosion+abrasion). Occlusal stress may contribute but is not a sole driver; avoid over-equilibration as a first-line “cure.”
★ Best toothpaste for erosive patients?
Stannous-containing pastes/rinses (e.g., SnF₂) can form protective, acid-resistant layers—use twice daily.
★ Does laser help DH?
Growing RCT-level evidence supports diode laser alone or with fluoride varnish; integrate after home pastes and before drilling.
★ When to choose GIC vs composite for NCCLs?
Similar 4-year performance has been reported; pick based on isolation, sclerotic dentin, esthetics, and occlusal load.
Conclusion
Non-carious lesions are rarely a single-cause problem—and they don’t need a single-shot fix.
The strongest evidence from the last seven years says: screen routinely, stabilize causes first, treat sensitivity stepwise, and use minimally invasive esthetic options before cutting tooth.
When you do restore, adhere to modern cervical bonding protocols and coordinate with periodontics for recession-linked NCCLs.
With preventive chemistry (Sn-based), stepwise DH care (including lasers when indicated), micro-invasive esthetics (resin infiltration), and smart material choices (GIC or composite as context dictates), you can stop progression, preserve vitality, and deliver durable esthetics—without overtreatment.
Key Sources
- Goodacre CJ et al. Noncarious cervical lesions: Morphology and progression. 2023.
- O’Toole S et al. Monitoring of erosive tooth wear: what to use and when. 2023.
- Inchingolo F et al. Advances in preventive and therapeutic approaches for dental erosion. 2023.
- Dionysopoulos D et al. Dentin hypersensitivity: Etiology, diagnosis and management. 2023.
- Briso ALF et al. In-office treatments for dentin hypersensitivity. 2024.
- Naghsh N et al. Gluma vs diode laser for cervical DH. 2024.
- Todorova V et al. 1- and 2-year efficacy of resin infiltration. 2025.
- Zaazou M et al. Icon and color masking. 2024.
- Meral E et al. 48-month GIC vs composite in NCCLs. 2025.
- dos Reis INR et al. 3D-printed multifunctional guide for NCCL + recession. 2025.
