Widening of PDL Increased mobility Root resorption Angular bony defects Bone condensation

Occlusal Trauma Flashcards by David Dunbar

Fan and Caton 2018

Excessive occlusal force: “Occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus, which results in occlusal trauma and/or causes excessive tooth wear.”

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Primary occlusal trauma

Tissue damage from excessive occlusal forces applied on a tooth with normal periodontal support.

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Secondary occlusal trauma

Tissue damage from normal occlusal forces applied on a tooth with inadequate periodontal support.

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, when the crown is subjected to excessive, non-axial (horizontal) forces, pressure and tension zones will develop

(Carranza 2015)

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Pressure zone

the periodontal ligament fibers display disorganization and decreased fiber production, cell production will decrease in the pressure side. These changes will eventually lead to increased vascularization and permeability, hyalinzation and necrosis of PDL fibers, hemorrhage and bone resorption should be expected, and in some cases root resorption and cemental tears.

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Tension zone

stimulated PDL fibers stretch resulting in increased fiber production, alveolar bone and cementum deposition

(Carranza 2015) (Fan and Caton 2018)

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Fan and Caton 2018

TFO requires histologic confrimation for true diagnosis

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Glickman 1965

TFO

Widening of PDL
Increased mobility
Root resorption
Angular bony defects
Bone condensation

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Ramfjord & Ash 1981

TFO

Increased mobility, discomfort

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Fan and Caton 2018

Proposed clinical and radiographic signs of TFO

Fremitus
Mobility
Occlusal discrepencies
Wear facets
Tooth migration
Fractured tooth
Thermal sensitivity
Discomfort/pain on chewing
Widned PDL space
Root resorption
Cemental tear

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Excessive occlusal force:

Occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus, which results in occlusal trauma and/or causes excessive tooth wear.” (Fan and Caton 2018)

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Primary occlusal trauma

Tissue damage from excessive occlusal forces applied on a tooth with normal periodontal support.

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Secondary occlusal trauma:

Tissue damage from normal occlusal forces applied on a tooth with inadequate periodontal support.

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Pressure zone

Carranza 2015

PDL fibers necrose from too much pressure. Bone resorption and root resorption can occur.

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Tension zone

Carranza 2015

PDL thickening with increased fiber production, bone and cementum deposition

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TFO requires what for confirmation/diagnosis

Histology (Fan and Caton 2018)
We use clinical and radiographic signs as a proxy

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Glickman 1965

Radiographic and clinical signs and symptoms of TFO

Widening of PDL
Increased mobility
Root resorption
Angular bony defects
Bone condensation

Ramfjord and Ash 1981

Radiographic and clinical signs and symptoms of TFO

Increasing mobility
Persistent discomfort or tenderness reported by the patient
Radiographic signs of bone resorption +/- root resorption

Fan and Caton 2018

Radiographic and clinical signs and symptoms of TFO

Fremitus
Mobility
Occlusal discrepencies
Wear facets
Tooth migration
Fractured tooth
Thermal sensitivity
Discomfort/pain
Widened PDL space
Root resorption
Cemental tear

Jin and Cao 1992

cross sectional human study

**Trauma from occlusion index:
**Signs: widened PDL and fremitus, increased CALoss, less bone height and deepr PD
Result: Susceptible to TFO

**Adaptability index:
**Sings: Wear facets, thickened lamina dura. less CALoss, more bone height
Result: Resistant to TFO

Karolyi 1901

Teeth with excessive forces have more periodontal disease

Gotlieb and Orban 1931

Dog study

Concluded TFO did not cause periodontitis

induced occlusal forces in dogs did not result in CALoss

Glickman’s camp for TFO

Occlusion acts as a co-destructive factor in periodontal disease

Glickman 1963

Glickman 1963 | Glickman camp (co-destruction)

**Zone of irritation:** marginal gingiva, papillae. Local irritants cause inflammation **Zone of co-destruction:** supporting PDL, alveolar bone and cementum. Inflammation and occlusionare co-destructive factors. TFO alone does not cause periodontal disease, just worsens it.

Glickman and Smulow 1965 | Glickman camp (co-destruction) ## Footnote human histologic study of 3 human jaws

* They concluded that when inflammation is confined to the marginal gingiva and transseptal fibers, **TFO has no influence**. * When the inflammation extends beyond the confines of marginal gingiva, TFO can act as **a co-destructive factor in the periodontal disease.**

Glickman 1967 | Glickman camp (co-destruction) ## Footnote Review

TFO is reversible, and results in angular defects

Lindhe and Svanberg 1974 | Glickman camp (co-destruction) ## Footnote 6 beagle dogs, Ligature induced periodontitis, histology

* Horizontal bone loss in perio group and perio+TFO group * Angular defects ONLY in TFO+perio group

Nyman 1978 | Glickman camp (co-destruction) ## Footnote 5 dogs, jiggling forces with ligature induced perio

Jiggling forces caused increased mobility, 8/10 test teeth showed CALoss

Waerhaug 1979a | Waerhaug camp (TFO is not a factor in perio) ## Footnote Cadaever study

Bone loss related to plaque downgrowth vertical defects found equally in TFO and nonTFO groups Distance from PDL to apical border of plaque called **plaque free zone** esd 0.2-1.8mm

Waerhaug 1979b | Waerhaug camp (TFO is not a factor in perio) ## Footnote Human study

Plaque free zone was 0.2-2.2mm Apical border of plaque to oposite wall of infrabony defect is 1-3mm TFO not a factor

Polson 1974a | Waerhaug camp (TFO is not a factor in perio) MAIN SUPPORTER ## Footnote Monkey study (n=28), ligature induced perio

Angular defects around ligatures, not from Thermal trauma

Polson 1974b | Waerhaug camp (TFO is not a factor in perio) MAIN SUPPORTER ## Footnote squirrel monkey study

toothpick wedging group had similar PDL width as only ligature perio group No sig diff in disease progression between groups

Polson and Zander 1983 | Waerhaug camp (TFO is not a factor in perio) ## Footnote Monkey study with orthdontic jiggling forces

Alveolar bone height was SSD reduced in jiggling group Tooth mobility also greater in jiggling group CT attachment showed no SSD

Waerhaug vs Glickman differences

(G) had longer studies (6 months) vs 10 weeks (W) (G) used infrabondy defects. (W) had supracrestal defects G had heavy forces for short period W had light forces for 2 days (long)

Nunn and Harrel 2001 | 2 part study ## Footnote Effect of occlusal discrepencies on periodontitis

* There’s a** sig, association** between **occlusal** **discrepancies** and **mobility**, +/- Periodontitis * There is a strong association between occlusal discrepancies and clinical parameters indicative of periodontitis such as pocket depth (SS), worse prognoses (SS) * * Teeth treated for occlusal discrepancies had **sig. deeper PDs/ year** compared to those without and teeth which were treated.

Harrel and Nunn 2004 ## Footnote The effect of occlusal discrepancies on gingival width

* NSSD between the presence of occlusal discrepancies and occlusal therapy and gingival width (KT= FGM-MGJ)

Harrel and Nunn 2009 ## Footnote The effect of occlusal discrepancies on probing depth

* Occlusal discrepancies were sig. associated with deeper PD and the assignment of less than “Good” prognosis

Ericsson & Lindhe 1977 | dog study, jiggling forces ## Footnote The effect of plaque and physical stress on periodontal tissues

* Traumatic occlusion did not initiate destruction in reduced but non-inflamed periodontium * There was no apical migration of JE caused by traumatic occlusion

# How would normal/excessive occlusion affect implants? Berglundh et al 2005 ## Footnote 6 beagle dog study

* Functional loading may enhance osseointegration, and does not result in marginal bone loss (MBL)

# How would normal/excessive occlusion affect implants? Isidor 1996 ## Footnote 4 monkeys

* No loss of osseointegration observed in implants w/plaque accumulation. * Loss of osseointegration observed in implants w/ occlusal load.

# Splinting mobile teeth? Schulz et al in 2004

there is no significant difference (NSSD) in PPD, CAL gain and horizontal mobility if splinting was done** post-surgically** compared to non-splinted teeth **pre-surgical splinting** resulted in statistically significant (SS) better PPD reduction, CAL gain and reduction on horizontal mobility compared to non-splinted and pos-sx splinted teeth

# Occlusal adjustment: Burgett et al 1992

investigated the effect of adjusting occlusal discrepancies following SRP +/- Modified Widman flap and **found that occlusal adjustments improved CAL gain compared to not**