Trauma From Occlusion
Dr. Handren Hunar NajeebTrauma From Occlusion
is defined as microscopic alterations of periodontal structures in the area of the periodontal ligament that become manifest clinically in the elevation of tooth mobility.Trauma From Occlusion
when occlusal forces exceed the adaptive capacity of the tissues, tissue injury results, which is also known as occlusal trauma.Classification of Trauma From Occlusion
classified according to :• the injurious occlusal force(s) mode of onset (acute and chronic) or
• the capacity of the periodontium to resist to occlusal forces (primary and secondary).
Acute and Chronic Trauma From Occlusion
Acute trauma from occlusion refers to periodontal changes associated with an abrupt occlusal impact such as:that produced by biting on a hard object (e.g., an olive pit).
restorations or prosthetic appliances that interfere with or alter the direction of occlusal forces on the teeth may also induce acute trauma.
Acute and Chronic Trauma From Occlusion
Acute trauma results in tooth pain, sensitivity to percussion, and increased tooth mobility.
If the force is dissipated by:
a shift in the position of the tooth
or by the wearing away or correction of the restoration,
• then the injury heals, and the symptoms subside.
Acute and Chronic Trauma From Occlusion
Chronic trauma from occlusion refers to periodontal changes associated with gradual changes in occlusion produced by tooth wear, drifting movement, and extrusion of the teeth in combination with parafunctional habits (e.g., bruxism, clenching)Acute and Chronic Trauma From Occlusion
Chronic trauma from occlusion is more common than the acute form and of greater clinical significance.Malocclusion is not necessary to produce trauma; periodontal injury may occur when the occlusion appears normal.
Primary and Secondary Trauma From Occlusion
Trauma from occlusion may be caused by:(1)alterations in occlusal forces,
(2) a reduced capacity of the periodontium to withstand occlusal forces,
(3) or both.
When trauma from occlusion is the result of alterations in occlusal forces, it is called primary trauma from occlusion. When it results from the reduced ability of the tissues to resist the occlusal forces, it is known as secondary trauma from occlusion.
Primary and Secondary Trauma From Occlusion
Primary trauma from occlusion occurs if trauma from occlusion is considered the primary etiologic factor in periodontal destruction and if the only local alteration to which a tooth is subjected is a result of occlusion.
Primary and Secondary Trauma From Occlusion
Examples for Primary trauma from occlusion include periodontal injury produced around teeth with a previously healthy periodontium after the following:(1) the insertion of a “high filling”.
(2) the insertion of a prosthetic replacement that creates excessive forces on abutment and antagonistic teeth.
(3) the drifting movement or extrusion of the teeth into spaces created by unreplaced missing teeth.
(4) the orthodontic movement of teeth into functionally unacceptable positions.
Primary and Secondary Trauma From Occlusion
Secondary trauma from occlusion occurs when the adaptive capacity of the tissues to withstand occlusal forces is impaired by bone loss that results from marginal inflammation.Stages of Tissue Response toIncreased Occlusal Forces
Tissue response occurs in three stages:• injury
• repair
• adaptive remodeling of the periodontium.
Stages of Tissue Response toIncreased Occlusal Forces
Stage I: InjuryTissue injury is produced by excessive occlusal forces. The body then attempts to repair the injury and restore the periodontium if the forces are diminished.
If the offending force is chronic, the periodontium is remodeled to cushion its impact. The ligament is widened at the expense of the bone, which results in angular bone defects without periodontal pockets, and the tooth becomes loose.
The areas of the periodontium that are most susceptible to injury from excessive occlusal forces are the furcations.
Stages of Tissue Response toIncreased Occlusal Forces
Stage II: RepairRepair occurs constantly in the normal periodontium, and trauma from occlusion stimulates increased reparative activity.
The damaged tissues are removed, and new connective tissue cells and fibers, bone, and cementum are formed in an attempt to restore the injured periodontium.
Stages of Tissue Response toIncreased Occlusal Forces
Stage III: Adaptive Remodeling of the PeriodontiumIf the repair process cannot keep pace with the destruction caused by the occlusion, the periodontium is remodeled in an effort to create a structural relationship in which the forces are no longer injurious to the tissues.
This results in a widened periodontal ligament, which is funnel shaped at the crest, and angular defects in the bone, with no pocket formation. The involved teeth become loose.
Effects of Insufficient Occlusal Force
Insufficient occlusal force may also be injurious to the supporting periodontal tissues.Insufficient stimulation causes:
• thinning of the periodontal ligament.
• atrophy of the fibers.
• osteoporosis of the alveolar bone.
• and a reduction in bone height.
Radiographic Signs of TraumaFrom Occlusion Alone
• Increased width of the periodontal space, often with thickening of the lamina dura along the lateral aspect of the root, in the apical region, and in bifurcation areas. These changes do not necessarily indicate destructive changes, because they may result from thickening and strengthening of the periodontal ligament and alveolar bone, thereby constituting a favorable response to increased occlusal forces.
• A vertical rather than horizontal destruction of the interdental septum.
• Radiolucency and condensation of the alveolar bone.
• Root resorption.