Trauma from Occlusion Flashcards
definition of trauma from occlusion
injury to the periodontium caused by occlusal forces, which exceed the reparative capacity of the attachment apparatus
components of the masticatory system
teeth
TMJ
muscles
attachment apparatus*
teeth - indications of trauma?
attrition
ware facets
craze lines
isolated deep probing depth
suscpision of fracture
factor associated with trauma
what happens to TMJ in trauma TMJ
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
signs of trauma in masticatory muscles
include definitions of each
myalgia - pain in masticatory muscles
trismus - spasm in mastiatory muscles
dyskenesia - incoordination of the jaw
jaw fatigue, headache. inability to open close
anatomy of periodontium - components
cementum
pdl
alveolar bone
glickmans concept - general
separated into two zones of attachment apparatus
- zone of irritation
- zone of co-destruction
zone of irritation
includes?
trauma from where? - what happens?
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
zone of co-destruction
includes?
trauma from where? - what happens?
includes the periodontal ligamen, the root cementum, and alveolar bone
trauma from occlusion
so any excessive forces have an effect on the periodontium
transeptal fibers
zone between the two zones
can be influenced by both zones
bacteria that infiltrates usually spreads where?
aka inflammatory lesion in the zone of irritation goes where?
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
occlusal truama causes what direction of defects?
ANGULAR – directly effects the pdl
where as inflammation from bacteria effects in a horizontal way then will eventually reach pdl in later stages
angular or horizontal bone loss is a result of? what conept is this?
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
physiopathology of occlusal trauma - general
injury
repair
adaptive remodeling
how do we see injusry clinically?
- widening of PDL
- angular bone defects
- no periodontal pockets
- tooth mobility
slight pressure (injury) what happens what do we see
- bone RESORPTION
- widening of PDL
- numerous blood vessels reduced in size
slight tension (injury)
location?
what do we see?
what happens?
OPPOSITE SIDE OF TOOTH FROM TENSION
- Apposition of bone (GROWTH)
- PDL fibers elongate
- blood vessels enlarged
why does the PDL widen?
Bone resoprtion starts - so creates more space and widens
can tension/ pressure zones coexist?
yes - coexist – areas of tension can see widening of pdl as well
so can see
what phase do you have more bone resorption/ formation?
injury – resoprtion
repair – formation
Greater tension (injury) what happens? what do we see?
- widening of pdl
- tearing of ligament
- hemorrhage
- thrombosis
- bone resorption
Greater pressure (injury) what happens? what do we see?
- compression of fibers
- vascular changes
- injury to fibroblasts, CT cells leading to necrosis of ligament
- increased bone / tooth resorption
how to tell where tooth is moving?
identify where pdl is wider and where it is not
what must happen for reparative phase to occur?
the reparative function must exceed the excessive forces
repair phase
formation of what?
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
adaptive remodeling
forces are excessive and exceed our capacity so then remodeling must occur
- periodontium is remodeled
- with remodeling, forces may no longer be injurious to the tissue
- 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
no periodontal pockets in trauma? T/F? Implication?
UNLESS A PRESENT PERIO PROBLEM there is NOT usually pocket formation
types of occlusal trauma?
tipping movement
bodily movement
tippping movement
direction?
zones?
effected / unaffected tissues?
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)
when will you stop seeing clinical signs of attachment loss?
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)
bodily movement example? direction? zones? effected / unaffected tissues? inflammation?
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)
primary occlusal trauma
definition
occurs in the presence of?
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
difference in bone loss from trauma vs perio problem?
trauma = demineralization of the bone
what does primary occlusal trauma cause and not cause?
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
main difference between primary and secondary occlusal trauma in the periodontium?
in secondary – we have REDUCED SUPPORT - so the capacity and support of the periodontium is less
secondary occlusal trauma
definition
occurs in the presence of?
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
loss of support will indicate primary or secondary?
secondary
what does primary occlusal trauma cause and not cause?
NOT:
- periodontal disease
DOES:
- bone loss and increasing tooth mobility
implication of occlusal trauma in teeth with progressive/ severe perio disease in teeth with
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
etiology of occlusal trauma
Increase of magnitud/ frequency of occlusal forces
ALSO
- para functional habits (clenching, bruxism)
- occlusal interferences
- fixed / removable rosthetic appliances
etiology / causes of occlusal trauma other than increases in occlusal force
- para functional habits (clenching, bruxism)
- occlusal interferences
- fixed / removable rosthetic appliances
causes / etiology of change of direction of occlusal force
- parafunctional habits in extreme eccentric positions
- tipping forces from occlusal interferences
- tilting/ drifting of teeth
- restorative/ prosthetic tx that generates tipping occlusal forces
- orthodontic teeth movement
what causes decreased resistance of the periodontium to occlusal forces (2 main things)
- loss of alveolar bone and periodontal support
- loss of a number of teeth (fewer teeth to absorb occlusal load)
ALSO when we have perio disease (basically bullet 1)`
characteristic clinical indication of occlusal trauma
mobility – progressive
clinical indicators of occlusal trauma
7
- mobility (progressive - so watch this)
- fremitus
- occlusal interferences
- wear facets in presence of other clinical indications
- tooth migration
- fractured tooth/teeth
- thermal sensativity
class I mobility
horizontal in buccal-lingual direction
mobility is greater than physiologic/ normal UP TO 1MM
class II mobility
still only movement in the horizontal direction (buccal-lingual) but is greater than 1mm
class III mobility
excessive horizontal (buccal-lingual) mobility and VERTICAL ( apical-coronal) tooth depression
how to check for mobility
two solid instruments - place in front of tooth and try and move it buccal lingual direction
fremitus
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
occlusal interferences implication?
if present - clinical sign of occlusal trauma and must eliminate
working or non working
locate with articulating paper
wear facets in presence of other clinical indications
severe attrition?
tooth migration implicatoin / sign of?
why does this occur?
can cause?
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
fractured tooth / teeth sign of?
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
radiographic indicators of occlusal trauma may include one or more of the following (6 things)
- widening of the PDL space
- bone loss (furcation, vertical, circumfrential)
- root resorption/ fracture
- hypercementosis
- thickened lamina dura –
- cemental tear – part of cementum of tooth
deminarlization in furcation?
sign of traumatic force/ occlusal trauma
main goal in tx of occlusal trauma
maintain the periodontium in comfort and function
other goals in tx of occlusal trauma
in addition to maintaining the periodontium in comfort and function
- reduce/ eliminate the tooth mobility
- eliminate occlusal prematuritites (contacts/ interferences) / fremitus
- eliminate parafunctional habits
- prevent further tooth migration
- decrease/ stablize radiographic changes
treatment options for trauma (6)
- occlusal adjustments
- management of parafunctional habits
- temporary / provisional or long-term stabilization of mobile teeth with removable or fixed appliances
- orthodontic tooth movement
- occlusal reconstruction
- extraction of selected teeth (last resort)
this has to be done wisely
- must know when and how to do these treatements
4 main tx options for primary occlusal trauma
- occlusal adjustment
- management of parafunctional
- ortho tooth movement
- occlusal guard
main tx options for secondary occlusal trauma
- splinting
- occlusal adjustment
- . management of parafunctional
- ortho tooth movement
- occlusal guard
*difference is that we add the splint
indication for occlusal tx? list them (4 main)
- to reduce traumatic forces on teeth that exhibit
- increasing mobility/ fremitus
- discomfort during occlusal contact /function - to achieve functional relationships
- as adjunctive therapy
- to reduce teeth contributing to soft tissue injury
contraindications for occlusal adjustments
4 points
- when no evidence of trauma - NOT preventative tx
- does not treat primary periodontal disease
- tx of parafunctional habit - without the existance of damage, pathosis or pain
- instance of severe extrusion, mobility, malpositioning of teeth that would no respond to occlusal adjustment alone
4 basic principles of occlusal adjustement
- mutually protected occlusoin
- mounted casts
- premature contacts
- “BULL” rule (working side)
buccal upper
lower liungual
what are the indications for splinting?
6 main things
- to stabalize teeth with increasing mobility that have not been responding to occlusal adjustment and periodontal treatment
- for patient’s comfort/funciton
- prior to periodontal instrumentation and occlusal adjustment procedures
- to prevent tipping/ drifting/ exxtrusion of teeth
- after orthodontic tx
- following acute trauma
BULL rule
component of basic principle of occlusal adjustment
on working side
buccal upper
lower lingual
cusp inclines – protect the mutually protected occlusion
contraindications for splinting
- when the treatment of inflammatory periodontal disease has not been addressed
- 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)
- when the sole objective of splinting is to reduce tooth mobility following the removal of the splint - think more comprehensively
types of splints
intra-coronal
extra -coronal
intra- coronal splint
this is a PERMANENT splint - so have to prep the teeth
preparations are made in the teeth and can be continous with neighbor teeth.
extra-coronal splint
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
is a FPD considered a splint?
yes - fixed partial denture
occlusal guard purpose?
protection - always helps outcome and can be used after any procedure
6 desired outcomes of successful tx
what would indicate unsuccessful tx?
- elimination / absence of tooth mobility
- further tooth migration should not occur
- relief of pain/ discomfort/ TMJ problems
- relief of premature contacts / fremitus/ interferences
- radiographic changes diminish or become stable
- 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)
10 main conclusions of trauma from occlusion
- CANNOT induce periodontal tissue breakdown
- Results in resorption of alveolar bone leading to an increased tooth mobility
- Does NOT cause gingivitis / periodontitis
- Does NOT cause progression of gingivitis to periodontitis
- MAY enhance the RATE OF PROGRESSION of severe periodontitis with deeper PD (periodontal disease), increased AL (attachment loss)
- Treat inflammation BEFORE occlusal correction
- Does NOT cause attachment loss
- Mutually protected occlusion - want this if we can
- Enamel does NOT grow back after occlusal adjustment
- After successful periodontal treatment, occlusal trauma does NOT cause additional attachment loss
T/F if someone has occlusal trauma it induces gingivitis – then periodontitis
FALSE – it CANNOT induce periodontal tissue breakdown
in occlusal trauma T/F you will NOT see clinical attachment loss but you may see radio-graphic attachment loss
TRUE
may see radiographic loss of bone
perio with occlusal trauma in terms of radioluscency?
if treat – will go away
then treat with occlusal trauma tx (like splinting) and the bone will remineralize
what is the ‘life-line’ of the periodontium
OCCLUSION
when does occlusal trauma act as a co-factor and co-exist with perio problems?
in cases of severe periodontisis - this is secondary
excessive forces in a reduced periodontium is classified as?
secondary trauma (reduced = secondary)
primary will be with normal bone levels and normal attachment levels
