Etiology and treatment of root hypersensitivity

Class V cervical lesions are often observed in older patients during their treatment planning phase, resulting from root caries, toothbrush abrasion, chemical erosion, or to absraction due to unusual tooth flexure. Besides providing a nuisance space as a food trap or plaque buildup, patients also complain of hypersensitivity to air blasts, mechanical stimulation, thermal extremes, or to osmotic fluid shifts. The location of the root lesion in relation to the cemento-enamel junction is of extreme importance. For that reason root lesions limited to the coronal portion of the tooth and completely surrounded by enamel lend themselves to traditional restorative treatment procedures. However, as the root lesion moves apically and its cavosurface circumference is increasingly bound by cementum, clinical treatment becomes much more difficult and in most cases virtually impossible with conventional retentive restorations, and they tend to threaten the root structure and the dental pulp. If these root lesions are left untreated, progressive destruction of root structure occurs and if the causative agents are not removed, the depth of the lesion will threaten the periodontium, dental pulp, and the occlusal integrity of the tooth crown. In addition, cemental lesions are often associated with increased levels of hypersensitivity. Historically, dentistry treated root lesions with direct gold, gold or porcelain inlays, amalgam alloys and crowns, all relying on resistance and retention form. When unrestorable, modification of tooth-brushing techniques along with desensitizing agents were the only desirable treatment due to problems involved with the insertion of a proper restoration. Clinical studies have reported these procedures are often transient, offering no durable restoration of the tooth or elimination of the hypersensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)