Traumatic occlusal forces Flashcards
Injury resulting in tissue changes within the attachment apparatus (PDL, cementum, & supporting bone) as a result of occlusal forces:
Occlusal trauma
Occlusal forces =
Teeth
T/F: OT may occur in an intact periodontium or in a reduced periodontium affected by perio disease
True
Reduced periodontium =
60% of bone loss
Gold standard for periodontal disease is:
attachment loss
Terminology in the 2017 AAP World Workshop changes the word excessive to:
traumatic
T/F: Overall, past studies showed lack of “cause & effect” such as OT did NOT cause pocket formation or lead to loss of connective tissue
True
List the parts of the periodontium affected by occlusal forces:
- cementum
- PDL
- Alveolar bone proper
T/F: The gingiva & JE are not affected by occlusal forces
True
List the categories of occlusal trauma:
1a) primary
1b) secondary
1c) orthodontic
Controlled occlusal trauma to change the relationship of the teeth to one another:
Orthodontics
What are the variables of occlusal trauma:
- DIRECTION of force
- MAGNITUDE of force
- DURATION of force
- FREQUENCY of occurrence
(direction, magnitude, duration, frequency)
Bone should be ____mm from the CEJ
1-2
Trauma from occlusion is considered to be:
Pathologic
Forces of occlusion _____ the adaptive capacity of the periodontiun
Exceed
List from pathological to physiologica:
PATHOLOGICAL
-occlusal trauma
-hyperfunction
-normal
-hypofunction
-disuse atrophy
PHYSIOLOGICAL
Occlusal trauma & hyperfunction are considered:
pathological
Hypofunction & disuse atrophy are considered:
Physiological
Placing a high amalgam restoration is an example of:
Hyperfunction
Tooth that is barely occluding is an example of:
Hypofunction
Traumatic occlusal forces applied to a tooth or teeth with normal periodontal support:
Primary occlusal trauma
With PRIMARY occlusal trauma we may clincially see _____ that _____
ADAPTIVE mobility that does NOT progress
Give an example of PRIMARY occlusal trauma:
High restoration with mobility resolving following reduction
T/F: SECONDARY occlusal trauma tends to happen in a fairly late stage of perio disease with nearly 60% bone loss
True
Injury resulting in tissue changes from normal or traumatic occlusal forces applied to a tooth or teeth with reduced periodontal force:
SECONDARY occlusal trauma
SECONDARY occlusal trauma may be seen as:
progressive mobility and/or pain
Moving tooth #19 towards tooth #18
Compression side=
Tension side=
Compression side= direction tooth is moving
tension side= direction opposite that tooth is moving
Direction that the tooth is moving due to OT:
Compression side
Direction OPPOSITE to moving tooth due to OT:
Tension side
As fibers are compressed due to OT, ____ is reduced
PDL space
Compression side results in loss of:
fiber orientation
Compression side results in increased capillary permeability, rupture of blood vessels and hemmorhage into PDL vasculature spaces ultimately resulting in:
edema
T/F: With compression, resorption of alveolar bone proper (root resorption if severe) and widening of the PDL will occur
true
-increased capillary permeability, dilation
-edema, disturbed fluid exchange
-vascular damage with stasis, clotting, thrombosis
-lowered periodontal resistance
-acommpanying tissue effects, usually minor
Minor trauma from occlusion
What happens to the PDL on the tension side?
lenghtening resulting in increase in PDL space
Lengthening occurs on the tension side resulting in:
increased PDL space
- increase in PDL space
-rupture of PDL fiber bundles - compression of PDL blood vessels & hemorrhage into perivascular space
-deposition of new alveolar bone & DECREASE in PDL space if severe cemental tears
Tension side
This act results in RESORPTION of alveolar bone proper & WIDENING of the PDL space (root resorption):
This act results in DEPOSITION of new alveolar bone & DECREASE of the PDL space (if severe cemental tears):
Compression side
Tension side
-crushing (pressure) injury, necrosis at furca, alveolar crest
-extravasated RBCs, hematoma, necvrosis, vascular damage
SEVERE trauma from occlusion
Traumatic occlusal forces applied to tooth or teeth with NORMAL periodontal support:
PRIMARY occlusal trauma
What is a manifestation of PRIMARY occlusal trauma:
adaptive mobility (not progressive or pathologic)
example: hyper occlusion
NORMAL or TRAUMATIC occlusal forces applied to tooth or teeth with REDUCED periodontal support:
Secondary occlusal trauma
What is a manifestation of SECONDARY occlusal trauma:
progressive mobility
What is the ONLY true way to determine occlusal trauma occurance?
BIOPSY
PROPOSED clinical & radiographic indicators of occlusal trauma:
- fremitus
- mobility
- occlusal discrepencies
- wear facets
- tooth migration
- fractured tooth
- thermal sensitivity
- discomfort/pain on chewing
- widened PDL ligament space
- root resorption
- cemental tear
A palpable or visible movement of a tooth when subjected to occlusal force:
fremitus
Clinical signs & symptoms of occlusal trauma:
- MOBILITY of affected teeth
- radiographic evidence of THICKENED PDL
- positive history of clenching or bruxism
- missing or tilted teeth
- evidence of occlusal interferences
What is the mobility index we currently use for occlusal trauma?
Miller
Classify the miller status
-first disntinguishable sign of movement greater than normal
Miller 1
Classify the miller status
-movement that allows the crown to move 1mm from its normal position in any direction
Miller 2
Classify the miller status
-tooth may be rotated or depressed in alveoli
Miller 3
T/F: It is acceptable to use fingers when determining miller class
False- MUST USE TWO RIGID INSTRUMENTS
Grinding, clenching or clamping of teeth. The force may damage tooth or attachment apparatus:
Bruxism
-Increased mobility
-Pulpal sensitivity
-Bite tenderness
-Non-masticatory/excessive occlusal wear
-Dull percussion sound
-Muscle tenderness/spasm/HYPERtrophy/tiredness
-TMJ pain
-Jaw lock
-Audible sounds
Bruxism indicators
What type of percussion sound will be heard with a bruxer?
Dull
Other manifestations of traumatic occlusal force include:
- malocclusions
- tooth migration
- fractured tooth
Radiographic signs of traumatic occlusal forces:
- WIDENED PDL space
- Thickening of lamina dura
- Vertical (angular) bone loss
- Furcal bone loss
- Alveolar radiolucency and/or condensation
The PDL is thickest at ____ & ____
apices & alveolar crest (0.20mm)
What is the measurement of the PDL at the mid-root?
0.15 mm
What is the biggest contraindication to occlusal adjustment?
When periodontal inflammation has NOT been controlled
Other contraindications include:
1. absence of pre-treatment diagnosis
2. prophylactic therapy or sole treatment of perio disease
3. as primary treatment of bruxism
4. severe extrusion or malpositioned teeth
T/F: Tooth mobility positively affects outcome of periodontal therapy and maintenance
False- negatively affects
T/F: Tooth mobility will generally decreases once inflammation is controlled
True
Occlusal adjustment is best done in conjunction with:
periodontal therapy
Hyperfunction is a slight increase in occlusal force. This is considered to be a ____ adaptation
Physiologic
Trauma from occlusion in the absence of inflammation does not cause:
- gingivitis
- periodontitis
- pocket formation
T/F: There is NO EVIDENCE that TOF causes no-carious cervical lesions (NCCLs)
True
NCCLS may result from:
- abrasion
- erosion
- corrosion
(NOT TOF)
T/F: Evidence from observational studies reveal that traumatic occlusal force does cause gingival recession
False- TOF does NOT cause gingival recession