A Systematic review of abfraction in non-carious cervical tooth loss

Objective:  Some clinicians suggested that biomechanical loading forces can cause flexure and failure of enamel and dentine at a location away from the loading. They called it abfraction which is regarded as a cause of non-caries cervical tooth loss. This study aimed to perform a systematic review on the studies on abfraction as a cause for cervical non-carious tooth loss. Method: A literature search was performed by two independent reviewers in March 2014. The PubMed database was searched using the key word ABFRACTION. The title and abstract of the publications identified were screened. Irrelevant papers such as reviews, discussion papers, case reports, clinical treatment, data studies, non-English articles and irrelevant reports were excluded. Full texts of the relevant publications were retrieved. A manual search was performed on the bibliographies of these publications and relevant studies were included in this review. The studies were classified as ‘strong evidence’, ‘some evidence’, or ‘weak or no evidence’ for supporting abfraction as a cause of cervical non-carious tooth loss. If there was disagreement between the 2 reviewers, the papers were discussed with another reviewer to reach an agreement. Results: A total of 105 publications were identified, and 82 of them were excluded after screening. Full texts of the 12 studies and 7 studies identified from the bibliographies were reviewed. There were 7 clinical studies, 8 laboratory studies and 4 studies on finite element analysis. Results of 6 (32%) studies gave strong evidence, and 5 (26%) studies showed some evidence of abfraction as a cause of non-carious tooth loss. However, results of 8 (42%) studies presented weak or no evidence and did not support abfraction as a cause of non-carious tooth loss. Conclusion:  This review found conflicting results from studies and therefore it is inconclusive to determine if abfraction is a cause of cervical tooth loss.