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Attrition Abrasion Corrosion and Abfraction Revisited
Attrition Abrasion Corrosion and Abfraction Revisited
physiologist John Hunter in 1778,1 the definitions and classification of the terms attrition,
abrasion and erosion have been in a state of
confusion. Furthermore, the more recent introduction of
the terms abfraction, to designate
2
Understanding the stress-induced noncarious lesions, and
3
pathodynamic corrosion, to designate chemical
degradation have not resolved this
mechanisms of
dilemma fully. During the two centuries
tooth surface that have ensued since Hunter publesions and their lished his work, a succession of investimany possible gators4-14 have unsuccessfully
interactions will approached the problem of tooth surface
enable the denudation or wasting, using terms
and definitions that were mutually
practitioner
contradictory.
to make
In the 1960s, investigations into the
an accurate etiology of tooth surface lesions by
differential German investigators15-18 generated
diagnosis and to renewed interest in these pathological
provide effective lesions. More recently, American, Australian, English and Japanese investigaprevention and
tors19-32 also have addressed the mechatreatment. nism of stress concentration in the
IO
N
Attrition, abrasion,
corrosion and
abfraction revisited
ABSTRACT
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BOX
PATHODYNAMIC MECHANISMS
OF TOOTH SURFACE LESIONS.
INDIVIDUAL
dAttrition-abfraction
dAbrasion-abfraction
dCorrosion-abfraction
dStatic stress corrosion
dCyclic (fatigue) stress corrosion
dAttrition-corrosion
dAbrasion-corrosion
dBiocorrosion (caries)-abfraction
MULTIFACTORIAL
C L I N I C A L
P R A C T I C E
TABLE
Corrosion (Chemical
Degradation)
Endogenous
Exogenous
Friction (Wear)
Endogenous (attrition)
Exogenous (abrasion)
ETIOLOGIC FACTORS
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STRESS
[Microfracture/
Abfraction]
COMBINED
MULTIFACTORIAL
FRICTION
[Wear]
COMBINED
COMBINED
CORROSION
[Chemical
Degradation]
multifactorial in nature.
Attempts at differential diagnosis, which gives primacy to a
single mechanism, are likely to
fail because they miss the interactive synergy of the various
coactive mechanisms. Understanding the multifactorial
nature of these lesions will assist
the clinician in developing a multifaceted approach to their prevention, diagnosis, treatment and
control. From a heuristic standpoint, we hope that use of the
schema will lead to research that
can pinpoint precisely which etiologic factors are active in any
given lesion and the extent or
significance of the specific factors
involved (Table).
CONCLUSION
Endogenous
Parafunction
Occlusion
Deglutition
STRESS
[Microfracture/
Abfraction]
COMBINED
Exogenous
Mastication
Habits
Occupational
Behaviors
Use of Dental
Appliance
Endogenous
Plaque
Gingival Crevicular
Fluid
Gastric Juice
MULTIFACTORIAL
FRICTION
[Wear]
COMBINED
COMBINED
CORROSION
[Chemical
Degradation]
Exogenous
Diet
Occupational Exposures
Use of Certain Drugs or Alcohol
Endogenous (Attrition)
Parafunction
Deglutition
Exogenous (Abrasion)
Mastication
Dental Hygiene
Habits
Occupational Behaviors
Use of Dental Appliances
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We feel that our proposed definitions of the mechanisms responsible for tooth surface lesions will
simplify and clarify dentistrys
understanding of the etiology of
both carious and noncarious
lesions. In light of evidence
gleaned from recent scientific
studies, it is incumbent that dentistry should achieve a common
language with our sister sciencesespecially the rapidly
emerging fields of biomedical
and biodental engineeringand
use more precise definitions and
terminology.
The mechanisms of stress, corrosion and friction appear to be
critical factors in the etiology and
progression of tooth surface
lesions. The pathodynamic
schema we present here can
become an effective guide for the
clinician in evaluating the many
clinical situations encountered.
It also may guide the researcher
to elucidate the impact of individual mechanisms and their
many possible interactions.
Understanding these mechanisms, their interactions and
C L I N I C A L
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