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Am J Dent. 2017 Aug;30(4):212-220.

Occlusal stress is involved in the formation of non-carious cervical lesions. A systematic review of abfraction.

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Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.



This systematic review on abfraction studied whether stress is a mechanism in the formation of non-carious cervical lesions (NCCLs).


A literature search was performed on three electronic databases (PubMed, ISI Web of Science, and EMBASE) using the keyword "abfraction" in publications published in English. The inclusion criteria were clinical and laboratory studies that investigated the role of abfraction in NCCLs. The title and abstract of the identified publications were screened by two investigators independently. Reviews, case reports, and irrelevant papers were excluded. Full text of the remaining publications were retrieved. A manual search was performed on the bibliographies of the selected publications to identify additional relevant publications for review.


A total of 372 publications were identified, and 165 duplicated publications and 166 irrelevant publications were excluded. From the bibliographies of the remaining 41 publications, 28 relevant publications were found. Therefore, 69 publications (31 clinical studies and 38 laboratory studies) were included in this review and the majority (56/69, 81%) found an association between occlusal stress and NCCLs. Although no clinical study demonstrated that NCCL was caused by stress alone, 23 studies reported that stress or occlusal factors were associated with NCCLs. Of the 38 laboratory studies, 24 that used finite element analysis found that stress was concentrated at the cervical region of the tooth. Nine laboratory studies suggested that stress was a mechanism for NCCLs, whereas five studies reported the opposite. In conclusion, current literature supported an association between occlusal stress and NCCLs.


This systematic review of abfraction found the majority of studies reported an association between occlusal stress and non-carious cervical lesions.

[Indexed for MEDLINE]

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