Dental Diseases
Abfraction
aka Stress Lesion · Non-Carious Cervical Lesion (NCCL)
Wedge-shaped cervical lesion thought to result from occlusal stress concentration at the CEJ.
§ figuresFigures (2)
Fig. 1Dental abfraction
“Dental abrasion klinovidny de207” · Финитор · CC BY-SA 3.0 · Wikimedia Commons
Fig. 2Clinical presentation of Abfraction non-carious tooth tissue lesions on the cervical margins of upper left canine and premolar
“Abfraction” · Talkteeth · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Abfraction figures pending faculty review.
§ overviewOverview
Non-carious cervical loss of tooth structure attributed to flexure and fatigue of enamel and dentin from eccentric occlusal loading.
§ icdICD Classification
K03.1
§ etiologyEtiology
- 01Occlusal stress (eccentric loading, bruxism)
- 02Multifactorial (stress + erosion + abrasion)
§ epidemiologyEpidemiology
Common finding; increases with age and bruxism.
§ pathogenesisPathogenesis
Occlusal forces cause tooth flexure → tensile stress at CEJ → enamel prism disruption and microfractures.
§ clinicalClinical Features
- 01Wedge/V-shaped notch at cervical area
- 02Sharp margins
- 03Typically on buccal surface
- 04Commonly on premolars
§ differentialDifferential Diagnosis
- 01Abrasion (softer margins, toothbrush history)
- 02Erosion (smooth, scooped)
- 03Caries
§ investigationsInvestigations
- 01Occlusal analysis
- 02Facet identification for bruxism
§ treatmentTreatment
- 01Occlusal adjustment if indicated
- 02Night guard for bruxism
- 03GIC or composite restoration if symptomatic/progressive
§ complicationsComplications
- 01Sensitivity
- 02Pulp exposure if progressive
§ prognosisPrognosis
Good with occlusal management.
§ examKey Examination Points
- 01V-shaped at CEJ
- 02Often on buccal of premolars
- 03Associated with occlusal stress indicators
§ revisionQuick Revision Summary
- 01Stress-induced flexure at cervical
- 02Multifactorial aetiology
- 03Night guard + restoration
§ vivaBDS Viva Questions
- 01What is the proposed mechanism of abfraction?
- 02How do you differentiate abfraction from abrasion?
- 03What is the role of occlusal splints?
§ mcqsMCQs — Assessment (3)
Question 1
Abfraction lesions are most commonly located:
Question 2
Proposed aetiology of abfraction:
Question 3
Management includes:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- Grippo JO. J Esthet Dent 1991;3:14
- Neville BW. Oral & Maxillofacial Pathology, 4e
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.