*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
What category do these periodontal splints fall into?
- swing-lock partial denture
- bite-plane
permanent extracoronal splints
What category do these periodontal splints fall into?
- amalgam/composite reinforced splint
- provisional crowns splinted together
provisional intracoronal splints
What category do these periodontal splints fall into?
- long-term cross-arch splinting - fixed
permanent intracoronal splints
True or false: When doing selective grinding, you should NEVER cut the crown height (cusp tips) to adjust occlusion.
true
When should you perform limited occlusal adjustment?
best time is after initial therapy because the mobility of the tissue will decrease when there is less inflammation
