9A. Occlusal Trauma Flashcards
Occlusal Trauma Clinical Symptoms • Awareness of \_\_\_\_ teeth • Tooth migration or Increased Spaces • \_\_\_\_ of periodontal structures • Sensitive teeth (temperature, pressure pulpitis) • \_\_\_\_ or Myofacial pain • None
loose
soreness
TMJ
Occlusal Trauma Clinical Signs • \_\_\_\_ • Tooth Migration • \_\_\_\_ Wear • Fracture • \_\_\_\_ • Restorative Failure • Implant Failure
mobility
abnormal
abfraction
Checking ____
FREMITUS • \_\_\_\_ patterns of teeth; it is examined by placing \_\_\_\_ finger over maxillary teeth and feeling degree of vibration present during various jaw and glide movements • Classified as Class I - \_\_\_\_ Class II - \_\_\_\_ Class III - \_\_\_\_
mobility index slight moderate visible
Root Fracture
• Root fractures can occur in patients where the teeth undergo trauma
• If a patient has a normal periodontium and you don’t find any ____, but then all of the sudden you fall into a 10mm deep pocket, there is a
high likelihood that it is related to a root fracture
• If it simply a periodontal pocket, we can treat it/correct it
• If it is a root fracture, it is hopeless (no treatment). We must make the correct diagnosis! It is tough bc they don’t show up on ____ well. May need to reflect tissue back to make the diagnosis, then remove the tooth and do bone grafting so we can do an implant in the future
pockets
radiograph
ABFRACTION
• Abfraction are these notches that occur in the ____ area
• These are poorly understood
– thought to be a result of excessive ____ causing flexing at the neck of the tooth, breaking down
the tooth structure
• Thought to be related to ____
CEJ
pressure
bruxism
ROOT RESORPTION
- Root resorption can occur due to orthodontic treatment (note how short the roots are here)
- This can be a result of ____ treatment (too much force, treatment was too prolonged)
- Can get ____ root resorption (shown here), or you can get ____ root resorption (next slide)
too
apical
cervical
Root Resorption
- Root resorption is a process where the bodies own cells start to eat away at the root surface
- Just like with caries, root resorption results in a hole. But it is a completely different process (it is ____, and body cells are eating into the ____ structure)
- We may be able to restore some of these if they are not too bad (we use materials compatible for the ____ environment, we do a flap, and try to place MTA, etc.)
- DIFFICULT to treat!
sterile
root
subgingival
Occlusal Trauma Radiographic Signs • \_\_\_\_ PDL • Vertical Bone Loss • Loss of \_\_\_\_ • Osteosclerosis Buttressing Bone • Altered \_\_\_\_ pattern • Root Resorption
widened
lamina dura
trabecular
Occlusal Trauma Radiographically
- This bridge was hitting hard/high. Note the widened ____, and the dense bone. When astronauts go to space, there is no gravity pressure on the bone. If you put excessive pressure on bone, it builds bone density
- The dense bone is known as ____ bone and is just the bodies response to what is going on
- The neighboring tooth has a well defined ____ around it, whereas the affected tooth does not
PDL
buttressing
lamina dura
Buttressing bone
• The dentist saw what looked like a periapical lesion (red arrow), and referred them to have a root canal. The root canal was done (see right pic) but the patient was still in pain. So they were referred to him (periodontist)
- The problem turned out to be the tooth ____ it (it is hard for patients to determine where the pain is coming from)
- The wide ____/____ indicates it is trauma (as opposed to an endo lesion)
behind
PDL
buttressing bone
Occlusal Trauma Histologically Effects the Attachment Apparatus
• Periodontal Ligament
Wide ____ ,Edema, ____, Hemorrage, fibrosis
• Cementum
____ Resorption, cemental tears
• Alveolar Bone
____, Apposition,
PDL
necrosis
root
resorption
This is a monkey. Note we are looking at two teeth, and shown here (yellow arrow) is the septal bone between two teeth
We will look at NORMAL, and then the changes that occur due to PERIODONTAL DISEASE/OCCLUSAL TRAUMA
There are trans-septal fibers (which cover the septal bone)that go from CEJ to
Root surface
CEJ (they are attached right at or below the CEJ)
• Within the sulcus (with JE) is purple. This purple area is ____ cells (we
will always see these, even in a healthy sulcus). These fight off the bacteria that
get into the sulcus
• Keep this picture in mind…we will then see what happens when there is trauma.
inflammatory
- You apply pressure to the tooth/root, compressing the ligament. Note this is what occurs with ____ treatment (ortho is a controlled form of occlusal trauma)
- Compressing of the PDL, and you start getting ____ that line up and remove the bone, making room for the tooth to move, or to widen the PDL.
- There is also a signal sent within the ____ that causes some undermining resorption.
ortho
osteoclasts
bone marrow
• This is an example of occlusal trauma
• Widening of the PDL, resorption, and you see less of the bone within this area
• Where is the attachment? It is still up at the CEJ. Important to
distinguish that they’ve lost ____, but NOT ____
• If you take a radiograph, you might see the bone is lower, so you assume it’s periodontal disease. But this is NOT ____ disease, it is what you’d expect with ____ trauma
bone
attachment
perio
occlusal
- What happens when you stop the trauma (take braces off, or patient is no longer bruxing, etc.)?
- Bone regrows and ____. You can see it looks like tree rings (note the yellow arrow pointing to ____ where bone is reforming)
- The ligament becomes ____ again, as well as the ____ spaces
- If this did not occur, we could never do braces!
recalcifies
laminar lines
narrow
haversian
• You can create periodontal disease in an experimental animal by tying silk ligatures around the teeth that harbor dense bands of bacteria
- Note the attachment loss on the left, whereas the attachment on the right side is normal
- On the left, if you put a perio probe in, you’d fall really deep, but on the right you have a normal pocket (orange arrows)
- The loss of attachment is due to ____ disease (loss of bone and loss of attachment are not the same thing)
periodontal
- Here we have experimental periodontal disease, but he also put separators between the teeth to displace them. The tooth becomes high, causing occlusal trauma
- This is combining occlusal trauma + periodontal disease
- RIGHT SIDE: Example of normal (normal ligament, attachment is at the CEJ)
- LEFT SIDE: periodontal disease (presence of a ____, as well as a widened ____) as well as ____ loss
- So the bone is being attacked both from ____ as well as the ____ process (cofactors of destruction).
- Occlusal problems do not cause ____ disease. But if you have periodontal disease with trauma, the disease may be more severe
pocket PDL bone trauma disease periodontal
- This patient has both perio disease + occlusal trauma
- It looks like there is no bone at all (yellow arrow), but when he probed it did not feel like he was going all the way down to the apex. So he thought some of what he was dealing with was due to occlusal trauma
- Here is the patient 23 years later (they were able to save the teeth)
- So despite the bone loss/loss of lamina dura, they were able to ____ the teeth
- Formation of ____ indicates that the bone is stable.
- He does not look at the level of bone as much as he does the health. Even if the bone level is low, if it is ____ (no bleeding, no excessive depth, presence of lamina dura) then it can usually be maintained. This case is an example
save
lamina dura
healthy
- You can change the ____ of the periodontal pockets by moving the teeth.
- We haven’t actually grown more bone to fill the pocket, but rather it is an anatomical thing
- If the tooth is at an angle and there is a deep pocket, as the tooth begins to go ____, the point of attachment remains constant (you can level periodontal pockets/defects by changing tooth position)
morphology
upright
