Questions for traumatic occlusal forces

Question 1

Does traumatic occlusal force or occlusal trauma cause periodontal attachment loss in humans?

Answer 1

• No evidence

Question 2

Can traumatic occlusal force cause periodontal inflammation?

Answer 2

• Limited evidence

Question 3

Does traumatic occlusal force accelerate the progression of periodontitis?

Answer 3

• Evidence from animal models indicate that traumatic occlusal forces may increase alveolar bone loss
• No evidence in humans

Question 4

Can traumatic occlusal forces cause non‐carious cervical lesions?

Answer 4

No evidence

Question 5

What is the evidence that abfraction exists with occlusal trauma?

Answer 5

• The existence of abfraction is not supported by current evidence

Question 6

Can traumatic occlusal forces cause gingival recession?

Answer 6

• There is evidence that it does not cause gingival recession (no evidence)

Question 7

Are orthodontic forces associated with adverse effects on the periodontium?

Answer 7

• Evidence from animal models suggests that certain orthodontic forces can adversely affect the periodontium and result in root resorption, pulpal disorders, gingival recession and alveolar bone loss
• Conversely, there is evidence from observational studies that with good plaque control, teeth with a reduced but healthy periodontium can undergo successful tooth movement without compromising the periodontal support

Question 8

Does the elimination of the signs of traumatic occlusal forces improve the response to treatment of periodontitis?

Answer 8

• There is evidence from one randomized clinical trial that reducing tooth mobility may improve periodontal treatment outcomes
• There is insufficient clinical evidence evaluating the impact of eliminating signs of traumatic occlusal forces on response to periodontal treatment

Question 9

Should we still distinguish primary from secondary occlusal trauma in relation to treatment?
(Define the two then justify)

Answer 9

Definitions:
• Primary occlusal trauma has been defined as injury resulting in tissue changes from traumatic occlusal forces applied to a tooth or teeth with normal periodontal support. This manifests itself clinically with adaptive mobility and is not progressive
• Secondary occlusal trauma has been defined as injury resulting in tissue changes from normal or traumatic occlusal forces applied to a tooth or teeth with reduced support. Teeth with progressive mobility may also exhibit migration and pain on function.

Answer:
• Current periodontal therapies are directed primarily to address etiology; in this context, traumatic occlusal forces
• A reduced periodontium is only meaningful when mobility is progressive indicating the forces acting on the tooth exceed the adaptive capacity of the person or site