Role of Occlusion on Perio Disease Progression

Question 1

What is there controversy on the role of occlusion?

Answer 1

1 - Different experimental Designs
2 - Different disciplines involved have different experiences
3 -Occlusal trauma can only be confirmed histologically
4 - Multiple definitions making the topic seem more complex than it is

Question 2

What were the different models and their researchers?

Answer 2

Sheep model (Box)
Human necropsy (Waerhaug, Glickman)
Squirrel (Polson)
Beagle Dog (Lindhe)

Question 3

Occlusion

According to the glossary of periodontal terms

Answer 3

Any contact of opposing teeth

Question 4

Centric occlusion

According to the glossary of periodontal terms

Answer 4

The maximum intercuspation of the teeth of opposing arches - AKA Acquired centric AKA habitual occlusion

Question 5

Eccentric occlusion

According to the glossary of periodontal terms

Answer 5

Any relation outside of centric

Question 6

Centric relation

According to the glossary of periodontal terms

Answer 6

The most retruded position of the mandible from which lateral movements can be made
The most posterior position at the established VDO

Question 7

Abfraction

According to the glossary of periodontal terms

Answer 7

Theoretical tooth surface abrasion in conjunction with occlusal forces

Question 8

Attrition

According to the glossary of periodontal terms

Answer 8

Physiological wearing away of a substance or structure, such as teeth

Question 9

Bruxism

According to the glossary of periodontal terms

Answer 9

Habit of clenching, grinding, or clamping of teeth ; Forces generated may damage tooth and/or tooth supporting structures

Question 10

Buttressing bone

According to the glossary of periodontal terms

Answer 10

Marginal linear aspect of bone - MAY be formed in response to heavy occlusal forces

Question 11

Facet

According to the glossary of periodontal terms

Answer 11

Flattened/worn spot on tooth surface

Question 12

Fremitus

According to the glossary of periodontal terms

Answer 12

Palpable or visible movement of tooth in response to occlusal forces

Question 13

Occlusal interferiences

According to the glossary of periodontal terms

Answer 13

Any contact that inhibits the remaining surfaces from achieving stable/harmonious contact

Question 14

Occlusal prematurity

According to the glossary of periodontal terms

Answer 14

Contact before desirable intercuspation

Question 15

Trauma from occlusion/Occlusal Trauma

Answer 15

A DIAGNOSIS
Injury that results in tissue changes within the attachment apparatus (including PDL, bone, cementum) as a result of occlusal forces

(must be confirmed histologically for definitive diagnosis)

Question 16

Occlusal Traumatism

Answer 16

Updated definition of TFO - Functional loading of teeth, usually off axis, that is sufficient to cause changes to the teeth (fractures/wear/etc) or supporting structures. Temporary or permanent

Question 17

Excessive occlusal forces

Answer 17

Forces that exceed the reparative capacity of the periodontium

Question 18

Traumatic Occlusal Force (TOF)

Fan & Caton 2018

Answer 18

Any occlusal force that results in injury to the tooth or attachment apparatus

Question 19

How does a leasion progress on the compression side?

Answer 19

Compression of the PDL with pressure
Loss of fiber orientation
Rupture of blood vessels/Hemmorage/Edema in PDL perivascular space
Resorption of alveolar bone proper (PDL Widening)

Question 20

How does a lesion progress on the tension side with bodily movement?

Answer 20

Increase in PDL space
Ruption of PDL fibers
Hemorrhage into perivascular space
Deposition of new alveolar bone and decrease PDL space - cemental tears if severe

Question 21

Where are the compression/tension zones in jiggling forces?

Answer 21

no clear zone

Question 22

What are the current conclusions on TFO?

Answer 22

1 - it does not initiate disease
2 - weak evidence that it can increase prate of progression
3 - still need to eval/address occlusion in perio patients

Question 23

What were some of the early thoughts on TFO?

Answer 23

Its the primary etiology of perio (Karolyi/Stillman/Bunting)
It has no impact on perio (Gotlieb & Orban)
May lead to increased PD - but does not induce (Box/Stones)

Question 24

What is the “Pathways of inflammation” Theory and how does it progress on the Buccal/Lingual sides?

Answer 24

Weinman et al. 1941
Histologic analysis of 32 Human Jaws

Buccal Lingual: Follows course of the periosteal side, then penetrates into the bone -

Buccal/Lingual

Question 25

How does inflammation progress in the interproximal sites?

Answer 25

Interproximal: Follows course of interseptal artery - Supporting bone destroyed first, then alveolar bone proper

Question 26

Does inflammation penetrate the PDL without trauma?

Answer 26

RARELY (Weinman 1941)

Question 27

Where does inflammation spread with trauma?

Answer 27

Macapanpan & Weinman 1954 Rat study - rubber dams placed between contacts - trauma caused inflammation in both pressure and tension side - **TENSION SIDE: INFLAMMATION GOES DIRECTLY INTO PDL** Trauma alone does not cause boneloss

Question 28

Pathway of inflammation with Perio + Trauma

Answer 28

Comar, Kollar and Gargoiulo 1969 Rhesus Monkeys High crown with overhanging margins Resorption at crest and furcation Most in 1st 14 days Increased "pseudo PD" **No altered pathway of inflammation** **No Apical migration of JE** Bone loss, but no PD

Question 29

Stahl et al. 1968

Answer 29

4 human jaws removed from cancer surgery - did histology inflammation and destruction have limited predictability with occlusal trauma Only 1 infrabony defect with TFO

Question 30

Summarize the pathways of inflammation

Answer 30

Question 31

What is EOF? who looked into this?

Answer 31

Muhlemann 0-100grams: movement within the alveolus (initial tooth movement) >100grams: Elastic deformation of the alveolar bone (Secondary tooth movement)

Question 32

How often does trauma need to happen to have an impact? What kind of forces?

Answer 32

With Jiggling forces - 4-5x/day Muhlemann

Question 33

Muhlmann & Herzog 1961

Answer 33

LIVE HUMAN STUDY 14yo girl had teeth scheduled for extraction Put a high inlay in and had patient cause self jiggling movements Started 4/day every other day (no trauma) Increased to 4/day every day (Mobility/Acute trauma) 4-6weeks After 3-4mo, NO PAIN (adaptation happened) Increased again - acute trauma again

Question 34

What are the components of occlusal forces?

Answer 34

Magnitude, direction, duration, Frequency Components focused on by Muhlmann

Question 35

Does splinting decrease mobility?

Answer 35

No Wust

Answer 36

Question 37

What is the difference between simple and compound periodontitis?

Answer 37

Simple: Perio alone Compound: Perio + Trauma

Question 38

What is the problem with Polson's studies?

Answer 38

Only 2 days of jiggling forces - not enough to cause acute trauma (found by Muhlmann)

Question 39

What are the differences between the LIndhe and Polson studies?

Answer 39