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Classic Lit Fall 2021 > Trauma from Occlusion > Flashcards

Trauma from Occlusion Flashcards

1
Q

What are the 4 main occlusal scheme philosophies?

A

Gnathology, Bioesthetics, Pankey-Dawson, Neuromuscular control

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2
Q

How do the different occlusal schemes relate/differ?

A

Similar in that the goal is to have even contacts - Different in the position by which intercuspation is built/patterns and pathways of guidance/vertical dimension

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3
Q

How big a difference can there be in centric relation and occlusion?

A

0.1 to 2mm

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4
Q

What is a normal CR to CO shift?

A

1.25mm (Clayton 1986)

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5
Q

What is Gnathology?

A

Condyle posterior superior
Occlusal scheme based off seating of condyle.
Anterior guidance in relation to the angle of articular eminence

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6
Q

What is Bioesthetics?

A

Similar to Gnathology in condylar seating and anterior guidance/posterior disclusion
Different from Gnathology in that Bioesthetics has strict measurements for anterior teeth size and depth of overbite/overjet

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7
Q

What is the Panky-Dawson model?

A

Similar to Gnathology in that it used condylar position (but anterior superior), used manual manipulation, and anterior guidance/posterior disclusion
Different from Gnathology in that the patient needs a custom anterior guidance

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8
Q

What is Neuromuscular control model?

A

Use a Neuromonitor/TENS unit - watch the motion and build occlusion in that position
Dont care about overbite/overjet

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9
Q

What is the Conformative model?

A

Most used technique in dentistry - Use current occlusion (have patient bite - make sure no heavy contact on filling/crown)

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10
Q

Centric Relation

A

The most posterior relation.
The most retruded physiologic relation that allows for lateral movements.

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11
Q

Centric occlusion

A

The repeatable intercuspal position in centric relation

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12
Q

Eccentric Occlusion

A

Set of contacts NOT in maximum Intercuspation

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13
Q

Centric slide

A

the physical movement of sliding from CO to MI

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14
Q

Curve of Spee

A

Curved plane tangent to the incisal edges and buccal cusps of the mandibular teeth viewed in sagittal plane

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15
Q

Curve of Wilson

A

Posterior occlusal plane or arch curvature when viewed in frontal plane

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16
Q

Curve of Monson

A

The curve of the dentition where the incisal edges/cusps contact an 8inch diameter sphere with center at glabella (incorporates spee and wilson)

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17
Q

Who defined Traumatic Occlusion and Occlusal Trauma?

A

Passanezi and Sant’Ana 2019

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18
Q

Occlusal forces which lead to changes in the periodontium depend on what factors? (Citation)

A

Magnitude
Duration
Frequency
Direction
(Passanezi and Sant’Ana 2019)

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19
Q

What are the most damaging directions for natural dentition?

A

Lateral and Rotational (Torque)

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20
Q

How does the periodontium respond to Pressure “within certain limits”?

A

PDL remains vital
Widening of PDL
OCs present on alveolus
“Direct bone resorption” is initiated

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21
Q

How does the periodontium respond to Tension “within certain limits”?

A

PDL fibers elongate
Apposition of Alveolar bone and cementum

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22
Q

How does the periodontium react to Pressure at “higher magnitude”?

A

PDL becomes necrotic and hyalinization occurs
OCs present in areas of less stress (marrow spaces) causing “indirect bone resorption”
Root resorption and/or cemental tears
hemorrhage
thrombosis

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23
Q

How does the periodontium respond to Tension at “Higher magnitude”?

A

PDL fibers tear
Alveolar bone resorption
Widening PDL space
Hemorrhage
Thrombosis

24
Q

Where do pressure zones occure during tipping forces?

A

Apical and Coronal

25
Q

What 3 types of loading forces are there?

A

Tipping
Bodily
Jiggling

26
Q

Citation for loading “within certain limits” and at “higher magnitude”

A

Fan and Caton 2018

27
Q

3 stages of tissue response to increased occlusal forces

A

Injury
Repair
Adaptive Remodeling

28
Q

Describe “Injury”

A

Initiated by excessive forces
Body will attempt repair if forces decrease or if tooth drifts away
Decrease in mitotic activity for fibroblasts and osteoid cells
Chronic - body creates a cushion (widened PDL/Angular defect/No PDs/ Mobility)

29
Q

What area is most susceptible to Injury from TFO?

A

Furcation

30
Q

Describe “Repair”

A

Ongoing in the periodontium
Damage > Repair = traumatic forces
Damaged tissues removed - new CT/Fibers/Bone/Cementum formed

31
Q

How does reparative activity react to TFO?

A

it increases

32
Q

Describe “Adaptive Remodeling”

A

Damage > Repair = Adaptive remodeling
Body creates structure to help avoid further damage

33
Q

What kind of adaptations take place during Adaptive Remodeling?

A

Widened PDL
Funnel Shaped defect
Angular defects
NO POCKET
Increased vascularization

34
Q

Gottlieb and Orban 1931

A

Dog study
Histological analysis
Axial forces = no mobility
Lateral forces = mobility SOMETIMES

No evidence that TFO is the primary cause of Perio

35
Q

Stones 1938

A

Monkey Study

Histological analysis

TFO is an etiologic factor fo vertical pocket formation

TFO is not the ONLY factor - but may CONTRIBUTE to periodontitis

36
Q

Glickman 1963

A

TFO alone doe NOT cause gingivitis/perio/CAL

2 zones: Zone of Irritation and Zone of Co-Destruction

37
Q

Glickman, Stein et al. 1961

A

Rhesus Monkeys

Effect of increased functional forces on splinted and non-splinted teeth

First study to show furcation is greatest area of risk for TFO

Splinted teeth had little change in furcation area

Non-splinted showed resorption of crest in the furcation (mesio-apical and disto-apical forces)

38
Q

What is the Zone of Irritation?

A

Glickman 1963

  • Contents:* interdental and marginal gingiva
  • Inflammation:* created by local irritants within the zone - degeneration and necrosis of epithelium/CT
  • Progression*: lesion will result in horizontal bone destruction

TFO: DOES NOT affect this zone

39
Q

What is the Zone of Co-Destruction?

A

Glickman 1963

  • Contents*: Cementum/PDL/Alveolar bone
  • Inflammation:* When spreading apically into this zone, TFO will accelerate tissue damage
  • Progression:* angular defect

TFO: Etiologic factor for angular defects with infrabony PD formation

40
Q

Waerhaug 1979a

A

in response to Glickman 1963 Waerhaug tried to prove him wrong

Apical border of plaque - PDL = 0.96mm

Apical border of plaque - Alveolar crest = 1.63mm

41
Q

Fan and Caton 2018

A

Thermal sensitivity

Fremitus

Occlusal discrepancies

Cemental tears

Root resorption

Mobility

Widened PDL

Tooth migration

Discomfort on chewing

Fractured tooth

Wear facets

42
Q

How does mobility affect probing depth?

A

Probe will penetrate 0.5mm deeper

Neiderud, Ericsson et al. 1992

43
Q

Burgett, Ramfjord et al. 1992

A

RCT 50pts

Perio Tx +/- occlusal adjustment

SSD: Patients who had OA had greater CALgain

44
Q

Harrel and Nunn 2001

A

Occlusal adjustment can decrease progression of periodontal disease

45
Q

What are treatment options for TFO?

A

Occlusal adjustment

Bite Splint

Splinting

46
Q

Articles to support Occlusal Adjustment

A

Burgett, Ramfjord et al. 1992

Harrel and Nunn 2001

47
Q

What are the ideal characteristics of a bite splint

A

According to Ramfjord and Ash

Maxillary bite plane with flat occlusal surface

Centric stops for all teeth

Cuspid rise to allow posterior disclusion while in lateral and protrusive movements

48
Q

What are some indications for a bite splint?

A

TMD

Severe bruxism

TFO on any part of the masticatory system

Stabilize maxillary mobile teeth to prevent mandibular hypereruption

Holding teeth after ortho or after extraction of opposing teeth

Tension headaches

49
Q

Articles for Splinting

A

Ramfjord and Ash 1981 (Splinting will not eliminate the cause of mobility)

50
Q

Alkan, Aykac at el. 2001

A

SRP alone vs SRP then splint vs Splint then SRP

NSSD

SRP alone had greatest decrease in mobility vs baseline

51
Q

Signs of Successful treatment of TFO

A

Mobility decrease/absent

Arrest migration

Radiographic changes decrease/stabilize

Pain relief/improved comfort

Relief of premature contacts/fremitus/interferences

Stable occlusion

AAP 2000

52
Q

What is the current understanding in terms of TFO’s impact of perio

A

TFO cannot induce periodontal tissue breakdown, but with plaque-associated periodontal disease, trauma may enhance the rate of progressions Lindhe and Lang 2015

53
Q

What is the plaque free zone and how large is it?

A

Zone where there is no buildup and no bone - 0.96mm apicocoronal and 1.63mm from tooth to crest

(Waerhaug 1979)

54
Q

How can the periodontium respond to TFO if someone is or is not susceptable?

A

Jin & Cao 1992

55
Q

Name a study that shows numbers for boneloss and furcation having the most

A

Mohgaddas & Stahl 1980

Interradicular: 0.23mm

Radicular: 0.55mm

Furcation: 0.88mm

Classic Lit Fall 2021 (29 decks)

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