When Class V cervical lesions are noncarious in nature, they are classified as abfractions, with an appearance characterized by a loss of hard dental structure near the cement-enamel junction. The lesions’ shape may resemble a wedge with an inward-pointing apex.1 The cause of abfractions is thought to be occlusal stress that produces cervical cracks and, subsequently, predisposes the tooth surface to the effects of erosion and abrasion.4 Although critical literature reviews suggest that abfraction is a hypothetical component of cervical wear, it is important to determine causative factors for noncarious lesions, as treatments range from eliminating the aggravating agents to specific restorative procedures.^4,5

Gingival Recession
Typically involving at least one tooth surface, gingival recession can lead to root surface exposure at the gingival margin.⁶ This not only causes aesthetic impairment, but the fear of tooth loss, an increased susceptibility to root caries, and hypersensitivity of the dentin.6 As gingival recession is the displacement of the soft tissue margin, tooth malpositions, high muscle attachment, frenal pull, and occlusal trauma can create the conditions necessary to cause recession and root exposure.⁷ Another less obvious cause, oral jewelry, also has been linked to gingival recession.⁸ Studies have shown that piercings in the lip and tongue lead to localized gingival recession as an adverse consequence.8 In one study, individuals with tongue piercings presented an 11-times greater risk of developing gingival recession over the control group

Traditionally, gingival recession has been treated with laser therapy, autogenous tissue grafting, flap designs, orthodontics, and guided tissue restoration.10 These types of treatments are not only costly and time consuming, but also may require long, painful recovery for patients.¹⁰ 

Laser treatment has been considered by some as the optimal option for correcting and halting gingival recession.¹¹ When gingival recession is observed in a patient with sensitivity caused by an exposed root, lasers have been used to remove the smear layer from the root surface to expose collagen fibers, which is believed to contribute to improved healing.12 Clinical studies, however, have been unable to find any significant improvements in recession and sensitivity from this type of treatment.¹² 

Tissue grafting is also considered one of the few viable treatment options to correct gingival recession.¹³ With the advent of tissue grafting techniques, periodontists have been able to correct gingival recession by grafting a patient’s own oral and mucosal tissues.¹⁴ This type of procedure, however, requires surgery and can be very costly. Whether using an envelope or tunnel technique, the tissue is grafted around the area of gingival recession.^15,16 It is then sutured into place and allowed to heal.¹⁷ A protective mouthpiece is often required to allow the graft site to heal properly.17 Grafting does allow for significant increases in gingival and root coverage and has proven to be very effective as a treatment option.

Another technique for correcting gingival recession is a minimally invasive flap design procedure intended for periodontally involved restorations.¹⁸ It involves cutting the tissue on 3 sides, leaving the base attached, to open the gingival tissue to allow for cleaning of the roots.¹⁸ This procedure often works with guided-tissue regeneration to allow coverage of the root and reduce gingival recession.18 Although this treatment option demonstrates good results, it still involves a surgical procedure and recovery time for the patient.¹⁸

Orthodontics may also be used to correct gingival recession, as conditions such as cross-bites and occlusion are seen as causes.¹⁹ By using orthodontic appliances to correct the abnormalities in bite and occlusion, studies have shown that gingival recession can be stopped and, many times, reversed.¹⁹ These results, however, are typically created through multidisciplinary approaches and not merely with orthodontic treatment and appliances.19 New techniques and materials, which show promising results for root coverage, have proven effective at covering, and in some cases stopping, gingival recession.

As the health and appearance of gingival tissue is important to the aesthetics of a smile, many with noncarious Class V lesions and/or exposed tooth structure from gingival recession wish to have their conditions treated without the cost or inconvenience of invasive methods.²⁰ Used to treat noncarious Class V legions, glass ionomer cements, compomers, and composite resins work alone or in combination to correct the aesthetic issues and prevent further damage.¹ When unaesthetic Class V lesions display caries, a combination of glass ionomer materials for the internal aspects of the restoration and a resin-based composite material for the surface has been advocated.3 This treatment method is believed to provide aesthetic results while increasing the potential for caries reduction.³

The physical properties of resin-based composites allow a bond to tooth structure, with highly aesthetic results, so many practitioners feel that they are the best materials to use when restoring cervical defects.⁵ In a recent study, resin composite restorations that were placed to treat noncarious cervical lesions exhibited no secondary caries and far less deficiencies in marginal adaptation than compomer restorations after 3 years.²¹ There are, however, some challenges in using resin-based composites for Class V lesions.²

When placing resin-based composite restorations in the aesthetic zone, it is good to have an understanding of the composites being utilized, especially with regard to their respective optical and physical characteristics.^22,23 When used and placed properly, the polychromatic effects seen in natural teeth can be replicated.^22,23 More importantly, producing outstanding composite resin restorations is achieved thorough comprehension of natural tooth morphology and how each component of tooth structure affects aesthetics.^24,25



Resin-Based Composites and Gingival Health

In past studies, resin-based composites showed promising results for treating Class V lesions and masking the effects of gingival recession.²⁶ Through observations of composites, it was found that they do not adversely affect gingival health, and that there is typically less inflammatory response to well-finished and contoured composite resins than carious lesions that are left untreated.²⁶Another study, comparing plaque buildup around newer composite resins and conventional composites, found that there was no significant difference in plaque formation of the 2 materials.²⁷ 

Unfortunately, when composite resins are applied to teeth presenting with gingival recession, the resulting tooth-colored restorations tend to make the teeth appear very long, leading to an unaesthetic appearance.²⁷ To correct this issue, the need for resins that are gingival-colored has increased.²⁷ Manufacturers have met this demand, creating products that demonstrate the aesthetics of natural gingival tissue.²⁷ Aside from the aesthetic value of these new materials, the composites also allow for minimally invasive procedures to cover the roots and exposed tooth structure caused by the gingival recession.²⁷ 

These new resin-based composites correct the aesthetic deficits of gingival recession by framing the tooth or teeth with material in a similar pink color to the gingival tissue.²⁰ These gingival-colored composites tend to demonstrate greater color stability and resistance to wear.20 When used in collaboration with the new generation of bonding agents, which enable bonding to metal, porcelain, enamel, and dentin, gingival-colored composites have been proven to enhance the smiles of patients with gingival recession.²⁰ More importantly, this treatment option provides a clinical solution for patients that is aesthetic, economical, and practical.²⁷ 



Aesthetic Gingival Composite Resins

An aesthetic gingiva-shaded light-cured composite resin (Amaris Gingiva [VOCO America]) was recently introduced, providing practitioners with the option of correcting gingival recession with a minimally invasive and less costly procedure. This pink-colored composite (available in one translucent gingival color and 3 pink flowable opaquers that can be mixed together to better match an individual’s gingival shade) was specifically developed for indications in the cervical area, including composite restorations in gingival colors, V-shaped defects, exposed cervical areas, aesthetic corrections of the gingiva area, primary splinting, and the correction of red/white aesthetics. This restorative material also gives the clinician the ability to mask exposed crown margins to improve aesthetics and patient satisfaction.