Trauma from occlusion: Natural Teeth Flashcards
Define “trauma from occlusion”
An injury to the attachment apparatus as the result of excessive occlusal forces
What are the 2 conditions for Primary trauma from occlusion?
- Excessive force (ex. high restoration of bruxism)
2. Normal periodontium
What are the 2 conditions for Secondary trauma from occlusion?
- Normal (or excessive) forces
2. Applied to a weakened periodontium
What are the 6 possible Clinical signs of Trauma from occlusion?
- Progressive tooth mobility
- Fremetis
- Functional mobility
- Pathologic migration
- Infaboney pockets (maybe?)
- Buttressing bone (maybe?)
What are infraboney pockets?
Defects around the tooth, epithelial migration, perio bone loss, loss of CT attachment going apical to bone.
What is buttressing bone?
Build up of alveolar bone
What 2 general categories of causation might possible radiographic signs of occlusal trauma represent?
- May represent adaptation
2. May represent an extension of inflammatory periodontal disease without occlusal trauma as a factor
What are the 5 possible radiographic signs of trauma from occlusion?
- Widened PDL space
- Thickened Radi. Lamina Dura
- Thickened trabecular bone
- Angular bone loss
- Furcations
What are 4 common consequences of a cantilever bridge?
- Increased PDL space
- Thickened Lamina Dura
- No loss of crest of bone
- Tooth mobilization
What happens to trabecular bone when there is NO occlusion?
Hypofunction leads to Sparce Trabecular bone
Clinically, what does angular bone loss result in?
A pocket
Why is it controversial to say that furcations may be the result of trauma from occlusion?
Furcations are a pattern of progressive periodontal disease, and not necessarily due to occlusal forces
What is the Co-Destruction Theory (Glickman)?
Occlusal trauma may be a co-destructive factor that alters the sensitivity and pattern of inflammatory periodontal disease
Describe the “pathway of PD” according to the co-destruction theory
Proposed that inflammation is channeled into a pocket creating a new pattern where occlusion bears an influence on periodontal disease because it gets “channeled” to the PDL.
What are the 2 “zones” according to the co-destruction theory?
- Zone of irritation
2. Zone of co-destruction
What occurs in the zone of irritation according to the co-destruction theory?
Host-parasite interaction
Describe the “Advancing Plaque Front” Theory (Waerhaug)
Occlusal trauma has NO ROLE in the severity and pattern of inflammatory periodontal disease progression (says it is just a problem of advancing plaque front, not occlusion)
In what way does trauma play a role in periodontal disease according to Dr. Claman?
Dr. Claman says that secondary causes pay a role in an already weakened periodontium, but occlusion does NOT play a major role as the cause…however, because trauma from occlusion effects treatment outcomes, it still needs to be addressed
In trauma from occlusion, crushing of the tooth against bone causes what (and where)?
Crushing of tooth against bone causes injury to periodontal ligament at sites of pressure and of tension
What are the 3 models for Role of Occlusal Trauma?
- Trauma from occlusion without periodontitis
- Trauma from occlusion with periodontitis: But NO co-destruction
- Trauma from occlusion with periodontitis: co-destruction occurs
What are the signs and symptoms of TFO without Periodontitis?
- Injury results in acute (not plaque associated) inflammation (ie high restoration)
- PDL collagen destruction
- Cementum resorption
- Bone loss
- NO attachment loss
- Jiggling movement
- Adaption may occurL tooth may become mobile, but no further injury
Describe Jiggling Movement/Forces in TFO without periodontitis
- Movement with excursive movements, including jiggling back and forth
- Jiggling causes injury to PDL and Cementum
Describe “adaptation” in TFO without periodontitis
Mobility and widened PDL space, but no further injury
Describe “occlusal therapy” for TFO without periodontitis
By occlusal reduction, splinting, or adding bite plates, there will NO longer be jiggling, with signs of occlusal trauma may diminish
What are the 3 phases of TFO without periodontitis?
- Injury Phase: initiated by crushing force, lead to bone resorption increasing and bone apposition decreasing
- Repair phase: Bone absorption goes down and apposition does up
- Adaptation phase: No longer under trauma
Describe the consequences of TFO on reduced periodontium without periodontitis
- Reduced, but healthy, periodontium (weakened tooth)
- TFO leads to breakdown of PDL -b/c of secondary occlusal trauma (weakened periodontium)
- no further attachment loss
Describe adaptation of reduced periodontium with TFO without periodontitis
Adaptation: mobility and widened PDL space
What is the outcome of occlusal therapy in a tooth experiencing TFO on reduced periodontium without periodontitis?
Occlusal reduction may decrease the signs of occlusal trauma, but sometimes also need to splint to healthier teeth
Describe the consequences of TFO with no inflammation in a tooth with previous attachment loss (reduced, but healthy)
- Tooth adapts
- No influence on course of periodontal disease
- No further attachment loss
- No co-destruction
- Bone thickens
What is the key to no co-destruction with TFO w/o inflammation on reduced periodontium?
Good oral hygiene….control of inflammation
Describe TFO with Periodontitis but No Co-destruction
- Injury from occlusion as well as Periodontal disease, however the 2 problems are occurring INDEPENDENTLY of one another
- Do not potentiate each other
- Destructive processes are occurring independently
Describe adaptation to occlusal trauma in a tooth with supracrestal periodontitis
Widened PDL space and Thickened bone
When should you perform occlusal therapy in a tooth with periodontitis?
NEVER PERFORM OCCLUSAL THERAPY UNTIL INFLAMMATION IS CONTROLLED….TX PERIODONTITIS FIRST!!!
Why must you treat the periodontitis (control the inflammation) before performing occlusal therapy in a tooth experiencing both TFO and periodontitis?
Because the high occlusion may actually be being CAUSED by the inflammation, so if you drill first, you may be removing sound tooth structure for no reason
Describe TFO with Periodontitis where Co-destruction occurs
Inflammation from periodontitis merges with the occlusal lesion and results in an ACCELERATED response.
As far as location, how does a periodontal lesion in a tooth with co-destruction vs. no co-destruction differ?
-TFO & periodontitis w/o co-destruction = SUPRAcrestal periodontitis lesion
Vs.
-TFO & periodontitis w/ co-destruction = SUBcrestal (infrabony pocket) with inflammatory infiltrate
How do periodontitis and TFO potentiate each other?
When the periodontitis MERGES with the increased TOOTH MOBILITY –> co-destruction occurs
Can you do occlusal therapy on a tooth with SUBCRESTAL periodontitis lesion?
NO! Never do occlusal therapy until you first have ANY periodontitis under control
If TFO and inflammatory periodontitis are _______ processes, ____ enhanced attachment loss
Independent processes –> NO enhanced attachment loss
Describe the conditions under which there will likely be co-destruction
- TFO with increasing mobility AND inflammatory infiltrate (periodontitis) at same site
- Two lesions COULD merge
- Downgrowth (apical migration) of pocket (junctional ) epithelium
- Enhanced (accelerated) attachment loss = co-destruction
Name 4 REVERSIBLE methods of occlusal therapy
- Night guard (bite plane)
- Extracoronal splints
- Muscle relaxants (meds)
- Muscle exercises
Name 4 IRREVERSIBLE methods of occlusal therapy
- Intracoronal splints (requires tooth preparation)
- Occlusal adjustment by selective grinding
- Orthodontics
- Orthognathic surgery
What are the 5 indications for occlusal adjustment by selective grinding?
- Periodontal occlusal trauma
- Post-orthodontics
- Prior to extensive (?)
- Certain types of TMD
- Certain wear patterns
What are the 5 CONTRAindications to occlusal adjustment?
- Severe malocclusion
- Non-ideal but tolerated occlusion
- Severe wear
- Patient in pain
- If no suitable end point
______ must be present for attachment loss to occur
Periodontitis (inflammation)
Occlusal trauma in the absence of periodontitis may be ______ and may result in ______
May be REVERSIBLE and may result in ADAPTATION (a mobile but otherwise healthy tooth)
No repair can occur unless inflammatory periodontal disease is first _____
Resolved
Occlusal trauma superimposed on an existing periodontitis MAY under certain conditions ______
Accelerate attachment loss (but not always)
When is occlusal therapy indicated with periodontal treatment?
When occlusal trauma is present with PD
During the initial periodontal therapy, why should occlusal therapy not be done until after inflammatory PD is first controlled?
Because PD therapy helps decrease the inflammation and therefore decrease the tooth mobility
What is unique about a treatment plan for periodontal regenerative therapy?
Occlusal therapy is especially indicated prior to regenerative therapy
______ is not justified in the absence of periodontal disease as a PD preventative measure
Occlusal therapy
