Periodontal considerations in restorative dentistry

Question 1

Define ‘excessive occlusal force’

Answer 1

occlusal force which exceeds the reparative capacity apparatus, resulting in occlusal trauma and/or excessive tooth wear

Question 2

define the term occlusal trauma

Answer 2

injury resulting in tissue changes within the attachment apparatus, including the periodontal ligament, as a result of occlusal force

Question 3

Tooth mobility can be accepted, unless…

Answer 3

• progressively increasing
• gives rise to symptoms
• creates difficulty with restorative treatment

Question 4

Therapy to reduce tooth mobility

Answer 4

control of plaque induced inflammation
correction of occlusal relations
splinting

Question 5

How does a healthy periodontium respond to occlusal trauma?

Answer 5

PDL increases in width until forces can be adequately dissipated
tooth mobility increased as a result
PDL width returns to normal if demand subsequently reduced

Question 6

If the demand of occlusal forces is too great or adaptive capacity of the PDL is reduced, what are the possible consequences?

Answer 6

PDL width continues to increase
PDL width and tooth mobility fail to reach a stable phase

Question 7

secondary occlusal trauma - define

Answer 7

injury resulting in tissue changes from normal of excessive occlusal forces applied to a tooth with reduced periodontal support
- occurs in the presence. of attachment loss, bone loss and normal/excessive occlusal force

Question 8

occlusal trauma - signs

Answer 8

tooth mobility which is progressively increasing
and/or
tooth mobility associated with symptoms
with
radiographic evidence of increased PDL width

Question 9

Whta is fremitus?

Answer 9

palpable or visible movement of a tooth when subjected to occlusal forces

Question 10

diagnosing occlusal trauma - clinical signs

Answer 10

• progressive tooth mobility
• wear facets
• tooth migration
• tooth fracture
• thermal sensitivity
• root resorption
• radiographic widening of PDL space
• fremitus

Question 11

why may tooth migration occur?

Answer 11

• loss of periodontal attachment
• unfavourable occlusal forces
• unfavourable soft tissue profile

Question 12

tooth migration - management

Answer 12

• treat the periodontitis
• correct occlusal relations

either
- accept tooth position and stabilise
or move teeth orthodontically and stabilise

Question 13

when may splinting be appropriate?

Answer 13

mobility is due to advanced attachment loss
mobility causing discomfort or difficulty when chewing
teeth need to be stabilised for debridement

Question 14

splinting - downsides

Answer 14

• does not influence rate of periodontal destruction
• may create hygiene difficulties