Occlusion and Periodontal disease Flashcards
what attaches the tooth to the alveolar bone? what happens when tissues cannot withstand the load ?
- Periodontium which Dissipates forces of occlusion to surrounding tissues
- changes may be seen in those tissues
define occlusal trauma
Occlusal trauma describes injury resulting in tissue changes within the attachment apparatus, including periodontal ligament, supporting alveolar bone and cementum, as a result of occlusal forces
define traumatic occlusal force?
any occlusal force resulting in injury of the teeth and/or the periodontal attachment apparatus. (Excessive occlusal force)
how can we diagnose trauma from occlusion?
- need to look at histological changes so can only get a definitive diagnosis from sectioning tooth and surrounding tissue
- but we cant do this on human so need to use clinal and radiographic findings to assist diagnosis
what are the indicators of occlusal trauma ?
what are other indicators ?
TMJ pain
hypertrophy of MoM
how is occlusal trauma broken up into ?
direct and indirect
what is direct trauma ?
- trauma directly applied to tissues
- in this eg it is due to the pts occlusion
class 2 div 2
what is indirect trauma?
- trauma thru teeth and then being applied to periodontal tissues
- in this eg trauma is thru lateral excursions and protrusion
how do we classify occlusal trauma 1999 edition ?
makes up section D
what classification do we use now ?
2017
comes under other
what comes under other conditions affecting periodontium ?
what are primary occlusal forces ?
Excessive occlusal forces on teeth with normal periodontal support
what are secondary occlusal forces ?
Normal or excessive
forces on teeth
with reduced periodontal
support (eg. due to periodontitis)
what is glickmans concept ?
Postulated that the type of attachment loss was different for teeth undergoing the application of forces of “abnormal magnitude” than for those undergoing normal loading.
Altered pathway of destruction
illustration of glickmans concept
- resulted into vertical bone defects or furcation defects
what is waerhaug concept
what are the problems with cadaver studies ?
Impossible to accurately assess the pre-death occlusion
No way to establish cause and effect
No knowledge of habits or parafunction
what is going on in this diagram? (animal study 1)
- P= pressure on PDL
- T= tension of PDL
- as tooth tips P and T exerted
- an eg of this is a removable appliance where the wire would apply force to crown
- in bodily movement: forces are applied evenly we would see this in fixed ortho appliances
- there is T on one side while fibres are stretched and P on side where PDl is getting stretched
what do we see in pressure zone if forces applied do not occlude the PDL blood flow ?
what do we see in pressure zones if forces do occlude the PDL blood flow ?
- osteoclasts will appear on bone
- if not too sever tissue can repair
what are jiggling forces ?
The reaction of the normal periodontium to forces applied in 2 alternate directions
- the teeth are not allowed to move away from the force pressure and tension on both sides of the jiggled tooth
- widening of PDL is seen in pic and can go back to normal if problem goes away
what are the conclusions to the above animal studies ?
- Bone resorption in response to traumatic, occlusal forces
- Widened periodontal ligament
- Resorption stops when force has been compensated for
- No apical migration of JE or loss of attachment
- Occlusal adjustment restores periodontal ligament width and tooth mobility to normal
Jiggling traumatic occlusal forces are applied to a tooth with a healthy periodontium. Which of the following does NOT occur:
Bone resorption
Widened periodontal ligament
Resorption stops when force has been compensated for
Apical migration of junctional epithelium
Increased tooth mobility
apical migration of JE
what happens when you have reduced bone support while you have active disease (periodisease)?
- occlusal focus are put on
- widening occurs which results in bone loss
- If tissues can not adapt then apical migration of JE and bone loss and attachment seen
- disease still remains
what happens when we apply even more force on a reduced bone supported tooth while having active disease?
- perio is aggravated by occlusal trauma
- additional bone los onto of perio bone loss
what are our conclusions from all studies ?
In the healthy periodontium, whether complete or reduced, there is no attachment loss following either unilateral or jiggling forces
Trauma from the occlusion cannot induce periodontal breakdown
Increase in periodontal ligament width and mobility should be regarded as physiological adaptation to increased occlusal loading - if u remove things go back to normal
In certain limited circumstances, when active disease is already present, increased occlusal load may enhance periodontal breakdown
what are some of the conclusions from accusal trauma in rats studies ?
Induced by placing an inlay or metal wire to raise occlusal surfaces
Receptor activator of nuclear factor-kappa B ligand (RANKL) is important in osteoclast differentiation, activation and survival
In presence of lipopolysaccharide-induced inflammation the expression of RANKL on endothelial cells, inflammatory cells and Periodontal Ligament cells was enhanced by occlusal trauma
Suggests that occlusal trauma is a co-factor
what can we take from humam studies on perio occlusaion trauma
Few studies
Ethical considerations
Require a treatment group and one receiving no treatment.
Not acceptable to have a control group for whom no perio treatment is provided
Therefore retrospective studies and descriptive studies
but
Patients with occlusal discrepancies have no more severe periodontal destruction than those without occlusal discrepancies
Patients who received occlusal adjustment as part of their perio treatment had greater attachment gain than those who did not.
Teeth with mobility did not gain as much attachment as those without mobility following periodontal therapy
Teeth with increased mobility showed more attachment loss in the maintenance period
what is abfraction?
Abfraction described as a wedge shaped cervical lesion resulting from flexure of the tooth with excessive occlusal forces as the cause
Now determined that no evidence to support the existence of abfraction
No credible evidence that traumatic occlusal forces cause non-carious cervical lesions
what are the ultimate key point from this lec ?
The periodontal tissues respond and adapt to occlusal loading even when there is reduced periodontal support following periodontal disease
* Occlusal forces cannot initiate periodontal breakdown
* The successful treatment of periodontal disease will arrest destruction even if occlusal trauma persists
* Where forces are too great for adaptation, teeth may become mobile or drift
May be some benefit to occlusal therapy but not strong evidence to support routine adjustment
how do we assess occlusion ?
Look for:
Occlusal interferences, wear facets, rotations, tilting, tooth loss, lateral excursions
Assess occlusion on study models mounted on semi-adjustable articulator
Palpate TMJ and muscles of mastication
what happens if we have mobility ?
- grade it and see if its getting worse
- some use splints however this can be a PRF which can aggravate perio
- may want to extract
