Periodontal Considerations in Restorative Dentistry 2

Question 1

What is the dal effect?

Answer 1

It causes teeth to intrude by bridge/crown etc in high- using physiological adaptation- it causes resorption at apex and tooth moves in, using ortho force generated by patient, this is an example of using occlusal trauma to cause intrusion of the teeth (don’t do this unintentionally)

Question 2

What are the two functions of the periodontium?

Answer 2

To attach teeth to the jaws

To dissipate occlusal forces.

Question 3

What are the two types of horizontal forces?

Answer 3

Constant- orthodontic

Intermittent (occlusal (jiggling)).

Question 4

What is jiggling?

Answer 4

Jiggling- parafunction habits and potentially arm of a clasp on denture etc- not physiological and can be negative.

Question 5

What is excessive occlusal force?

Answer 5

Occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus, which results in occlusal trauma and/or excessive tooth wear (loss).

Question 6

What is occlusal trauma?

Answer 6

An injury resulting in tissue changes within the attachment apparatus including periodontal ligament, supporting alveolar bone and cementum, as a result of occlusal forces. Occlusal trauma may occur in a reduced periodontium causes by periodontium disease.

Question 7

Why will we get more PDL movement with oedema?

Answer 7

Full of inflammatory fluid rather than collagen and fibroblasts therefore will get more movement.

Question 8

What changes can tooth mobility produce that does necessarily represent a pathological state?

Answer 8

Indicates successful adaption of the periodontium to functional demands and or reflect the nature of the remaining attachment.

Question 9

Tooth mobility can be accepted unless…

Answer 9

It is progressively increasing
It gives rise to symptoms
It creates difficulty with restorative treatment.

Question 10

What is primary occlusal trauma?

Answer 10

Injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support. It occurs in the presence of normal clinical attachment levels, normal bone levels, and excessive occlusal forces.

Question 11

What is the response of the healthy periodontium when force is applied?

Answer 11

PDL width increases until forces can be adequately dissipated, the PDL width should then stabilise
Tooth mobility will be increased as a result
This can be regarded as successful adaption to increased demand and therefore physiological
If demand is subsequently reduced, PDL width should return to normal
If the demand of occlusal forces is too great or the adaptive capacity of the PDL reduced, PDL width may continue to increase
PDL width and tooth mobility fail to reach as a stable phase
This failure of adaption may be regarded as pathological.

Question 12

What is the HISTOLOGICAL response of the healthy periodontium when force is applied?

Answer 12

• Zones of tension and pressure within the adjacent periodontium
• Location and severity of the lesions vary based on the magnitude an direction of applied forces
• On the pressure side these changes may include increased vascularisation and permeability, hylinisation/necrosis of the PDL, hemorrhage, thrombosis, bone resorption and in some instances, root resorption and cemental tears
• On the side of tension, these changes may include elongation of the PDL fibers and apposition of alveolar bone and cementum
• Collectively, the histologic changes reflect an adaptive response within the periodontium to occlusal trauma
• As a result of sustained occlusal trauma, the density of the alveolar bone decreases while the width of the PDL space increases
• Leads to tooth mobility (radiographic widening of the PDL space, either limited to the alveolar crest or through the entire width of the alveolar bone).

Question 13

What does pressure and tension do to bone?

Answer 13

Pressure- bone dissolved away

Tension- bone formed.

Question 14

*Remember periodontitis is a plaque-related disease and gingival inflammation is NOT initiated by occlusal forces- there is no change in the level of attachment.

Answer 14

.

Question 15

What is secondary occlusal trauma?

Answer 15

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

Question 16

Will the amount of force have a bigger effect in periodontal patients?

Answer 16

Yes.

Question 17

What is occlusal trauma?

Answer 17

Tooth mobility which is progressively increasing and/or
Tooth mobility associated with symptoms
with
Radiographic evidence of increased PDL width.

Question 18

What is fremitus?

Answer 18

Palpable or visible movement of a tooth when subjected to occlusal forces.

Question 19

What is bruxism?

Answer 19

A habit of grinding, clenching or clamping the teeth. The force generated may damage both tooth and attachment apparatus.

Question 20

What is a vertical bony defect?

Answer 20

A vertical bone defect was defined as a one-sided bone resorption of the interdental marginal bone > or = 2 mm that had a typical angulation towards either the mesial or distal aspect of the root.

Question 21

What are abnormal occlusal contacts associated with?

Answer 21

Significantly deeper probing depths, greater clinical attachment loss and increased assignment to a less favourable prognosis.

Question 22

Some studies found that teeth with occlusal discrepancies:

• deeper initial probing depths
• more mobility
• poorer prognoses than those without occlusal discrepancies.

Answer 22

*

Question 23

How can you correct occlusal relations?

Answer 23

Occlusal adjustment (selective grinding)
Restorations
Orthodontics.

Question 24

Why should the patient’s occlusion should be carefully examined and recorded before and after treatment?

Answer 24

The occlusion of periodontally compromised teeth should b designed to reduce the forces to be within the adaptive capabilities of the reduced periodontal attachment.

Question 25

When might splinting might be appropriate?

Answer 25

Mobility is due to advanced loss of attachment
Mobility is causing discomfort or difficulty in chewing
Teeth need to be stabilised for debridement.

Question 26

Does splinting influence the rate of periodontal destruction?

Answer 26

No, may create hygiene difficulties too.

Question 27

What might happen to upper incisors if there is reduced PDL support?

Answer 27

Teeth might splay out as a result of less bone to hold them in- may be bruxism present.

Question 28

How do you manage tooth migration?

Answer 28

Treat the periodontitis
Correct occlusal relations
Either:
A) Accept the position of the teeth and stabilise or
B) Move the teeth orthodontically and stabilise.

Question 29

What are the effects of excessive occlusal forces on gingival recession?

Answer 29

Historically, it has been suggested that excessive occlusal force might be a factor in gingival recession and the loss of gingiva but these historic references are based on uncontrolled clinical observations
No correlation has been identified between mobility and gingival recession
A recent retrospective study: no relationship between the presence of occlusal discrepancies and initial width of the gingival tissue or between occlusal treatment and changes in the width of the gingiva
Existing data does not provide any solid evidence to substantiate the effects of occlusal forces on NCCLs and gingival recession.

Question 30

What is NCCLs?

Answer 30

Noncarious cervical lesions (NCCLs) are defined as a loss of hard dental tissue near the cementoenamel junction, usually on the buccal surfaces of teeth, resulting in a grooved or wedge-shaped area of missing tooth structure. These lesions are increasing in prevalence, especially among adolescents and older adults.