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Trauma from Occlusion

Trauma from Occlusion. Trauma from Occlusion. Introduction: “Margin of safety” Occlusal forces > adaptive capacity  Trauma from Occlusion Refers to tissue injury (injury to periodontium) NOT the occlusal force

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Trauma from Occlusion

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  1. Trauma from Occlusion

  2. Trauma from Occlusion • Introduction: • “Margin of safety” • Occlusal forces > adaptive capacity  Trauma from Occlusion • Refers to tissue injury (injury to periodontium) NOT the occlusal force • Any occlusion can produce periodontal injury – malocclusion is not necessary

  3. Acute & Chronic Trauma • Acute trauma: • Sudden occlusal impact • E.g. biting on olive pit • Restorations or prosthetics may alter occlusal forces • Tooth pain, sensitivity to percussion • Increasing tooth mobility • Identification of cause  symptoms subside, injury heals

  4. Acute & Chronic Trauma • Chronic trauma: • Develops over time • Tooth wear, drifting movement combined with parafunctional habits  create gradual changes in occlusion • More difficult to treat

  5. Primary Trauma from Occlusion • Etiology: • Increase in occlusal force (direction or quantity) • Periodontal structures relatively healthy • Occurs with: • High filling • Prosthetic replacement or failure to replace tooth/teeth • Orthodontic movement of teeth into functionally unacceptable positions

  6. Primary trauma from occlusion • We do not see: • Changes in clinical attachment levels • Development of pockets

  7. Secondary Trauma from Occlusion • Etiology: • Adaptive capacity of tissues is impaired as a result of bone loss • Periodontium vulnerable • Previously well-tolerated forces become excessive

  8. Secondary Trauma from Occlusion • Does not cause periodontal disease • Bone loss & increasing tooth mobility will result

  9. Stages of Tissue Response • Stage I – Injury: • Changes in occlusal forces causes injury • Repair attempted • Either forces diminished • Tooth drifts away from forces • Remodeling occurs if forces are chronic • Varying degrees of pressure & tension create varying degrees of changes

  10. Slight pressure : Resorption of bone Widened periodontal ligament space Blood vessels numerous & reduce in size Slight tension : Periodontal ligament fibers elongate Apposition of bone Blood vessels enlarge Stage I - Injury

  11. Greater pressure: Compression of fibers Injury to fibroblasts, CT cells  necrosis of ligament Vascular changes Resorption of bone Greater tension: Widened periodontal ligament space Tearing of ligament Hemorrhage Stage I - Injury

  12. Stage II - Repair • Reparative activity includes formation of: • New CT tissue cells & fibers, bone & cementum • Thinned bone is reinforced with new bone – buttressing bone formation • Repair occurs as long as reparative capacity exceeds traumatic forces

  13. Stage III – Adaptive remodeling • Forces exceed repair capacity, periodontium is remodeled • With remodeling, forces may no longer be injurious to the tissues • Results in thickened periodontal ligament, with no pocket formation • Following remodeling, stabilization of resorption & formation occurs

  14. Reversible Traumatic Lesions • Trauma from occlusion is reversible • Repair or remodeling occurs if: • Teeth can “escape” from force • Periodontium adapts to force • Inflammation inhibits potential for bone regeneration – inflammation must be eliminated

  15. Clinical Signs of Trauma from Occlusion • Tooth mobility: • Occurs during injury stage (injured PL fibers) • Also occurs during repair/remodeling (widened PL space) • Tooth mobility greater than normal BUT, • Not considered pathologic unless tooth mobility is progressive in nature

  16. Clinical Signs • Fremitus • Pain • Tooth migration • Attrition • Muscle/joint pain • Fractures, chipping

  17. Radiographic Signs of Trauma from Occlusion • Changes in shape of periodontal ligament space, bone loss • Thickened lamina dura: • Lateral aspect of root • Apical area • Furcation areas • Vertical destruction of interdental septum • Root resorption, hypercementosis

  18. Treatment Outcomes • Proposed by AAP (1996) • Reduce/eliminate tooth mobility • Eliminate occlusal prematurities & fremitus • Eliminate parafunctional habits • Prevent further tooth migration • Decrease/stabilize radiographic changes

  19. Primary Occlusal Trauma: Selective grinding Habit control Orthodontic movement Night guard Secondary Occlusal Trauma: Splinting Selective grinding Orthodontic movement Therapy

  20. Prognosis • Sooner it is diagnosed the better • Periodontal disease compromises healing • Inflammatory pathway altered – vertical bone loss • Height of alveolar bone • Forces: • Change in direction: most harmful • Distribution of forces • Duration • Frequency: continuous vs. intermittent

  21. Unsuccessful Therapy • Increasing tooth mobility • Progressive tooth migration • Continued client discomfort • Premature contacts remain • No change in radiographs/worsening • Parafunctional habits remain • TMJ problems remain or worsen

  22. Trauma from Occlusion • Remember: • Trauma from occlusion does not cause: • Gingivitis • Periodontitis • Pocket formation • Clinical attachment loss

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