#7 trauma-from-occlusion-final.pdf

Trauma From Occlusion Dr. Jafar Naghshbandi D.D.S;M.S Diplomate of the American Board of Periodontology 12/05/2023 1  Special thanks whoever taught me a word make me his servant D...

Trauma From Occlusion Dr. Jafar Naghshbandi D.D.S;M.S Diplomate of the American Board of Periodontology 12/05/2023 1  Special thanks whoever taught me a word make me his servant Dr. Raul caffesse Dr. Jim Simon Causes of alveolar bone loss I. Extension of gingival inflammation II. Trauma from occlusion III. Systemic factors IV. Orthodontic treatment V. Periodontitis VI. Periodontal abscess VII. Food impaction VIII. Overhanging restoration IX. Adjacent tooth extraction X. Ill-fitting prosthesis  Physiologic adaptive capacity of the periodontium to occlusal forces The periodontium attempts to accommodate the forces exerted on the crown. This adaptive capacity varies in different persons and in the same person at different times. When occlusal forces exceeds the adaptive and reparative capacity of the periodontal tissues, tissue injury results (trauma from occlusion)  Extension of gingival inflammation The most common cause of bone destruction in periodontal disease is extension of inflammation from the marginal gingiva into the supporting PD tissue. Periodontitis is always preceded by gingivitis, but not all gingivitis progresses to periodontitis The transition from gingivitis to periodontitis is associated with changes in composition of bacterial plaque.  Trauma from Occlusion Trauma from occlusion is a tissue injury resulting from occlusal forces exceeding the adaptive capacity of the tissues Trauma from occlusion is the tissue injury – not the occlusal force An occlusion that produces such injury is called a traumatic occlusion  A. Magnitude Factors contributing to increase traumatic B- Direction forces: C. Duration  A. Magnitude When magnitude of occlusal forces is increased: 1. The periodontium responds with a widening of the periodontal ligament space. 2. Increase in the number and width of periodontal ligament fibers. 3. Increase in the density of alveolar bone. B)Direction of the occlusal forces Periodontal ligament fibers are arranged so that the occlusal forces are applied along the long axis of the tooth. Change in the direction of the occlusal forces lead to change the orientation of periodontal ligament fibers.  C) Duration and frequency of occlusal forces Constant pressure on the bone is more injurious than intermittent forces. The more frequent the application of an intermittent force, the more injurious the force to the periodontium.  Classification Acute and Chronic Trauma Primary , Secondary and Combined TFO  Acute Trauma Results from an abrupt change in occlusal force such as that produced by biting on a hard object or restorations and prosthetic appliances that interfere with or alter the direction of occlusal forces on the teeth Clinical features: Tooth pain Sensitivity to percussion Increased tooth mobility Acute Trauma  Chronic Trauma Is more common than acute form Most often develops from gradual changes in the occlusion produced by: Tooth wear Drifting movement Teeth extrusion Parafunctional habits such as bruxism and clenching Chronic Trauma  1. Primary trauma from occlusion : Occurs when trauma from occlusion is the primary etiologic factor in periodontal destruction  1. 2. Primary trauma Secondary trauma from occlusion : from occlusion: Occurs when trauma Occurs when trauma from occlusion from occlusion is the is considered a secondary cause of primary etiologic factor periodontal destruction; this is the in periodontal case when the adaptive capacity of destruction the tissues to withstand occlusal forces is impaired. Alveolar bone loss is the most common cause of secondary trauma and may be difficult to treat.  1. 2. Primary trauma Secondary trauma from occlusion : from occlusion: Occurs when trauma Occurs when trauma from occlusion is considered a from occlusion is the secondary cause of periodontal primary etiologic factor destruction; this is the case when the adaptive capacity of in periodontal the tissues to withstand destruction occlusal forces is impaired. Alveolar bone loss is the most common cause of secondary trauma and may be difficult to treat. Combined TFO It is the injury that occurs to the periodontium resulting from abnormal occlusal forces that are applied to a tooth or teeth with abnormal periodontal support.  Clinical features 1) Mobility (progressive) 2) Pain on chewing or percussion Combined 3) Fremitus 4) Occlusal prematurities/ TFO discrepancies 5) Wear facets in the presence of other clinical indicators 6) Tooth migration 7) Chipped or fractured tooth (teeth) 8) Thermal sensitivity Radiographic findings of TFO 1. Increased width of periodontal ligament space. 2. Thickening of lamina dura 3. Vertical or angular bone loss 4. Radiolucency in furcation areas.  Bone destruction caused by trauma from occlusion Trauma from occlusion can produce bone destruction in absence or presence of inflammation In the presence of inflammation, the changes cause Bizarre patterns In the absence of inflammation, the changes are caused by increased compression and tension of PDL and increased osteoclasis of alveolar bone to necrosis of PDL and bone and resorption of bone These changes are reversible which may cause angular shape bone loss  Treatment A goal of periodontal therapy in the treatment of occlusal traumatism should be to maintain the periodontium in comfort and function. Treatment 1. Occlusal adjustment 2. Management of parafunctional habits 3. Temporary, provisional or long-term stabilization of mobile teeth with removable or fixed appliances 4. Orthodontic tooth movement 5. Occlusal reconstruction 6. Extraction of selected teeth periodontal abscess caused by occlusal trauma  Trauma leaves fingerprints on the victim. These don’t fade when the bruises do. Dr. Ellen Taliaferro  One person's trauma is another's loss of innocence Jodi Picoult