Occlusal considerations in perio

• What is occlusal trauma?

  Lesion of the supporting tissues due to the effect of abnormal or excessive forces transmitted by the tooth to its supporting structures
• What is primary occlusal trauma?

  The result of excessive occlusal force applied to a tooth or teeth with normal and healthy supporting tissues
• What is secondary occlusal trauma?

  Refers to harmful effect of normal or abnormal forces on the supporting tissues of teeth already weakened by loss of connective tissue attachment

  May arise: In periodontal tissues restored to health by periodontal treatment or Tissues which are affected by an on going destructive lesion
• What are causes of occlusal trauma?

  Tooth to tooth

  • tooth to soft tissue
  • tooth to forgoen

  
• What are some signs and symptoms of occlusal trauma?

  
• What are some extra oral signs and symptoms of occlusal trauma?

  TMJ dysfunction

  ◦ Pain

  ◦ Noise e.g. clicks

  ◦ Altered function

  
  

  Masseter hypertrophy

  
  

  Tenderness of the muscles of mastication
• What are signs and symptoms of occlusal trauma intra-orally?

  Wear facets

  
  

  Tooth mobility (but may be due to root fracture, apical abscess)

  
  

  Tooth migration e.g. drifting

  
  

  Teeth or tooth painful on chewing or maybe sensitive to percussion

  
  

  Fractured enamel or restorations

  
  

  Fremitus - tooth moves as occluded teeth slide laterally or in protrusion
• Signs and symptoms of occlusal trauma in the soft tissues

  
• What are radiographic signs of occlusal trauma?

  Widening or funnelling of the pdl

  
  

  Discontinuity of the lamina dura

  
  

  Thickening of the lamina dura

  
  

  Root resorption

  
  

  Alveolar bone radiolucency

  
  

  Hypercementosis
• What are radiographic signs of secondary occlusal trauma?

  
• What is masseter hypertrophy?

  Enlargement of one or both of the masseter muscles
• Does occlusal trauma initiate periodontal destruction?

  No, the effects on the periodontal space and tooth mobility arereversible
• Do occlusal forces influence the onset of plaque induced inflammation?

  
  

  Do occlusal forces enhance the rate of periodontal destruction?

  
• Can occlusal trauma act as a co-factor in periodontal destruction and increase the rate of attachment loss?

  
• What are the most important points animal models have showed in regards to the relationship between occlusal trauma and periodontal disease?


  Control of plaque in a lesion with periodontitis and occlusal trauma led to gains in attachment and bone levels

  
  

  Removal of occlusal trauma only, had little effect

  
  

  Successful treatment of periodontal disease will arrest periodontal destruction even if occlusal trauma persists
• Occlusal forces cannot....

  initiate periodontal breakdown or initiate gingivitis
• Occlusal trauma will not initiate..

  further loss of connective tissue attachment loss in a tooth with a reduced but healthy periodontium
• Wear facets, occlusal trauma bone loss example radiographically

  
• How to treat patients with occlusal trauma?

  Treat the periodontal disease

  Dentist:Analyse the occlusion and carry out selective grinding to remove interferences and/or to provide a mouth guard
• What is the treatment for Primary occlusal trauma?

  Maintain periodontal health

  
  

  Selective grinding to remove interferences

  
  

  Make occlusal guard for night wear

  
  

  Splinting of teeth is only rarely indicated
• What is the treatment for secondary occlusal trauma?

  Control of inflammation is most important aspect

  
  

  PMPR and plaque control

  
  

  Root surface debridement

  
  

  Selective grinding

  
  

  Occlusal guard

  
  

  Possibly splinting

  
  

  Extraction of un-saveable teeth
• What can the reduction of tooth mobility enhance?

  The effect of periodontal therapy.
• Loose teeth flow chart for treatment