Influences of occlusal trauma on the periodontium

Question 1

Define trauma from the oclcusion

Answer 1

“ Trauma from occlusion is used to describe
pathological alterations or adaptive changes
which develop in the periodontium as a result of
excessive occlusal stresses.”

Question 2

Excessive occlusal load occurs due to (2)

Answer 2

Primary occlusal trauma is an injury to periodontium of normal height as a result of excessive occlusal force
Secondary occlusal traum is an injury to a periodontium of reduced height as a results of excessive occlusal load
-i.e. there are two types of traumatic occlusion

Question 3

Aetiology - primary occlusal trauma (4)

Answer 3

1. It can occur where an individual tooth or a group of
   teeth are in premature contact e.g. high restoration, tooth malposition, denture, ortho
2. It may occur where there is ‘parafunction’, eg: Bruxism, Clenching
3. It may occur in conjunction with loss or migration (perio)
   of premolar and molar teeth with an accompanying, gradually developing spread of anterior teeth of the maxilla
4. Occlusal discrepancy e.g. crossbite

Question 4

Aetiology - secondary occlusal trauma (3)

Answer 4

Following periodontal tissue loss NORMAL forces are no
longer tolerated, but may also :
1. involve an individual tooth or a group of teeth which
are in premature contact
2. occur where there is ‘parafunction’, eg: Bruxism,
Clenching
3. occur in conjunction with loss or migration of
premolar and molar teeth with an accompanying,
gradually developing spread of anterior teeth of the
maxilla.

Question 5

Clinical features (6)

Answer 5

Increased mobility
Fremitus: movement of tooth / teeth subjected to functional occlusal forces
Tooth migration
Pain and tenderness
Tooth surface loss
Temporomandibular signs

Question 6

Radiographic features (2)

Answer 6

1. : PDL widening

2. : bone loss and PDL widening

Question 7

Pathogenesis (2)

Answer 7

Abnormal occlusal forces can change the course of plaque-induced perio and cause angular bony defects in teeth with perio (Glickman’s concept)
OR
Angular bony defects and pockets develop equally in teeth with or without occlusal trauma (Waerhaug’s concept)

Question 8

Types of occlusal forces (2)

Answer 8

2 main categories

• ortho type force
• jiggling-type trauma

Question 9

Jiggling-type forces effects (2)

Answer 9

In absence of inflammatory disease, jiggling forces do not affect supracrestal CT attachments an do not cause pocket formation in healthy periodontium. May only cause PDL widening and > mobility as a physiological adaptation
Long term high-intensity jiggling-type trauma to teeth with active plaque-associated inflammatory perio, may act as destructive co-factor and enhance rate of disease progression

Question 10

Tooth mobility

Answer 10

Physiological or pathological
Physiological mobility characterised by > occlusal load and PDL widening **
Pathological/ progressive mobility often associated with actively progressing inflammatory perio and can be characterised by
-> tooth mobility, tooth migration of drifting
-fremitus
-persistent discomfort on eating

Question 11

Management: physiological mobility & normal perio bone height

Answer 11

as well as mobile tooth with > PDL width and < bone height after successful tx of perio can be managed by occusal adjustment if necessary

Question 12

Management of mobile tooth with normal PDL width but reduced height of bone in absence of inflamm perio

Answer 12

Can be managed without any tx if asymptomatic or splinted to adjacent teeth if mobility is causing discomfort for pt

Question 13

Management of teeth with progressive mobility, active bone loss and inflamm disease

Answer 13

Often poorer prognosis and management options include

• maintaining tooth and tx of inflamm perio disease and considering splinting tooth to reduce mobility
• extraction and replacement of tooth

Question 14

Occlusal adjustment (3)

Answer 14

Selective grinding (in ICP and excursions)
Restorations
Orthodontics

Question 15

Spints 94)

Answer 15

Temporary: used for few months during perio healing period
Semi-permanent: used longer before and after regenerative surgery
Permanent: used indefinitely
Fixed or removable
-removable indicated for pts with TMD/ parafunctional habits
-fixed: direct adhesive composite fibre splint; wire splint; indirect cast splint

Question 16

Splint requirements

Answer 16

Incorporate as many firm teeth around the arch
Hold teeth rigid
Not interfere with occlusion
Must not irritate surrounding soft tissues
Designed so it can be kept clean