Occlusion and Perio Flashcards
State some features of an ideal occlusion
- Posterior stability
- Anterior guidance maintaining posterior disclusion on excursions
- Canine guidance and group function
- Mutual protection
State some signs of significant occlusal disorder
- Repeated fracture of teeth or restorations
- Repeated debonding of adhesive restoration
- Repeated loss of cementation of indirect restorations
- Drifting or mobility of a tooth, or group of teeth
- Attrition of the functional surfaces of teeth
- Signs or symptoms from the TMJs or associated musculature
How long after perio surgery may a patient feel some mobility? Why is this?
6-8 weeks
Loss of granulation tissue
State some causes of tooth mobility
- Periodontal disease
- Occlusal trauma
- During ortho
- Periapical infections
State some clinical signs of occlusal trauma
- Hypermobility
- Fremitus
- Occlusal prematurity’s
- Wear facets
- Tooth migration
- Fractured tooth
- Thermal sensitivity
State some radiographic signs of occlusal trauma
- Widened PDL space
- Bone loss ( furcation, vertical, circumferential)
Describe a basic occlusal examination
- Centric occlusion
- Lateral excursions
- Protrusion
- Centric relation
Define “occlusal trauma”
Injury to the attachment or tooth as a result of excessive occlusal forces
What is “primary occlusal trauma”? What may cause it?
- Excessive forces + tooth with normal support
- Functional response to an increased load
- E.g. Bruxism
What is “secondary occlusal trauma”?
- Normal forces + tooth with inadequate support
What does the PDL look like in primary and secondary occlusal trauma?
Primary = Increased PDL width uniformly Secondary = Funnelling shape of PDL
What were the findings from Lindhe and Ericsson regarding occlusal trauma in healthy periodontal conditions?
Occlusal trauma does not initiate or induce periodontal breakdown. But it can instigate marginal bone remodelling and widening of the PDL leading to increased tooth mobility.
What were the findings of the study : ‘Gickman, 1965 - Effect of Excessive Occlusal Forces upon the Pathway of Gingival Inflammation in Humans’ ?
- Theory of “co-destruction”
- Periodontal fibres became parallel to tooth surface at the pressure side of teeth under excessive forces
- Gingival inflammation and occlusal trauma exert a combined co-destructive effect with a different pathway of progression producing infrabony pockets
Describe the “plaque front theory”
- Infrabony defects appear equally often at teeth with/without traumatic occlusion
- Pattern of bone loss related to the apical extension of the plaque front and the bone volume
What were the conclusions of animal studies about occlusal trauma?
- Both animal studies agreed the control of plaque and gingival inflammation would stop the progression of disease, with or without occlusal trauma
What was the findings of the following study: ‘ Fleszar et al, 1980 – Tooth mobility and periodontal therapy’?
Pockets of clinically mobile teeth do not respond as well to periodontal treatment as do those of firm teeth exhibiting the same initial disease severity.
State some reasons to treat mobile teeth
- Where patient comfort or function is affected
- Where patient is disturbed by tooth mobility
- Prior to GTR (results of GTR will not be good if tooth is mobile)
State some reasons of when to NOT treat mobile teeth
- If increased tooth mobility does not interfere with patient’s chewing function or comfort
- Stability
What were the findings of the following systematic study? “Foz et al, 2012 - Occlusal adjustment associated with periodontal therapy—A systematic review”
There is insufficient evidence to presume that occlusal adjustment is necessary to reduce the progression of periodontal disease
What are the aims of a Michigan splint?
- Aims to give patient ideal occlusion and increased OVD
What are the problems with a Michigan splint?
Compliance can be an issue because if not worn teeth will drift and it wont fit
What are some indications for splinting teeth?
- Increased mobility + normal periodontal ligament width
- Marked reduction in periodontal support leading to increased mobility
What is “combined occlusal trauma”?
Excessive forces + tooth with inadequate support
