Occlusal Trauma Effect And Impact On The Periodontium Pdf
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- Occlusal considerations in periodontics
- Periodontal Changes and Oral Health
- Occlusal trauma
- Dental Health, Oral Disorders & Therapy
Traumatic occlusion provides a trauma that affects the whole tooth and its supporting tissues. To study the effect of this trauma on CGRP and SP immunoreactive nerve morphology in pulp and periodontium, traumatic occlusion was induced in 2-months-old rats. The occlusal surface of the first maxillary molar in 30 rats were unilaterally raised 1 mm with a composite material.
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Received: June 07, Published: March 14, The effect of traumatic occlusion on healing of periapical lesion: a case report.
Occlusal considerations in periodontics
Trauma from the occlusion, however, has been linked with periodontal disease for many years. Karolyi published his pioneering paper, in 'Beobachtungen uber Pyorrhoea alveolaris' occlusal stress and 'alveolar pyorrhoea'.
Occlusal trauma has been defined as 'injury to the periodontium resulting from occlusal forces which exceed the reparative capacity of the attachment apparatus' : ie the tissue injury occurs because the periodontium is unable to cope with the increased stresses it experiences.
Compare this definition with the one for inflammatory periodontal disease:. Both processes result in injury to the attachment apparatus because the periodontium is unable to cope with the pathological insult which it experiences. It is quite right, therefore, that dentists should ask themselves two questions:. Before attempting to answer these two questions, the different types of trauma from occlusion need to be defined.
Historically trauma from occlusion has been classified as either primary or secondary. Primary occlusal trauma results from excessive occlusal force applied to a tooth or to teeth with normal and healthy supporting tissues. Secondary occlusal trauma refers to changes which occur when normal or abnormal occlusal forces are applied to the attachment apparatus of a tooth or teeth with inadequate or reduced supporting tissues. Recently, the distinction between primary and secondary occlusal trauma has been challenged as meaningless since the changes that occur in the periodontium are similar irrespective of the initial level of periodontal attachment.
More usefully, occlusal trauma can also be described as acute or chronic. Acute trauma from occlusion occurs following an abrupt increase in occlusal load such as occurs as a result of biting unexpectedly on a hard object.
Chronic trauma from occlusion is more common and has greater clinical significance. In the context of this paper occlusal trauma will mean chronic occlusal trauma. Considerable energy has been directed at trying to determine the answer to these questions, because of the possibility that trauma from occlusion might contribute to the pathogenesis of periodontal disease.
Research studies designed to examine the effects of occlusion fall into three categories:. Studies published in the s and s were inconclusive. In these studies the variables were the level of periodontal attachment and the characteristics of an applied force, and the way in which it might be varied See Figure 1 for a summary of the results.
A healthy periodontal support but a reduced bone height. This is the experimental model equivalent of a post-periodontal therapy level. Either a jiggling force, which is produced by multi-directional displacement of a tooth in alternating buccolingual or mesiodistal directions. This is usually created in the animal by the provision of a supraoccluding onlay. Or is an orthodontic force, created by a spring and is a unilateral force that results in the deflection of the tooth away from the force.
Few clinical studies have identified a clear relationship between trauma from the occlusion and inflammatory periodontitis in humans. A major problem with clinical studies of this type is the lack of a reliable index for measuring the degree of occlusal trauma to which a tooth is subjected. If trauma from occlusion exists there are obvious difficulties in assessing whether the rate of attachment loss is greater in patients with a continuing plaque induced periodontitis.
This is because secondary referral units where the majority of clinically based studies are carried out, do not routinely monitor patients who maintain good plaque control. On the system level ideal occlusion is or is not ideal for the rest of the articulatory system: the temporomandibular joints and the masticatory muscles.
It has, however, been stressed that there is no such thing as an intrinsically bad occlusal contact, because the effect is a product of not only the'quality' of the contact or contacts but also the frequency at which the contact or contacts are made.
Also, it is widely accepted that some patients, at some times will have an articulatory system which is compromised by other factors which reduce their tolerance to a less than ideal occlusion. Factors may range from a systemic disease such as rheumatoid arthritis to the debilitating effects of chronic long term stress.
On the tooth level an occlusion may or may not be ideal for the attachment apparatus, and the same consideration must be given to the frequency of occlusal contact, ie Does parafunction occur? In addition, the ability of the attachment apparatus to withstand a less than ideal occlusion may be compromised by periodontal inflammation. If it is accepted that increased occlusal forces could result in a further loss of attachment for teeth with an active inflammatory periodontitis, then it follows that a treatment plan aimed at preserving these teeth must address both problems.
This does not mean that trauma from occlusion causes periodontitis; rather, it means that occlusal forces may exceed the 'resistance threshold' of a compromised attachment apparatus thereby exacerbating a pre-existing periodontal lesion. While we know that trauma from occlusion can have an effect on the supporting tissues of the teeth, there is no evidence, at present, that trauma from occlusion is an aetiological factor in human periodontal disease.
It follows, therefore, that even though occlusal trauma is not a proven aetiological factor in periodontal disease dentists as part of their responsibility to help patients keep their teeth for as long as possible in maximum health, comfort and function must carry out a thorough occlusal examination.
Treatment aimed at reducing occlusal forces so that they fall within the adaptive capabilities of each patient's dental attachment apparatus will benefit; particularly those with, or at future risk, of periodontitis. Increased tooth mobility is not always indicative of trauma from occlusion. It is important, however, that hypermobility which does occur as a result of trauma from occlusion is detected in patients with reduced periodontal attachment.
The reason for this is that trauma from occlusion may accelerate further reduction in attachment in a patient with active periodontitis. A clinical diagnosis of occlusal trauma can only be confirmed where progressive mobility can be identified through a series of repeated measurements over an extended period.
This means that simple but reliable monitoring needs to be undertaken. A simple monitoring protocol is needed Fig. Increasing tooth mobility and migration or drifting Fig. Examination of the dynamic occlusal contacts of this tooth indicate that the marked wear facet fits closely against those of LR 2 and LR1 42, 41 during a right lateral excursion of the mandible.
The common radiographic signs of occlusal trauma are Fig. Conventional methods for measuring tooth mobility are based on the application of a force to the crown of the tooth to assess the degree of tooth movement in the horizontal and vertical directions. Pathological mobility is defined as horizontal or vertical displacement of the tooth beyond its physiological boundaries.
Clinically detectable mobility indicates some change in the periodontal tissues ie it is pathological and the cause of the mobility needs to be diagnosed. Manual evaluation of mobility is best carried out clinically using the handles of two instruments to move the teeth buccally and lingually.
Fremitus is the movement of a tooth or teeth subjected to functional occlusal forces, this can be assessed by palpating the buccal aspect of several teeth as the patient taps up and down. A periodontometer was a research tool used in the s and s to standardise the measurement of even minor tooth displacement.
To date, this instrument has been used in a few clinical studies and has limited practical use. This device Fig. It is designed to measure the reaction of the periodontium to a defined percussion, delivered by a tapping instrument.
Again this is of limited use in general dental practice. Independent of the state of the supporting tissues of a tooth, if it has moved its position in the mouth, then some force has been responsible for pushing or pulling it. Clearly that force may be extrinsic such as can be seen in pipe smokers or in pencil chewers. Secondarily a soft tissue force may be responsible as with tongue thrusting or lip position Fig.
However, the force may be from an occlusal contact especially parafunction. A frequently encountered scenario is drifting of an upper lateral incisor. This is a common reason for referral of an adult patient to an orthodontist; a referral made usually at the patient's request, with the aim of restoring their appearance. It is important to discover the cause of the drifting before considering any treatment. Initial examination of the UR 1 11 , in Fig. It is important to evaluate how tooth mobility affects the patient.
If there is discomfort when eating this will have a direct influence upon treatment. The decision will need to be taken, in consultation with the patient, whether to accept the discomfort, extract or splint. Occlusal equilibration is the modification of the occlusal contacts of teeth to produce a more ideal occlusion. The literature does not give an answer to this question. Some studies have shown occlusal therapy to be beneficial in the management of periodontal disease, whilst others have failed to do so.
There is no evidence at the present time to suggest that occlusal equilibration is an appropriate method for preventing the progression of periodontitis. It would, however, be useful to know whether equilibration of a periodontally compromised dentition is beneficial for the long-term preservation and comfort of teeth, in those patients who fail to achieve an excellent level of plaque control.
In a patient with mobile teeth, it may be necessary to temporarily stabilise those teeth before equilibration is possible Fig. If a tooth is mobile, it is very difficult if not impossible to effectively modify its shape with the aim of reducing the occlusal forces acting upon it equilibration.
Note: The adjustment to the lower anteriors was only to the labial aspect of the incisal edges: the exposed dentine was already present! When to equilibrate Fig. Indications for occlusal treatment and splinting 4 , 8 , 9 , 10 , Whether the inflammatory periodontitis has been treated successfully. If there is an inflammatory periodontal process this should be treated initially.
Subsequently when the periodontal condition is stable, occlusal therapy may be necessary for some patients and could involve either occlusal equilibration or splinting.
The radiographic appearance of the periodontal support. Occlusal equilibration is considered an effective form of therapy for teeth with increased mobility which has developed together with an increase in the width of the periodontal ligament PDL.
Reducing the occlusal interference on a tooth with normal bone support will normalise the width and height of the PDL. Eliminating any occlusal interferences for a tooth which has a reduced bone height as a result of periodontal disease will result in bone formation and remodelling of the alveolus only to the pre-trauma level.
In contrast, if the hypermobile tooth has reduced bone height but normal periodontal ligament width , then elimination of occlusal trauma will not alter the mobility of the tooth. In this situation occlusal equilibration is only indicated if the patient is complaining of loss of function or discomfort. When there are occlusal contact relationships that cause trauma to the periodontium, joints, muscles or soft tissues.
When should teeth be splinted together in the patient with reduced periodontal support? Also outlined 13 were some indications for splinting, not only restricted to patients with reduced periodontal support:. To stabilise teeth with increased mobility that have not responded to occlusal adjustment and periodontal treatment. The first guideline refers to patients with reduced periodontal support. There are two situations in which splinting may be beneficial:.
Periodontal Changes and Oral Health
Correspondence Address : Dr. Occlusion can be described in very simple terms as an intercuspal relationship between the set of maxillary and mandibular teeth. It plays an important role in the pathogenesis of periodontal diseases and traumatic lesions are often manifestation of faulty occlusion. Mc neil defined occlusion as the functional relationship between the components of the masticatory system, temporomandibular joint TMJ , and craniofacial skeleton. From a research point of view, the TMJ serves primarily as a reference from which mandibular movements are duplicated.
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Objective: This study aims to systematically evaluate the effects of traumatic occlusion on the periodontal tissue of rats. The set of questions to be answered were—Can traumatic occlusion acting on a healthy and an unhealthy periodontium cause periodontal destruction? Design: The protocols for systematic review were all developed, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and applied to animal research. Reporting of In vivo experiment guidelines for reporting animal research to assess the risk of bias of the studies.
This study aimed to histometrically evaluate the presence of gingival recession in the mesial surface of the teeth of rats experimentally subjected to primary occlusal trauma. This evaluation verified the distance from the cement-enamel junction CEJ to the free marginal gingiva FMG and to the height of the alveolar bone crest CEJ-crest bone distance. Thus, it can be concluded that the OT induction model, after 14 days of experiment, promoted bone resorption.
Dental Health, Oral Disorders & Therapy
Author s : G. Bokadia , Sathish , Padma Ariga. Email s : snehabokadia gmail. DOI: Address: G.
The periodontal tissue reaction to variations in occlusal forces has been described in the literature wherein clinical and histologic changes are discussed that produced due to stresses in the periodontal structures. Unfortunately, these stresses are not quantified. The aim of this study is to determine the stress produced on various periodontal tissues at different occlusal loads using finite element model FEM study. All the models were assumed to be isotropic, linear, and elastic, and the analysis was performed on a Pentium IV processor computer using the ANSYS software. Based on the findings of the present study, there is reasonably good attempt to express numerical data of stress to be given normal occlusal and hyperfunctional loads to simulate clinical occlusal situations which are known to be responsible for healthy and diseased periodontium. The role of occlusion on periodontal health is challenging, and the results of research studies are contradictory and inconclusive.
Several studies have shown that occlusal trauma can have destructive pathological effects on the periodontium, alveolar bone, masticatory muscles, dental structure, temporomandibular joint (TMJ), and even on the central nervous childrenspolicycoalition.org study the effects of occlusal trauma on the max- illary-dental system, animal.
Occlusal trauma is the damage to teeth when an excessive force is acted upon them and they do not align properly. When the jaws close, for instance during chewing or at rest, the relationship between the opposing teeth is referred to as occlusion. When trauma, disease or dental treatment alters occlusion by changing the biting surface of any of the teeth, the teeth will come together differently, and their occlusion will change. This is called traumatic occlusion. Traumatic occlusion may cause a thickening of the cervical margin of the alveolar bone  and widening of the periodontal ligament , although the latter is can also be caused by other processes.
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