Tx of trauma from occlusion Flashcards
when is the best time to treat traumatic occlusal forces
Best time to do it is after SRP
We want to wait until all the inflammation is gone because inflammation leads to mobility
primary TFO results in _ PDL
primary TFO - excessive forces (e.g. high amalgam restoration, bruxism)
on normal periodontium (no bone loss)
widened PDL space
we want to put the forces in the axial direction
reducing PDL space and injury
what is secondary occusal trauma
occlusal trauma on a reduced periodontium
normal or excessive forces applied to a weakened periodontium (weakened tooth)
we want to corerct it with splints for stabilization
methods of occlusal therapy that are reversible
night guard - bite plane
extracoronal splints
muscle relaxants - meds
muscle exercises
methods of occlusal therapy that are irreversible
intracoronal splints - require tooth preparation
occlusal adjustment by selective grinding
orthodontics
orthognathics surgery
principles of Occlusal adjustment
oocclusal adjustment by _ is one of the most irreversible dental procedures you will ever do - know the limitations
selective grinding
principles of Occlusal adjustment
knowing the _ to occlusal adjustment is more important than knowing the indications to adjust
contraindications
occlusal adjustment by selective grinding _
periodontal occlusal trauma post-orthodontics - fine tuning prior to extensive restorations certain types of TMD certain wear patterns
indications
occlusal adjustment by selective grinding _
severe malocclusion
non-ideal but well tolerated occlusion
severe wear or if occlusal adjustment would expose dentin
patient in pain
if no suitable end point can be reached (because of malocclusion or tooth malposition)
contraindications
goals in occlusal adjustment
_ overtime
_ loading forces
_ guideance in excursions that are smooth gliding and unrestrained
occlusal stability over time
axial loading of forces
anterior guidance in excursions that are smooth gliding
Occlusal adjustment by selective grinding _ a. CR b. excursions non-working side (balancing) working side protrusive
comprehensive
Occlusal adjustment by selective grinding
- _: mainly excursive movements
a. directed toward eliminating lateral “jiggling-type” forces
limited: mainly excursive movements
Occlusal adjustment: general concepts
- _ so that CR-to-CO is not an inclined deflective contact
- _ of forces to prevent jigglying buccolingual forces
- reduction of wear facets by _ _ _
- NO _ contacts
- working contacts = _ guided if possible. _ if needed(with less force on molars)
- Protrusive: anterior contacts no _ protrusive contacts
- long centric
- axial loading of forces
- grooving, spheroiding, pointing
- no non-working balancing contacts
- canine guided if possible, group function if needed
- no posterior protrusive contacts
steps in comprehensive occlusal adjustment by selective grinding
- _ hit and slide - eliminate or reduce
- non-working side “balancing inferences
- working contacts
- protrusive contacts
- sharp or irregular incisal edges
- _ all teeth that were adjusted
- CR-CO hit and slide - eliminate
- eliminate them
- canine guide smooth and gliding
- anterior
- recontour them
- polish all teeth that were adjusted
what jaw position do we adjust in
jaw positioning
contact relationships
occlusal adjustment in _
CR
chin grasp
bilateral mandibular manipulation
leaf gauge
patient determined
CR; patient determined
chair at _ degrees
patient open
ask patient to place tongue on _
patient closes into centric
chair at 60degrees
tongue on soft palate
CR-CO deflection
direction: _ (upper or lower jaw) guides anterior and vertical
CR relation interferences usually the _ inclines maxillary against the _ inclines mandibular
mandible guides anterior and vertical
more than 2mm it is difficult to get a long centric relation
mesial inclines maxillary
against distal inclines mandibular - forward displacement so we trim those areas
possible contact relationships
_ is ideal _ acceptable _ _ not good _worse _ worst
cusp to fossa ideal
cusp to flat area - acceptable
cusp to incline and cusp to embrasure not good
incline to incline worse
cusp to cusp worst
flatten _ contacts to establish long centric
flatten inclined contacts
By adjusting the inclines we are able to get the cusp in the fossa
reduce _
As teeth wear due to diet, parafunctional habits, age, they tend to become flattened
So we recontour the teeth - slightly smaller tooth with the same anatomical proportions
Within the scoop of not affecting the dentin
reduce wear facets
CR doesn’t = CO
it is usually the mesial of max and distal of mandi so the premature posterior contact causes the mandible to displace in which direction
anteriorly
CR mandibular cusp tip to incline
solution?
flatten maxillary mesial incline
incline to incline contact
solution
recontour both maxillary mesial incline and mandibular distal incline
when do you spheroid the maxillary palatal cusp
prematurity in centric, working and nonworking
premature contact in centric only, working and nonworking are okay
deepen the fossa
CR incline to incline contact on both maxillary and mandibular holding cusps
recontour cusp inner inclines (not cusp tips)
incline to incline premature contact on maxillary palatal holding cuso
recontour both cusp inclines max and mandi
incline to incline premature contact on mandibular buccal holding cusps
recontour both cusp inclines
as a general rule do not reduce a _ cusp tip
holding or functional cusp tip
buccal of mandi
lingual of max
adjust on inclines
flatten the cusp tip on when there is a _ relationship, then place the contact on flat areas
cusp to embrasure
non-working side contacts = _ = _trusive
balancing is a denture term to stablize denture
these interferences are not desireable for natureal dentition (cause _ forces)
balanacing = mediotrusive
cause lateral jiggling forces
rule or adjusting non-working-balanacing-mediotrusive contacts
we want to eliminate all
PUBL - functional cusps
palatal upper
buccal lower
working-side contacts
canine guided is possible
group function is acceptable if posterior teeth not compromised
_ working slide contacts are interferences
decrease frictional contact
cross tooth (lingual cusp) working side
rule for adjusting working side contacts
BULL
max inner incline buccal cusp
mand inner incline lingual cusp
protrusive contacts should have _ guidance and no _ interferences
if there are which to eliminate?
anterior guidance
no posterior interferences
BULL
maxillary buccal
mandi lingual
nonfunctional
polishing sequence
use _ midgets then _ midgets (color)
use fine _
make certain patient is comfortable
then follow-up _ months after
green
brown
fine polish
1 month follow up- allows tooth stabilization, refine adjustment
appliance for the immobilization or stabilization of injured or diseased parts
periodontal splints
these are indications for _
to immobilizae excessively mobile (class 2/3) teeth by sharing forces with more stable teeth
to stablize teeth in their new position after orthodontic treatment
periodontal splints
out come of spliting - while they stablize teeth, they do not decrease individual tooth mobility once the splint is removed
