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Periodontics I > Traumatic Occlusal Forces > Flashcards

Traumatic Occlusal Forces Flashcards

1
Q

what is occlusal trauma

A

injury resulting in tissue changes within the attachment apparatus (PDL, cementum, and supporting bone) as a result of occlusal forces

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2
Q

what are the occlusal forces

A

teeth

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3
Q

where may occlusal trauma occur

A

on an intact periodontium or in a reduced periodontium affected by periodontal disease

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4
Q

what is a reduced periodontium

A

based on an in vitro study, reduced is loss of greater than 60% of bone support

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5
Q

what are the parts of the periodontium affectde by occlusal forces

A
  • cementum
  • PDL
  • alveolar bone proper
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6
Q

are the gingiva and JE affected by occlusal forces

A

no

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7
Q

what are the classes of traumatic occlusal forces. on the periodontium

A
  • primary occlusal trauma
  • secondary occlusal trauma
  • orthodontic forces
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8
Q

is occlusal truma called excessive or traumatic

A

traumatic

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9
Q

what are the variables affecting occlusal trauma

A
  • direction of force
  • magnitude of force
  • duration of force
  • frequency of occurence
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10
Q

trauma from occlusion is considered to be:

A

pathologic

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11
Q

describe trauma from occlusion

A

forces of occlusion exceed the adaptive capacity of the periodontium

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12
Q

what are the types of occlusal wear that are considered physiological

A
  • hypofunction
  • disuse atrophy
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13
Q

what are the types of occlusal wear are considered pathological

A
  • occlusal trauma
  • hyperfunction
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14
Q

what is primary occlusal trauma

A
  • traumatic occlusal forces applied to a tooth or teeth with normal periodontal support
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15
Q

what is seen with primary occlusal trauma

A

may see adaptive mobility - does not progress

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16
Q

what is an example of primary occlusal trauma

A

a high restoration with mobility resolving following reduction

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17
Q

what is secondary occlusal trauma

A

injury resulting in tissue changes from normal or traumatic occlusal forces applied to a tooth or teeth with reduced periodontal support

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18
Q

what may secondary occlusal trauma be seen as

A

progressive mobility and/or pain

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19
Q

what are the forces in primary occlusal trauma

A
  • points of rotation of tooth with horizontal force
  • results from trauma from occlusion from non-vertical forces
  • traumatic force on a normal system
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20
Q

what is seen with secondary occlusal trauma

A

reduced bone support
- normal or traumatic forces on reduced periodontal support
- results from normal or traumatic forces on a reduced periodontium

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21
Q

what happens from the compression from trauma from occlusion

A
  • PDL space is reduced as fibers are compressed
  • loss of fiber orientation
  • increased capillary permeability, rupture of blood vessels and hemorhage into PDL perivascular spaces (edema)
  • resorption of alveolar bone proper (root resorption if severe) then widening of PDL space
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22
Q

what is happening on the tension side from trauma from occlusion

A
  • increase in PDL space
  • rupture of PDL fiber bundles
  • compression of PDL blood vessels and hemorrhage into perivascular spaces
  • deposition of new alveolar bone and decrease in PDL space
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23
Q

what is happening in severe trauma from occlusion

A
  • crushing pressure injury - necrosis at furca, alveolar crest
  • extravasated RBCs, hematoma, necrosis, vascular damage
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24
Q

describe what happens in severe trauma from occlusion

A
  • well. defined necrosis, including PDL, cementum, bone
  • degenerative changes ( hyaline, mucoid, liquefaction)
  • repair from PDL, endosteal cells, bone marrow, Haversian systems (rear resorption)
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25
Q

what is the definition and manifestation of primary occlusal traum

A
  • traumatic occlusal forces applied to tooth or teeth with normal periodontal support
  • adaptive mobility- not progressive or pathologic
26
Q

what is the definition and manifestation of secondary occlusal trauma

A
  • normal or traumatic occlusal forces applied to a tooth or teeth with reduced periodontal support
  • progressive mobility - may exhibit mobility and/or pain on function. consider splinting
27
Q

the lesion of occlusal trauma can only be confirmed:

A

histologically by block section biopsy, so must use other surrogate indicators such as clinical and radiographic

28
Q

what are the proposed clinical and radiographic indicators of occlusal trauma

A
  • fremitus
  • mobility
  • occlusal discrepancies
  • wear facets
  • tooth migration
  • fractured tooth
  • thermal sensitivity
  • discomfort/pain on chewing
  • widened PDL space
  • root resorption
  • cemental tear
29
Q

what is fremitus

A

a palpable or visible movement of a tooth when subjected to occlusal forces

30
Q

what are the clinical signs and symptoms of occlusal trauma

A
  • mobility of affected teeth
  • radiographic evidence of thickened PDL
  • positive hx of clenching or bruxism
  • missing or tilted teeth
  • evidence of working and/or balancing side occlusal interferences
31
Q

what are the classes of mobility index

A
  • 1: first distinguishable sign of movement greater than normal ( physiologic)
    -2: movement which allows crown to move 1mm from its normal position in any direct
  • 3: tooth may be rotated or depressed in alveoli
32
Q

how do you test mobility

A

using 2 rigid instruments
- not fingers

33
Q

what are the occlusal discrepancies

A
  • working and/or balancing interferences
  • evidence of occlusal slide in CR or CO
  • evidence of occlusal interferences in protrusive mandibular movement
  • extremely steep cuspal inclines
  • wear facets- but may be a normal part of aging
34
Q

what is bruxism and what can it cause

A
  • grinding, clenching, or clamping of the teeth
  • the force may damage tooth or attachment apparatus
35
Q

what are the signs and symptoms of bruxism

A
  • increased mobility
  • pulpal sensitivity/bite tenderness
  • non- masticatory/ excessive occlusal wear
  • dull percussion sound
  • muscle tenderness/spasm/ hypertrophy/tiredness (am)
  • TMJ pain/jawlock
  • audible sounds
36
Q

what are the other manifestations of traumatic occlusal force

A
  • malocclusions
  • tooth migration
  • fractured teeth
37
Q

what are the radiographic signs of occlusal trauma

A
  • widened PDL space
  • thickening of lamina dura
  • vertical (angular) bone loss
  • furcal bone loss
  • alveolar radiolucency and/or condensation
38
Q

what are the PDL dimensions

A
  • PDL thickest at apices and alveolar crest ( 0.2 mm)
  • less at mid root (0.15mm)- varies with functional/force status of tooth
39
Q

what are the problems with surrogate indicators

A
  • existing loss of attachment may contribute to mobility
  • wear facets may be due to normal function rather than parafunctional habits ( bruxism, clenching, grinding)
  • altered vitality of teeth may be due to other factors
40
Q

what are the indications for occlusal adjustment

A
  • traumatic injuries/soft tissue injury; food impaction
  • increasing mobility or fremitus
  • parafunctional habits
  • in conjugation with orthodontic/orthognathic therapy
41
Q

what are the contraindications to occlusal adjustment

A
  • absence of a pre treatment diagnosis
  • as prophylactic therapy or only treatment for periodontal disease
  • as primary therapy of bruxism
  • severe extrusion or malpositioned teeth
  • when periodontal inflammation has not been controlled
42
Q

what are the effects of periodontal treatment on mobility

A
  • tooth mobility negatively affects outcomes of periodontal therapy and maintenance
  • tooth mobility generally will decrease once inflammation is controlled
43
Q

if signs and symptoms of occlusal trauma and patients comfort and function are impacted then:

A
  • perform occlusal adjustment in conjunction with periodontal therapy
  • evaluate and record occlusion before, during, and after treatment
  • treatment of occlusal truama may slow the progression of periodontitis and improve the prognosis
44
Q

what is occlusal hyperfunction

A

slight increase in occlusal force

45
Q

occlusal hyperfunction is considered to be a ____ adaptation

A

physiologic

46
Q

what are the clinical symptoms of occlusal hyperfunction

A
  • increase in number and diameter of collagen fiber bundles in PDL
  • increased width of PDL
  • increased density and thickness of alveolar bone proper (lamina dura)
  • radiographic evidence of osteosclerosis
  • slight or undetectable tooth mobility
47
Q

how can occlusal hypofunction be diagnosed

A

only by histology

48
Q

describe the features of occlusal hypofunction

A
  • decrease in number of PDL fiber bundles but normal orientation
  • decreased physiologic turnover and remodeling of alveolar bone
  • narrowing of PDL space
  • no change in tooth mobility
49
Q

what is disuse atrophy

A

total removal of occlusal forces resulting in lack of the level of physiological stimulation required to maintain normal form and function

50
Q

disuse atrophy is considered _____ adaptation

A

physiologic

51
Q

what are the clinical symptoms of disuse atrophy

A
  • radiographic evidence of decreased width of PDL space
  • increased tooth mobility is always present
  • absence of occlusal antagonist
52
Q

what are the features of disuse atrophy

A
  • loss of orientation of the principle fiber bundles of the PDL
  • narrowed PDL width
  • significant decrease in number of bony trabeculae such as localized osteoporosis
53
Q

trauma from occlusion in the absence of inflammation, does not cause:

A
  • gingivitis
  • periodontitis
  • pocket formation
54
Q

is there evidence that traumatic occlusal forces cause periodontal attachment loss in humans

A

no

55
Q

is there evidence that traumatic occlusal forces cause inflammation in the periodontal ligament

A

limited evidence

56
Q

are traumatic occlusal forces associated with severity of periodontitis

A

no

57
Q

truamatic occlusal forces have a relationship with:

A
  • non carious cerival lesions/abfraction
  • recession
58
Q

is there evidence that traumatic occlusal forces cause non carious servical lesions

A

no

59
Q

non carious cervical lesions may result from:

A

abrasion, erosion, corrosion

60
Q

does traumatic occlusal forces cause gingival recession

A

no

61
Q
A

Periodontics I (13 decks)

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