Exam 2 - Trauma/Restoration relationships

Question 1

Define Trauma from occlusion

Answer 1

Defined as damage to the periodontium caused by stresses on the teeth produced directly or indirectly by teeth in the opposing jaw.

• *Considered to be pathologic
• *Forces of occlusion that exceed the adaptive capacity of the periodontium

Question 2

Variables in the relationship of occlusal trauma to periodontal disease

Answer 2

1. Direction of force
2. Magnitude of force
3. Duration of force
4. Frequency of occurrence

Question 3

Parts of the periodontium affected by occlusal forces

Answer 3

1. Cementum
2. PDL
3. Alveolar bone proper

*gingival and JE are NOT affected by occlusal forces

Question 4

7 Clinical symptoms of occlusal trauma

Answer 4

1. Mobility of affected teeth
2. Radiographic evidence of thickened PDL
3. Positive Hx of clenching or bruxism
4. Missing or tilted teeth
5. Evidence of working and/or balancing side occlusal interferences
6. Evidence of occlusal slide in centric relation or centric occlusion (CR/CO)
7. Evidence of occlusal interference in protrusive mandibular movement

Question 5

What is Fremitus:

Answer 5

A tremulous vibratory movement of a tooth when teeth come into functional contact - generally detected by finger palpation

Question 6

5 characteristic of trauma from occlusion on the compression side

Answer 6

1. Compression of PDL fibers with initial decrease in width of PDL space
2. Loss of fiber orientation
3. Rupture of capillaries and hemorrhage into PDL perivascular spaces
4. Resorption of alveolar bone proper followed by widening of PDL space
5. If severe, root resorption may occur

Question 7

5 characteristics of trauma from occlusion of the Tension side

Answer 7

1. Tension (stretching) of fibers with initial increase in PDL space
2. Rupture of PDL fiber bundles
3. Compression of PDL capillaries and hemorrhage into PDL perivascular spaces
4. Apposition of new alveolar bone proper followed by decrease in PDL space
5. Cemental tearing

Question 8

Define Primary occlusal trauma

Answer 8

Occurs when occlusal forces are EXCESSIVE and the amount of alveolar bone support is NORMAL

Question 9

Define Secondary occlusal trauma

Answer 9

Occurs when occlusal forces are NORMAL or EXCESSIVE and the amount of alveolar bone support is REDUCED

Question 10

Define Occlusal Hyperfunction

Answer 10

Slight increase in occlusal force

* Considered to be a physiologic adaptation and not a pathologic entity

Question 11

Describe the histology and clinical characteristics of Occlusal hyperfunction

Answer 11

1. Increase in number and diameter of collagen fiber bundles in PDL
2. Increased width of PDL
3. Increased density and thickness of alveolar bone proper (lamina dura)
4. Radiographic evidence of osteosclerosis of alveolar bone with PDL insertions
5. Slight or undetectable tooth mobility

Question 12

What is Occlusal Hypofunction

Answer 12

1. A mild weakening of the tooth supporting structures due to lack of physiologic stimulation
2. Considered to be a physiologic adaptation and not a pathologic entity

Question 13

How is occlusal hypo function diagnosed?

Answer 13

Only by the histology

Question 14

Describe the histology of Occlusal hypofunction

Answer 14

1. Decrease in number of PDL fiber bundles but normal orientation
2. Decreased physiologic turnover and remodeling of alveolar bone
3. Narrowing of PDL space
4. No change in tooth mobility

Question 15

What type of adaptation is disuse atrophy?

Answer 15

Considered to be a physiologic adaptation rather than a pathologic feature of disease

Question 16

What is disuse atrophy

Answer 16

Total removal of occlusal forces resulting in lack of the level of physiologic stimulation required to maintain normal form and function

Question 17

Histologic and clinical characteristics of disuse atrophy

Answer 17

1. Radiographic evidence of decreased width of PDL space
2. Increased tooth mobility is always present
3. Absence of occlusal antagonist
4. Loss of orientation of the principle fiber bundles of the PDL
5. Significant decrease in number of bony trabeculae

Question 18

Trauma from occlusion, in the absence of inflammation, does not cause what?

Answer 18

1. Gingivitis
2. Periodontitis
3. Pocket formation

Question 19

If bone loss is the result of periodontitis in the presence of occlusal trauma, is it positive to remove the occlusal trauma?

Answer 19

Not necessarily, the removal of occlusal trauma will not result in regeneration of crestal bone

Question 20

Are bone alterations reversible when they resulted from occlusal trauma

Answer 20

Yes

Question 21

If bone loss is the result of periodontitis in the presence of occlusal trauma, what occurs if removal of both factors is carried out?

Answer 21

A remarkable, but not complete, regeneration of bone

Question 22

T or F, Periodontitis with superimposed occlusal trauma produces less bone loss than periodontitis alone

Answer 22

False, More

Question 23

Define Iatrogenic disease

Answer 23

The creation of additional problems or complications as a result of treatment

Question 24

T or F, Restorations placed in the mouth have negative effect on periodontal health

Answer 24

True

Question 25

3 main points of clinical research on the association of restorative dentistry and poor periodontal health

Answer 25

1. Gingival margin overhangs of inter proximal restorations are associated with periodontal pockets that are deeper than sites with no restoration
2. Gingival inflammation and plaque retention scores show significant decreases following removal of the overhang
3. Gingival margin overhangs are associated with:
   
   • gingival inflammation
   • bone loss
   • microbial plaque and calculus accumulation

Question 26

Force vectors outside the long axis of the roots tend to produce what?

Answer 26

A rocking motion and vertical bone loss