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Occlusion > Trauma from Occlusion > Flashcards

Trauma from Occlusion Flashcards

1
Q

definition of trauma from occlusion

A

injury to the periodontium caused by occlusal forces, which exceed the reparative capacity of the attachment apparatus

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2
Q

components of the masticatory system

A

teeth
TMJ
muscles
attachment apparatus*

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3
Q

teeth - indications of trauma?

A

attrition
ware facets
craze lines

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4
Q

isolated deep probing depth

A

suscpision of fracture

factor associated with trauma

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5
Q

what happens to TMJ in trauma TMJ

A

dense fibrous tissue on the articualtion surfaces of the TMJ remodels

discomfort around TMJ. face/neck
limitation of movements
pain upon opening/closing
clicking and or popping 
jaw fatigue/ headache
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6
Q

signs of trauma in masticatory muscles

include definitions of each

A

myalgia - pain in masticatory muscles

trismus - spasm in mastiatory muscles

dyskenesia - incoordination of the jaw

jaw fatigue, headache. inability to open close

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7
Q

anatomy of periodontium - components

A

cementum
pdl
alveolar bone

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8
Q

glickmans concept - general

A

separated into two zones of attachment apparatus

  1. zone of irritation
  2. zone of co-destruction
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9
Q

zone of irritation
includes?
trauma from where? - what happens?

A

includes marginal and interdental gingiva

gingival inflammation cannot be induced by trauma from occlusion but is the result of irritation from microbial plaque

any inflammation here is not induced by occlusal trauma but from BACTERIA

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10
Q

zone of co-destruction
includes?
trauma from where? - what happens?

A

includes the periodontal ligamen, the root cementum, and alveolar bone

trauma from occlusion
so any excessive forces have an effect on the periodontium

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11
Q

transeptal fibers

A

zone between the two zones

can be influenced by both zones

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12
Q

bacteria that infiltrates usually spreads where?

aka inflammatory lesion in the zone of irritation goes where?

A

outside of the alveolar process and causes horizontal bone loss

so into the alveolar bone in teeth not subjected to trauma and THEN
direclty into the periodontal ligament in teeth also subjected to trauma from occlusion

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13
Q

occlusal truama causes what direction of defects?

A

ANGULAR – directly effects the pdl

where as inflammation from bacteria effects in a horizontal way then will eventually reach pdl in later stages

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14
Q

angular or horizontal bone loss is a result of? what conept is this?

A

gingival inflammtion

the foramtion of either horizontal or angular bone defects were dependent on the width of the interproximal bone

waerhaug’s concept - which contradicted glickmans

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15
Q

physiopathology of occlusal trauma - general

A

injury
repair
adaptive remodeling

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16
Q

how do we see injusry clinically?

A
  1. widening of PDL
  2. angular bone defects
  3. no periodontal pockets
  4. tooth mobility
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17
Q 
slight pressure (injury) 
what happens what do we see
A
  1. bone RESORPTION
  2. widening of PDL
  3. numerous blood vessels reduced in size
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18
Q

slight tension (injury)
location?
what do we see?
what happens?

A

OPPOSITE SIDE OF TOOTH FROM TENSION

  1. Apposition of bone (GROWTH)
  2. PDL fibers elongate
  3. blood vessels enlarged
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19
Q

why does the PDL widen?

A

Bone resoprtion starts - so creates more space and widens

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20
Q

can tension/ pressure zones coexist?

A

yes - coexist – areas of tension can see widening of pdl as well

so can see

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21
Q

what phase do you have more bone resorption/ formation?

A

injury – resoprtion

repair – formation

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22
Q 
Greater tension (injury) 
what happens?
what do we see?
A
  1. widening of pdl
  2. tearing of ligament
  3. hemorrhage
  4. thrombosis
  5. bone resorption
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23
Q 
Greater pressure (injury) 
what happens?
what do we see?
A
  1. compression of fibers
  2. vascular changes
  3. injury to fibroblasts, CT cells leading to necrosis of ligament
  4. increased bone / tooth resorption
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24
Q

how to tell where tooth is moving?

A

identify where pdl is wider and where it is not

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25
Q

what must happen for reparative phase to occur?

A

the reparative function must exceed the excessive forces

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26
Q

repair phase

formation of what?

A

Reparative activity inlcudes formation :

  • New CT cells and fibers, bone and cementum
  • thinned bone is reinforced with new bone

as long as reparative capacity EXCEEDS traumatic forces

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27
Q

adaptive remodeling

A

forces are excessive and exceed our capacity so then remodeling must occur

  1. periodontium is remodeled
  2. with remodeling, forces may no longer be injurious to the tissue
  3. results in widened PDL, funneling at the crest of bone (crestal area where you see angulation - but not true angular defects), and angular defects, NO POCKETS, and some tooth mobility
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28
Q

no periodontal pockets in trauma? T/F? Implication?

A

UNLESS A PRESENT PERIO PROBLEM there is NOT usually pocket formation

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29
Q

types of occlusal trauma?

A

tipping movement

bodily movement

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30
Q

tippping movement
direction?
zones?
effected / unaffected tissues?

A

type of occlusal trauma
excessive horizontal directed forces

ALTERATIONS – contralateral sides of pressure and tension zones

SUPRA-ALVEOLAR CT REMAINS UNAFFECTED (tissue that is above the crest of bone)

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31
Q

when will you stop seeing clinical signs of attachment loss?

A

when the tooth is no longer subjected to the trauma – you will get complete regeneration of periodontal tissues - thus no signs of CAL (clinical attachment loss)

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32
Q 
bodily movement 
example?
direction?
zones?
effected / unaffected tissues?
inflammation?
A

type of occlusal trauma

example - ortho tx

zones of pressure and tension extend over the ENTIRE TOOTH SURFACE

supra-alveolar tissue remains unaffected

forces will NOT induce inflammatory reactions in the gingiva (so not causing gingivitis or attachment loss)

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33
Q

primary occlusal trauma
definition
occurs in the presence of?

A 
injury resulting in tissues changes from excessive occlusal forces applied to a tooth or teeth with normal support. 
presence of
1. normal bone levels
2. normal attachment levels
3. excessive occlusal forces
34
Q

difference in bone loss from trauma vs perio problem?

A

trauma = demineralization of the bone

35
Q

what does primary occlusal trauma cause and not cause?

A

DOES NOT cause gingivitis and there are NO changes in clinical attachment levels and NO perio pockets

we DO see bone loss in the form of demineralization and increasing tooth mobility

36
Q

main difference between primary and secondary occlusal trauma in the periodontium?

A

in secondary – we have REDUCED SUPPORT - so the capacity and support of the periodontium is less

37
Q

secondary occlusal trauma
definition
occurs in the presence of?

A

injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with REDUCED SUPPORT
occurs in the presence of :
1. bone loss
2. attachment loss
3. “normal” / or excessive occlusal forces

38
Q

loss of support will indicate primary or secondary?

A

secondary

39
Q

what does primary occlusal trauma cause and not cause?

A

NOT:
- periodontal disease

DOES:
- bone loss and increasing tooth mobility

40
Q

implication of occlusal trauma in teeth with progressive/ severe perio disease in teeth with

A

the trauma from occlusion - under certain conditions, will enhance the rate of progression of the disease and act as A CO-FACTOR in the destructive process

41
Q

etiology of occlusal trauma

A

Increase of magnitud/ frequency of occlusal forces
ALSO
- para functional habits (clenching, bruxism)
- occlusal interferences
- fixed / removable rosthetic appliances

42
Q

etiology / causes of occlusal trauma other than increases in occlusal force

A
  • para functional habits (clenching, bruxism)
  • occlusal interferences
  • fixed / removable rosthetic appliances
43
Q

causes / etiology of change of direction of occlusal force

A
  1. parafunctional habits in extreme eccentric positions
  2. tipping forces from occlusal interferences
  3. tilting/ drifting of teeth
  4. restorative/ prosthetic tx that generates tipping occlusal forces
  5. orthodontic teeth movement
44
Q

what causes decreased resistance of the periodontium to occlusal forces (2 main things)

A
  1. loss of alveolar bone and periodontal support
  2. loss of a number of teeth (fewer teeth to absorb occlusal load)
    ALSO when we have perio disease (basically bullet 1)`
45
Q

characteristic clinical indication of occlusal trauma

A

mobility – progressive

46
Q

clinical indicators of occlusal trauma

7

A
  1. mobility (progressive - so watch this)
  2. fremitus
  3. occlusal interferences
  4. wear facets in presence of other clinical indications
  5. tooth migration
  6. fractured tooth/teeth
  7. thermal sensativity
47
Q

class I mobility

A

horizontal in buccal-lingual direction

mobility is greater than physiologic/ normal UP TO 1MM

48
Q

class II mobility

A

still only movement in the horizontal direction (buccal-lingual) but is greater than 1mm

49
Q

class III mobility

A

excessive horizontal (buccal-lingual) mobility and VERTICAL ( apical-coronal) tooth depression

50
Q

how to check for mobility

A

two solid instruments - place in front of tooth and try and move it buccal lingual direction

51
Q

fremitus

A

if positive - can be clinical sign of occlusal trauma – this is either present or absent - no classification

tell patient to close normally and after teeth come into contact - ask to tap tap tap note if there is any vibration of tooth in socket when they come into contact or occlude

52
Q

occlusal interferences implication?

A

if present - clinical sign of occlusal trauma and must eliminate
working or non working

locate with articulating paper

53
Q

wear facets in presence of other clinical indications

A

severe attrition?

54
Q

tooth migration implicatoin / sign of?
why does this occur?
can cause?

A

sign of occlusal trauma
can occur because tooth will shift away from the forces / trauma
they shift to get out of the traumatic occlusion
can shift buccal/ lingual too

can cause malocclusion

55
Q

fractured tooth / teeth sign of?

A

sign of occlusal trauma
can co-exist with other factor to be more prone to fracture but excessive forces - like vertical fractures 0 see these in the center / middle of the root - due to the occlusal force

56
Q

radiographic indicators of occlusal trauma may include one or more of the following (6 things)

A
  1. widening of the PDL space
  2. bone loss (furcation, vertical, circumfrential)
  3. root resorption/ fracture
  4. hypercementosis
  5. thickened lamina dura –
  6. cemental tear – part of cementum of tooth
57
Q

deminarlization in furcation?

A

sign of traumatic force/ occlusal trauma

58
Q

main goal in tx of occlusal trauma

A

maintain the periodontium in comfort and function

59
Q

other goals in tx of occlusal trauma

A

in addition to maintaining the periodontium in comfort and function

  1. reduce/ eliminate the tooth mobility
  2. eliminate occlusal prematuritites (contacts/ interferences) / fremitus
  3. eliminate parafunctional habits
  4. prevent further tooth migration
  5. decrease/ stablize radiographic changes
60
Q

treatment options for trauma (6)

A
  1. occlusal adjustments
  2. management of parafunctional habits
  3. temporary / provisional or long-term stabilization of mobile teeth with removable or fixed appliances
  4. orthodontic tooth movement
  5. occlusal reconstruction
  6. extraction of selected teeth (last resort)

this has to be done wisely
- must know when and how to do these treatements

61
Q

4 main tx options for primary occlusal trauma

A
  1. occlusal adjustment
  2. management of parafunctional
  3. ortho tooth movement
  4. occlusal guard
62
Q

main tx options for secondary occlusal trauma

A
  1. splinting
  2. occlusal adjustment
  3. . management of parafunctional
  4. ortho tooth movement
  5. occlusal guard

*difference is that we add the splint

63
Q 
indication for occlusal tx?
list them (4 main)
A
  1. to reduce traumatic forces on teeth that exhibit
    - increasing mobility/ fremitus
    - discomfort during occlusal contact /function
  2. to achieve functional relationships
  3. as adjunctive therapy
  4. to reduce teeth contributing to soft tissue injury
64
Q

contraindications for occlusal adjustments

4 points

A
  1. when no evidence of trauma - NOT preventative tx
  2. does not treat primary periodontal disease
  3. tx of parafunctional habit - without the existance of damage, pathosis or pain
  4. instance of severe extrusion, mobility, malpositioning of teeth that would no respond to occlusal adjustment alone
65
Q

4 basic principles of occlusal adjustement

A
  1. mutually protected occlusoin
  2. mounted casts
  3. premature contacts
  4. “BULL” rule (working side)
    buccal upper
    lower liungual
66
Q

what are the indications for splinting?

6 main things

A
  1. to stabalize teeth with increasing mobility that have not been responding to occlusal adjustment and periodontal treatment
  2. for patient’s comfort/funciton
  3. prior to periodontal instrumentation and occlusal adjustment procedures
  4. to prevent tipping/ drifting/ exxtrusion of teeth
  5. after orthodontic tx
  6. following acute trauma
67
Q

BULL rule

A

component of basic principle of occlusal adjustment

on working side
buccal upper
lower lingual
cusp inclines – protect the mutually protected occlusion

68
Q

contraindications for splinting

A
  1. when the treatment of inflammatory periodontal disease has not been addressed
  2. when occlusal adjustment to reduce trauma and/ or interference’s has not been addressed (like if you splint pt in traumatic occlusion this can cause fracture, etc)
  3. when the sole objective of splinting is to reduce tooth mobility following the removal of the splint - think more comprehensively
69
Q

types of splints

A

intra-coronal

extra -coronal

70
Q

intra- coronal splint

A

this is a PERMANENT splint - so have to prep the teeth

preparations are made in the teeth and can be continous with neighbor teeth.

71
Q

extra-coronal splint

A

more common
these DO NOT involve teeth preparation and can be done with composite alone (temporary splint) or reinforce with a wire or mesh for more prolonged usage.

Usually confined to the lingual side of pt - for esthetic purposes but can be placed on buccal when tx calls for it

example - orthodontic wire

72
Q

is a FPD considered a splint?

A

yes - fixed partial denture

73
Q

occlusal guard purpose?

A

protection - always helps outcome and can be used after any procedure

74
Q

6 desired outcomes of successful tx

what would indicate unsuccessful tx?

A
  1. elimination / absence of tooth mobility
  2. further tooth migration should not occur
  3. relief of pain/ discomfort/ TMJ problems
  4. relief of premature contacts / fremitus/ interferences
  5. radiographic changes diminish or become stable
  6. establishment of an occlusion that is stable, functional, physiologic, compatible with periodontal health, and esthetically acceptable

opposite of these = unsuccessful (increasing mobility, progressive migration, continued discomfort, etc)

75
Q

10 main conclusions of trauma from occlusion

A
  1. CANNOT induce periodontal tissue breakdown
  2. Results in resorption of alveolar bone leading to an increased tooth mobility
  3. Does NOT cause gingivitis / periodontitis
  4. Does NOT cause progression of gingivitis to periodontitis
  5. MAY enhance the RATE OF PROGRESSION of severe periodontitis with deeper PD (periodontal disease), increased AL (attachment loss)
  6. Treat inflammation BEFORE occlusal correction
  7. Does NOT cause attachment loss
  8. Mutually protected occlusion - want this if we can
  9. Enamel does NOT grow back after occlusal adjustment
  10. After successful periodontal treatment, occlusal trauma does NOT cause additional attachment loss
76
Q

T/F if someone has occlusal trauma it induces gingivitis – then periodontitis

A

FALSE – it CANNOT induce periodontal tissue breakdown

77
Q

in occlusal trauma T/F you will NOT see clinical attachment loss but you may see radio-graphic attachment loss

A

TRUE

may see radiographic loss of bone

78
Q

perio with occlusal trauma in terms of radioluscency?

A

if treat – will go away

then treat with occlusal trauma tx (like splinting) and the bone will remineralize

79
Q

what is the ‘life-line’ of the periodontium

A

OCCLUSION

80
Q

when does occlusal trauma act as a co-factor and co-exist with perio problems?

A

in cases of severe periodontisis - this is secondary

81
Q

excessive forces in a reduced periodontium is classified as?

A 
secondary trauma 
(reduced = secondary)

primary will be with normal bone levels and normal attachment levels

Occlusion (10 decks)

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