Periodontal considerations in restorative dentistry 2 Flashcards
What is the function of the periodontium
attach tooth to jaw
dissipate occlusal forces
What are the forces a tooth can experience
tension
compression
viscous forces
What are constant horizontal forces generated by
ortho
What are intermittent horizontal forces caused by
parafunctional habits / paranormal tooth contacts
NOT PHYSIOLOGICAL
What is excessive occlusal force
occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus which results in occlusal trauma and or excessive tooth wear
What is occlusal trauma
describes injury resulting in tissue changes within attachment apparatus including periodontal ligament, supporting alveolar bone and cementum and as a result of occlusal forces
What are factors that effect tooth mobility
width of pDL
height of pDL
inflammation
number, shape and length of roots
What does tooth mobility indicate
not always pathology
may indicate successful adaption of the periodontium to functional demands and/or
reflect the nature of the remaining attachment
When can tooth mobility not be accepted
it is progressively increasing
gives rise to symptoms
creates difficulty with restorative tx
What is the therapy to reduce tooth mobility
control of plaque induced inflammation
correction of occlusal relations
splinting
What is primary occlusal trauma
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
What is the response of the healthy periodontium to heavy force
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
What is the response of the healthy periodontium if the occlusal forces are too great or the adaptive capacity of the PDL is reduced
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
What is secondary occlusal trauma
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
What happens histologically in secondary occlusal trauma
zones of tension and pressure within adjacent periodontium
location and severity of the lesions vary based on magnitude and direction of applied forces
What happens in the pressure side
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
What happens on the side of tension
these changes may include elongation of the periodontal ligament fibers and apposition of alveolar bone and cementum
What do the histological changes reflect
an adaptive response with the periodontium to occlusal trauma
What happens as a result of the sustained occlusal trauma
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
What is occlusal trauma
tooth mobility which is progressively increasing and or tooth mobility associated with symptoms with radiographic evidence of increased PDL width
What is fremitus
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
What are the clinical diagnoses
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
How can we correct occlusal relations
occlusal adjustment (selective grinding) restorations orthodontics
What are abnormal occlusal contacts associated with
significantly deeper probing depths, greater CAL and increased assignment to a less favorable prognosis
What did teeth with frank signs of occlusal trauma see
teeth with frank signs of occlusal trauma including fremitus and a widening periodontal ligament space demonstrated greater probing depth, CAL and bone loss
What is the effect of periodontal therapy
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
What were teeth with occlusal discrepancies found to have
deeper initial probing depths
more mobility
poorer prognoses than those teeth without occlusal discrepancies
When is splinting appropriate
when mobility is due to advanced loss of atachment
mobility is causing discomfort or difficulty in chewing
teeth need to be stabilized for debridement
What are the results of splinting
does not influence the rate of perio destruction
may create hygiene difficulties
What can tooth migration be a result of
loss of perio attachment
unfavorable occlusal forces
unfavorable soft tissue profile
What is the management of tooth migration
tx periodontitis
correct occlusal relations
either accept position of teeth and stabilize or move them orthodontically
