Periodontal considerations in restorative dentistry 2

Question 1

What is the function of the periodontium

Answer 1

attach tooth to jaw

dissipate occlusal forces

Question 2

What are the forces a tooth can experience

Answer 2

tension
compression
viscous forces

Question 3

What are constant horizontal forces generated by

Answer 3

ortho

Question 4

What are intermittent horizontal forces caused by

Answer 4

parafunctional habits / paranormal tooth contacts

NOT PHYSIOLOGICAL

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

Question 6

What is occlusal trauma

Answer 6

describes injury resulting in tissue changes within attachment apparatus including periodontal ligament, supporting alveolar bone and cementum and as a result of occlusal forces

Question 7

What are factors that effect tooth mobility

Answer 7

width of pDL
height of pDL
inflammation
number, shape and length of roots

Question 8

What does tooth mobility indicate

Answer 8

not always pathology

may indicate successful adaption of the periodontium to functional demands and/or
reflect the nature of the remaining attachment

Question 9

When can tooth mobility not be accepted

Answer 9

it is progressively increasing
gives rise to symptoms
creates difficulty with restorative tx

Question 10

What is the therapy to reduce tooth mobility

Answer 10

control of plaque induced inflammation
correction of occlusal relations
splinting

Question 11

What is primary occlusal trauma

Answer 11

injury resulting in tissue changes from excessive occlusal forces appleid 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 12

What is the response of the healthy periodontium to heavy force

Answer 12

PDL width increases until forces can be adequately dissipated, PDL width should then stabilize

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

Question 13

What is the response of the healthy periodontium if the occlusal forces are too great or the adaptive capacity of the PDL is reduced

Answer 13

PDl width may continue to increase
PDL width and tooth mobility fail to reach a stable phase
this failure of adaption may be regarded as pathological

Question 14

What is secondary occlusal trauma

Answer 14

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 attachment loss, bone loss and normal/excessive occlusal force

Question 15

What happens histologically in secondary occlusal trauma

Answer 15

zones of tension and pressure within adjacent periodontium

location and severity of the lesions vary based on magnitude and direction of applied forces

Question 16

What happens in the pressure side

Answer 16

changes may include increased vascularization and permeability, hyalinization/nercosis of the periodontal ligament, hemorrhage, thrombosis, bone resorption and in some instances root resorption and cemental tears

Question 17

What happens on the side of tension

Answer 17

these changes may include elongation of the periodontal ligament fibers and apposition of alveolar bone and cementum

Question 18

What do the histological changes reflect

Answer 18

an adaptive response with the periodontium to occlusal trauma

Question 19

What happens as a result of the sustained occlusal trauma

Answer 19

the density of the alveolar bone decreases while the width of the PDL space increases
this leads to an increased tooth mobility which can be seen as radiographic widening of PDL space, either limited to the alveolar crest or through the entire width of the alveolar bone

Question 20

What is occlusal trauma

Answer 20

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

Question 21

What is fremitus

Answer 21

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

bruxism or tooth grinding is a habit of grinding, clenching or clamping the teeth

the force generated may damage both tooth and attachment apparatus

Question 22

What are the clinical diagnoses

Answer 22

progressive tooth mobility
fremitus
occlusal discrepancies/disharmonies
wear facets
tooth migration
tooth fracture
thermal sensitivty
root resorption
cement tear
widening of PDL space upon radiographic exam

Question 23

How can we correct occlusal relations

Answer 23

occlusal adjustment (selective grinding)
restorations
orthodontics

Question 24

What are abnormal occlusal contacts associated with

Answer 24

significantly deeper probing depths, greater CAL and increased assignment to a less favorable prognosis

Question 25

What did teeth with frank signs of occlusal trauma see

Answer 25

teeth with frank signs of occlusal trauma including fremitus and a widening periodontal ligament space demonstrated greater probing depth, CAL and bone loss

Question 26

What is the effect of periodontal therapy

Answer 26

decreased CAL gain post HPT
increased CAL over time
mobile teeth treated with regeneration do not respond as well as non mobile teeth
no association was drawn between mobility and occlusal forces

Question 27

What were teeth with occlusal discrepancies found to have

Answer 27

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

Question 28

When is splinting appropriate

Answer 28

when mobility is due to advanced loss of atachment
mobility is causing discomfort or difficulty in chewing
teeth need to be stabilized for debridement

Question 29

What are the results of splinting

Answer 29

does not influence the rate of perio destruction

may create hygiene difficulties

Question 30

What can tooth migration be a result of

Answer 30

loss of perio attachment
unfavorable occlusal forces
unfavorable soft tissue profile

Question 31

What is the management of tooth migration

Answer 31

tx periodontitis
correct occlusal relations
either accept position of teeth and stabilize or move them orthodontically