Occlusion and Periodontal disease

Question 1

what attaches the tooth to the alveolar bone? what happens when tissues cannot withstand the load ?

Answer 1

• Periodontium which Dissipates forces of occlusion to surrounding tissues
• changes may be seen in those tissues

Question 2

define occlusal trauma

Answer 2

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

Question 3

define traumatic occlusal force?

Answer 3

any occlusal force resulting in injury of the teeth and/or the periodontal attachment apparatus. (Excessive occlusal force)

Question 4

how can we diagnose trauma from occlusion?

Answer 4

• 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

Question 5

what are the indicators of occlusal trauma ?

Answer 5

Question 6

what are other indicators ?

Answer 6

TMJ pain
hypertrophy of MoM

Question 7

how is occlusal trauma broken up into ?

Answer 7

direct and indirect

Question 8

what is direct trauma ?

Answer 8

• trauma directly applied to tissues
• in this eg it is due to the pts occlusion
  class 2 div 2

Question 9

what is indirect trauma?

Answer 9

• trauma thru teeth and then being applied to periodontal tissues
• in this eg trauma is thru lateral excursions and protrusion

Question 10

how do we classify occlusal trauma 1999 edition ?

Answer 10

makes up section D

Question 11

what classification do we use now ?

Answer 11

2017
comes under other

Question 12

what comes under other conditions affecting periodontium ?

Answer 12

Question 13

what are primary occlusal forces ?

Answer 13

Excessive occlusal forces on teeth with normal periodontal support

Question 14

what are secondary occlusal forces ?

Answer 14

Normal or excessive
forces on teeth
with reduced periodontal
support (eg. due to periodontitis)

Question 15

what is glickmans concept ?

Answer 15

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

Question 16

illustration of glickmans concept

Answer 16

• resulted into vertical bone defects or furcation defects

Question 17

what is waerhaug concept

Answer 17

Question 18

what are the problems with cadaver studies ?

Answer 18

Impossible to accurately assess the pre-death occlusion

No way to establish cause and effect

No knowledge of habits or parafunction

Question 19

what is going on in this diagram? (animal study 1)

Answer 19

• 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

Question 20

what do we see in pressure zone if forces applied do not occlude the PDL blood flow ?

Answer 20

Question 21

what do we see in pressure zones if forces do occlude the PDL blood flow ?

Answer 21

• osteoclasts will appear on bone
• if not too sever tissue can repair

Question 22

what are jiggling forces ?

Answer 22

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

Question 23

what are the conclusions to the above animal studies ?

Answer 23

• 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

Question 24

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

Answer 24

apical migration of JE

Question 25

what happens when you have reduced bone support while you have active disease (periodisease)?

Answer 25

• 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

Question 26

what happens when we apply even more force on a reduced bone supported tooth while having active disease?

Answer 26

• perio is aggravated by occlusal trauma
• additional bone los onto of perio bone loss

Question 27

what are our conclusions from all studies ?

Answer 27

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

Question 28

what are some of the conclusions from accusal trauma in rats studies ?

Answer 28

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

Question 29

what can we take from humam studies on perio occlusaion trauma

Answer 29

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

Question 30

what is abfraction?

Answer 30

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

Question 31

what are the ultimate key point from this lec ?

Answer 31

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

Question 32

how do we assess occlusion ?

Answer 32

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

Question 33

what happens if we have mobility ?

Answer 33

• 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