09/29/2026
Noncarious Cervical Lesions, NCCLs: Causes, Abfraction, Occlusion, Gingival Recession, and When to Restore. A wedge shaped cervical lesion appears on a premolar. One dentist sees toothbrush abrasion. Another sees erosion. Another sees abfraction from occlusal stress. The evidence suggests the answer is usually more complicated.
The safest term is noncarious cervical lesion, or NCCL. Current literature supports a multifactorial model involving chemical degradation, mechanical wear, brushing behavior, dietary or gastric acids, tooth position, periodontal anatomy, and possibly occlusal loading.
Occlusion remains controversial. Teeth flex under load, and some studies associate NCCLs with wear facets, parafunction, and heavy contacts. But association is not causation. Clinical evidence has not established occlusal stress as an independent cause, and the classic abfraction mechanism remains unproven.
The same caution applies to toothbrushing. Aggressive brushing may contribute, especially to acid softened tooth structure, but it does not explain every lesion.
So look beyond the defect. Ask about acidic drinks, reflux, xerostomia, brushing technique, dentifrice, parafunction, tooth position, recession, and sensitivity.
Then ask the most important question: Does this NCCL actually need to be restored? Many do not. Stable, cleansable, asymptomatic lesions with little structural risk can often be monitored. Consider restoration when there is documented progression, sensitivity, esthetic concern, plaque or food retention, loss of cervical anatomy, or structural risk.
When restoring, remember that NCCLs often contain sclerotic dentin with limited enamel and difficult isolation. A cervical composite that debonds does not prove tooth flexure caused the failure.
Gingival recession should also be evaluated separately. Recession and NCCLs frequently coexist, but one does not automatically cause the other. Some cases require periodontal treatment, some restorative treatment, and deeper combined defects may require both.
