Periodontal considerations in Restorative Dentistry - Occlusion and the periodontal tissues Flashcards
What are the primary functions of the periodontium?
To attach teeth to the jaws.
To dissipate occlusal forces.
What are the types of forces that act on the periodontium?
Tension
Compression
Viscous forces
What are the two main types of horizontal forces on the periodontium?
Constant forces (e.g., orthodontic forces).
Intermittent forces (e.g., occlusal jiggling).
How do abnormal occlusal forces affect different types of periodontium?
Healthy periodontium: Adaptive changes may occur.
Healthy but reduced periodontium: Potential for trauma and further damage.
Diseased periodontium: Plaque-induced inflammation exacerbates damage.
Define excessive occlusal force and occlusal trauma.
Excessive occlusal force: A force that exceeds the reparative capacity of the periodontal attachment, leading to trauma or excessive wear.
Occlusal trauma: Tissue injury within the attachment apparatus (PDL, alveolar bone, cementum) due to occlusal forces.
What factors contribute to tooth mobility?
Width and height of the periodontal ligament (PDL).
Presence of inflammation.
Number, shape, and length of roots.
When is tooth mobility considered pathological?
If it is progressively increasing.
If it causes symptoms.
If it interferes with restorative treatment.
What are the treatment options to reduce tooth mobility?
Control of plaque-induced inflammation.
Correction of occlusal discrepancies.
Splinting (only when necessary).
Differentiate between primary and secondary occlusal trauma.
Primary occlusal trauma: Excessive occlusal force on a tooth with normal periodontal support.
Secondary occlusal trauma: Normal/excessive force on a tooth with reduced periodontal support due to attachment loss.
How does the periodontium adapt to occlusal forces in a healthy state?
The PDL width increases to dissipate forces.
Tooth mobility increases but stabilizes over time.
If demand decreases, the PDL returns to normal width.
What happens if occlusal forces exceed the adaptive capacity of the periodontium?
Continuous widening of the PDL.
Persistent tooth mobility without stabilization.
Considered a pathological state.
What are the histological changes in response to occlusal trauma?
Pressure side: Increased vascularization, hyalinization, hemorrhage, bone resorption.
Tension side: Elongation of PDL fibers, apposition of alveolar bone and cementum.
Overall: Decreased alveolar bone density, increased tooth mobility.
What is fremitus?
Fremitus is the palpable or visible movement of a tooth when subjected to occlusal forces.
What are the clinical signs of occlusal trauma?
Progressive tooth mobility.
Fremitus.
Occlusal discrepancies/disharmonies.
Wear facets.
Tooth migration.
Widened PDL space on radiographs.
Does occlusion cause periodontitis?
No, periodontitis is a plaque-induced disease. However, occlusal forces can influence attachment loss in the presence of inflammation.
How does occlusal trauma interact with periodontal disease in animal studies?
Without plaque-induced inflammation, occlusal trauma alone does not cause irreversible bone loss.
When combined with inflammation, occlusal trauma accelerates connective tissue attachment loss.
What are the causes of pathological tooth migration?
Loss of periodontal attachment.
Unfavorable occlusal forces.
Unfavorable soft tissue profile.
What are the management options for pathological tooth migration?
Treat periodontitis first.
Correct occlusal relationships.
Either stabilize the current tooth position or move teeth orthodontically.
What are the effects of occlusal discrepancies on periodontal health?
Deeper probing depths.
Greater clinical attachment loss.
Increased tooth mobility.
More bone loss.
What is the effect of excessive occlusal forces on gingival recession?
No proven correlation between occlusal forces and gingival recession.
Studies suggest no direct causation.
How do occlusal forces impact periodontal therapy outcomes?
Decreased clinical attachment gain post-HPT.
Increased attachment loss over time in mobile teeth.
Mobile teeth respond less favorably to regenerative therapy.
How can occlusal discrepancies be corrected?
Occlusal adjustment (selective grinding).
Restorations.
Orthodontic treatment.
What did a controlled clinical trial reveal about occlusal adjustment before periodontal therapy?
0.4 mm greater clinical attachment gain with occlusal adjustment.
Probing depth and mobility reduction were comparable in both groups.
What is the long-term impact of untreated parafunction on periodontal health?
Increased clinical attachment loss and tooth loss over time.
Teeth with untreated occlusal discrepancies showed increased probing depths.
