A proposed mechanism for non-carious cervical lesions, root resorption and abutment screw loosening

Abstract

Objectives The purpose of this paper is to present a mechanism for the shared etiologies of non-carious cervical lesions (NCCLs), orthodontics-associated root resorption and implant abutment screw loosening. These are persistent clinical problems with equivocal etiologies. Methods A matched pair of 1st molar denture teeth was set into occlusion within a testing apparatus. The weighted maxillary assembly, guided by slides, was cyclically lowered onto, and raised from, the mandibular tooth. The forces and moments on the mandibular tooth were continuously recorded by a load cell. The maxillary crown was rigidly fixed (ankylosed or implant supported). The mandibular tooth was rigidly fixed or supported by a PDL analogue. For statistics, 21 occlusal relationships were tested. Results The measurements confirmed earlier non- and counter-intuitive results. The directly relevant data were that the measured loads on the tooth, during the span of an individual chomp, are characterized by a wide range of magnitudes and directions. Moreover, these load profiles change with rigid vs. PDL support (p = 0.001), occlusal relationship (p < 0.001) and occlusion vs. disclusion (p = 0.002). Conclusion The demonstrated transient loads within the span of a single chomp produce complex mechanical environments. Thus, it is proposed that NCCLs, orthodontic root resorption and abutment screw loosening result from load component combinations, not from solitary occlusion forces as typically applied in experimental and numerical investigations. In principle, the loading combination concept applies to all phenomena that involve occlusal contacts, including occlusal trauma, implant loading, jaw fracture repairs, etc.