*01/28 - Treatment of Trauma from Occlusion Flashcards
What are the clinical signs of occlusal trauma?
- progressive tooth mobility
- teeth moving teeth (fremitus and functional mobility)
- pathologic migration (supraeruption)
- infrabony pockets (controversial)
- buttressing bone (controversial)
- flaring and heavy contact (?)
What are the radiographic signs of occlusal trauma?
- widened PDL space and/or thickened radiographic lamina dura
- trabecular bone (hypofunction and hyperfunction)
- angular bone loss and furcations (controversial - may be due to tooth and bony anatomy and progression of inflammatory periodontal disease)
What is the difference between primary and secondary trauma from occlusion?
- PRIMARY: excessive force on a normal periodontium
- SECONDARY: normal (or excessive) force on a weakened periodontium
Describe the role of occlusal trauma in the pathogenesis of periodontal disease.
CO-DESTRUCTION THEORY OF TRAUMA FROM OCCLUSION - periodontal disease may find a pathway into the PDL with occlusal trauma; expected periodontal bone loss (horizontal) will change (more angular)
What are the objectives in occlusal adjustment?
- occlusal stability over time
- axial loading of forces
- anterior guidance in excursions
- smooth gliding unrestrained
What are the reversible methods of occlusal therapy?
- night guard (bite plane)
- extracoronal splints
- muscle relaxants (medications)
- muscle exercises
What are the irreversible methods of occlusal therapy?
- intracoronal splints (require tooth preparation)
- occlusal adjustment by selective grinding
- orthodontics
- orthognathic surgery
What are the indications for selective grinding?
- periodontal occlusal trauma
- post-orthodontics (fine-tuning)
- prior to extensive restorations
- certain types of TMD
- certain wear patterns
What are the contraindications for selective grinding?
- severe malocclusion
- non-ideal but well-tolerated occlusion
- severe wear or if occlusal adjustment would expose dentin
- patient in pain
- if no suitable end-point can be reached (because of malocclusion or tooth malposition)
What are the general concepts of occlusal adjustment?
- long centric (so that CR-to-CO is not an inclined deflective contact)
- axial loading of forces (to prevent “jiggling” bucco-lingual forces)
- reduction of wear facets by: grooving, spheroiding, and pointing
- NO non-working (“balancing”) contacts
- working contacts canine guided, if possible (group function, if needed)
- protrusive anterior contacts (NO posterior contacts)
What are the steps in occlusal adjustment by selective grinding?
- CR-CO hit-and-slide –> eliminate or reduce
- non-workin side (“balancing”) interferences –> eliminate
- working contacts –> canine guided, smooth, and gliding
- protrusive contacts –> anterior
- sharp or irregular incisal edges –> recontour
- polish all teeth that were adjusted
What are the indications for periodontal splints?
- to immobilize excessively mobile (class II or III mobility) teeth by sharing forces with more stable teeth
- to stabilize teeth in their new position after orthodontic treatment
True or false: Periodontal splints stabilize teeth while lessening the tooth’s mobility once the splint is removed.
FALSE: They do not decrease individaul tooth mobility once the splint is removed.
What are the 4 types of periodontal splints?
- provisional extracoronal splints (no tooth prep)
- provisional intracoronal splints (tooth prep required)
- permanent extracoronal splints (no tooth prep)
- permanent intracoronal splints (tooth prep required)
What category do these periodontal splints fall into?
- wire and acrylic/composite splints
- acid etch composite splints
- mesh splints attached by composites
- cast splints attached by composites (“Maryland-bridge type”)
provisional extracoronal splints
