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TRAUMA FROM

OCCLUSION

GUIDED BY: PRESENTED BY: DR DIVYA JAGGI DR ANKITA DADWAL

MDS 2ND YR

CONTENTS INTRODUCTION DEFINITION TYPES OF TRAUMA FROM OCCLUSION GLICKMAN CONCEPT WAERHAUG CONCEPT STAGES OF TISSUE RESPONSE TO INJURY CLINICAL AND RADIOGRAPHIC FEATURES OF TFO CLINICAL DIAGNOSIS OF TFO TFO AND IMPLANTS TREATMENT OF TFO CONCLUSION REFRENCES

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INTRODUCTION Trauma from occlusion is a term used to describe

pathologic alterations or adaptive changes which develop in the periodontium as a result of undue force produced by the masticatory muscles. It is only one of many terms that have been used to describe such alterations in the periodontium.

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DEFINITION “A condition where injury results to the supporting structures of the teeth

by the act of bringing the jaws into a closed position”. (Stillman 1917)

When occlusal forces exceed the adaptive capacity of the tissues, tissue injury results. this resultant injury is termed TFO.

(Glickman 1962)

“Damage in the periodontium caused by stress on the teeth produced directly or indirectly by teeth of the opposing jaw”.

( WHO1978)

An injury to the attachment apparatus as a result of excessive occlusal force.

(Glossary of periodontic terms ,1992)

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OTHER NAME OF TFO Traumatizing occlusion Occlusal trauma Traumatogenic occlusion Periodontal traumatism Overload Occlusal disharmony Functional imbalance Occlusal dystrophy

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ACUTE TRAUMA FROM OCCLUSION results from an abrupt occlusal impact, such as that

produced by biting on a hard object (e.g., an olive pit).

In addition, restorations or prosthetic appliances that interfere with the direction of occlusal forces on the teeth may induce acute trauma

Clinical features :1. Tooth pain.2. Sensitivity to percussion.3. Tooth mobility.

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CHRONIC TRAUMA FROM OCCLUSION develops from gradual changes in

a) occlusion produced by tooth wear, b) drifting movement, c) extrusion of teeth, d) combined with parafunctional habits such as bruxism

and clenching .

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PRIMARY TRAUMA FROM OCCLUSION A tissue reaction , caused by excessive

and non-physiological forces exerted on teeth with a normal ,healthy and non-inflamed periodontium.

The forces may be exerted on the periodontal structures

in one direction (orthodontic forces) or as ‘jiggling ’ forces.

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In the periodontal ligament, zone of compression zone of tension

temporary increased mobility (functional adaptation ).

- no changes in the supracrestal fibres, - no loss of periodontal attachment, - no increased probing pocket depth.

Forces too high (above the adaptation level),

- aseptic necrosis of the PDL. - root resorption occurs - resulting in shorter roots. 8/31

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NORMAL PERIODONTIUM

SECONDARY TRAUMA FROM OCCLUSION It is related to situations in which occlusal forces cause

damage in a periodontium of reduced height (attachment loss present).

In his original studies in the 1960s, Glickman formulated the hypothesis that premature contacts and excessive occlusal forces could be a cofactor in the progression of periodontal disease by changing the pathway and spread of inflammation into the deeper periodontal tissues.

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HEALTHY PERIODONTIUM WITH REDUCED HEIGHT

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ADVANCED BONE LOSS AND POCKETS

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GLICKMAN CONCEPT Glickman (1965, 1967)

claimed that the pathway of the spread of a plaque‐associated gingival lesion can be changed if forces of an abnormal magnitude are acting on the contaminated tooth.

ZONE OF IRRITATION ZONE OF CO

DESTRUCTION14/31

ZONE OF IRRITATION The zone of irritation includes the marginal and interdental gingiva. The soft tissue of this zone is bordered by hard tissue (the

tooth) only on one side and cannot therefore be affected by forces of occlusion.

The gingival lesion is the tissue response to products from microbial plaque.

This gingival lesion at a “non‐traumatized” tooth propagates, in the apical direction by first involving the alveolar bone and only later the periodontal ligament area.

The progression of this lesion results in an even (horizontal) bone destruction.

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ZONE OF CO DESTRUCTION It was claimed that the fiber

bundles which separate the zone of co‐destruction from the zone of irritation can be affected from two different directions:

1. From the inflammatory gingival lesion maintained in the zone of irritation

2. From trauma‐induced changes in the zone of co‐destruction

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WAERHAUG’S CONCEPT (1979) The loss of connective attachment and bone around

teeth is, according to Waerhaug, exclusively the result of inflammatory lesions associated with subgingival plaque.

Waerhaug concluded that angular bony defects and infrabony pockets occur when the subgingival plaque of one tooth has reached a more apical level than the plaque on the neighbouring tooth, and when the volume of the alveolar bone surrounding the roots is comparatively large.

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STAGES OF TISSUE RESPONSE TO OCCLUSAL FORCES STAGE –I: INJURY - slightly excessive pressure and tension -increased pressure and tension -severe tension

STAGE II: REPAIR - central buttressing - peripheral buttressing

STAGE III: ADAPTIVE REMODELLING

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CLINICAL FEATURES OF TFO

1)Tooth mobility2) Pain on chewing or percussion3) Fremitus4) Occlusal prematurities/discrepancies5) Wear facets6) Tooth migration7) Chipped or fractured tooth (teeth)8) Thermal sensitivity

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RADIOGRAPHIC FEATURES OF TFO Increased width of periodontal ligament space. Injury phase : increase in thickness of lamina dura

noted in apices, furcation and and marginal areas. Repair phase : widening of pdl space Advanced traumatic lesions: Vertical or angular bone

loss combine with marginal inflammation lead to intrabony pocket formation.

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CLINICAL DIAGNOSIS OF TFOTOOTH MOBILITY : 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 .

HOW TO MEASURE TOOTH MOBILITY???1. MANUAL EXAMINATION2. FRMITUS TEST3. PERIOTEST4. PERIODONTOMETRE

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2. WEAR PATTERNS: a) BRUXISM- wear facets on occlusal and incisal

surfaces which can be identified as shiny and irregular surfaces.

b) ABFRACTIONS- excessive lateral forces, abfractions can be seen on pre molars.

3. THERMAL SENSITIVITY 4. MUSCLE HYPERTONOCITY5. T- SCAN

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TRAUMA FROM OCCLUSION AND IMPLANTS An osseointegrated implant is in direct contact with

bone. No periodontal ligament space Functional load enhance osseointegration and doesnot

result in marginal bone loss. Occlusal overload adversely affect osseointegration Lead to implant failure

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Key factors controlling bone remodelling at molecular level are:

1. strain: change in length to the original length2. modulus of elasticity: stiffness of material

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TREATMENT OF TFO A goal of periodontal therapy in the treatment of

occlusal traumatism should be to maintain the periodontium in comfort and function.

PROPOSED BY AAP(1996)1. Reduce /eliminate tooth mobility2. Eliminate occlusal prematurities and fremitus3. Eliminate parafunctional habits4. Prevent further tooth migration5. Decrease / stablize radiographic changes

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OCCLUSAL ADJUSTMENTIndications (1989 WORLD WORKSHOP IN PERIODONTICS)

1) To reduce traumatic forces to teeth that exhibit: • Increasing mobility or fremitus . • Discomfort during occlusal contact or function.

2) To achieve functional relationships and masticatory efficiency in conjunction with restorative treatment, orthodontic, orthognathic surgery or jaw trauma when indicated.

3) As adjunctive therapy that may reduce the damage from parafunctional habits.

4) To reshape teeth contributing to soft tissue injury. 5) To adjust marginal ridge relationships and cusps that are contributing to food

impaction 27/31

SPLINTINGINDICATIONS : (1989 WORLD WORKSHOP)1) Stabilize teeth with increasing mobility that have not responded to occlusal

adjustment and periodontal treatment. 2) Stabilize teeth with advanced mobility that have not responded to occlusal

adjustment and treatment when there is interference with normal function and patient comfort.

3) Facilitate treatment of extremely mobile teeth by splinting them prior to periodontal instrumentation and occlusal adjustment procedures.

4) Prevent tipping or drifting of teeth and extrusion of unopposed teeth. 5) Stabilize teeth, when indicated, following orthodontic movement.

6) Create adequate occlusal stability when replacing missing teeth. 7) Stabilize teeth following acute trauma. 28/31

PARAFUNCTIONAL HABITS BRUXISM : night guard

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CONCLUSION Periodontal structures depend on functional occlusal

forces to activate the periodontal mechanoreceptors in the neuromuscular physiology of the masticatory system. A traumatic occlusion on a healthy periodontium leads to an increased mobility but not to attachment loss. In inflamed periodontal structures traumatic occlusion contributes to a further and faster spread of the inflammation apically and to more bone loss.

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REFRENCES1) Carranza’s Clinical Periodontology; 4th edition

2) Carranza’s Clinical Periodontology; 9th edition

3) Carranza’s Clinical Periodontology; 10th edition

4) Clinical Periodontology and Implantology;6th edition; Jan Lindhe

5) Trauma from occlusion: a review- Commander R. “Dave” Rupprecht, DC, US. CLINICAL UPDATES VOL26,NO.1 JANUARY 2004.

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