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Classic Lit Fall 2021 > Trauma from Occlusion > Flashcards

Trauma from Occlusion Flashcards

1
Q

What are the 4 main occlusal scheme philosophies?

A

Gnathology, Bioesthetics, Pankey-Dawson, Neuromuscular control

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2
Q

How do the different occlusal schemes relate/differ?

A

Similar in that the goal is to have even contacts - Different in the position by which intercuspation is built/patterns and pathways of guidance/vertical dimension

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3
Q

How big a difference can there be in centric relation and occlusion?

A

0.1 to 2mm

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4
Q

What is a normal CR to CO shift?

A

1.25mm (Clayton 1986)

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5
Q

What is Gnathology?

A

Condyle posterior superior
Occlusal scheme based off seating of condyle.
Anterior guidance in relation to the angle of articular eminence

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6
Q

What is Bioesthetics?

A

Similar to Gnathology in condylar seating and anterior guidance/posterior disclusion
Different from Gnathology in that Bioesthetics has strict measurements for anterior teeth size and depth of overbite/overjet

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7
Q

What is the Panky-Dawson model?

A

Similar to Gnathology in that it used condylar position (but anterior superior), used manual manipulation, and anterior guidance/posterior disclusion
Different from Gnathology in that the patient needs a custom anterior guidance

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8
Q

What is Neuromuscular control model?

A

Use a Neuromonitor/TENS unit - watch the motion and build occlusion in that position
Dont care about overbite/overjet

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9
Q

What is the Conformative model?

A

Most used technique in dentistry - Use current occlusion (have patient bite - make sure no heavy contact on filling/crown)

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10
Q

Centric Relation

A

The most posterior relation.
The most retruded physiologic relation that allows for lateral movements.

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11
Q

Centric occlusion

A

The repeatable intercuspal position in centric relation

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12
Q

Eccentric Occlusion

A

Set of contacts NOT in maximum Intercuspation

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13
Q

Centric slide

A

the physical movement of sliding from CO to MI

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14
Q

Curve of Spee

A

Curved plane tangent to the incisal edges and buccal cusps of the mandibular teeth viewed in sagittal plane

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15
Q

Curve of Wilson

A

Posterior occlusal plane or arch curvature when viewed in frontal plane

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16
Q

Curve of Monson

A

The curve of the dentition where the incisal edges/cusps contact an 8inch diameter sphere with center at glabella (incorporates spee and wilson)

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17
Q

Who defined Traumatic Occlusion and Occlusal Trauma?

A

Passanezi and Sant’Ana 2019

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18
Q

Occlusal forces which lead to changes in the periodontium depend on what factors? (Citation)

A

Magnitude
Duration
Frequency
Direction
(Passanezi and Sant’Ana 2019)

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19
Q

What are the most damaging directions for natural dentition?

A

Lateral and Rotational (Torque)

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20
Q

How does the periodontium respond to Pressure “within certain limits”?

A

PDL remains vital
Widening of PDL
OCs present on alveolus
“Direct bone resorption” is initiated

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21
Q

How does the periodontium respond to Tension “within certain limits”?

A

PDL fibers elongate
Apposition of Alveolar bone and cementum

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22
Q

How does the periodontium react to Pressure at “higher magnitude”?

A

PDL becomes necrotic and hyalinization occurs
OCs present in areas of less stress (marrow spaces) causing “indirect bone resorption”
Root resorption and/or cemental tears
hemorrhage
thrombosis

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23
Q

How does the periodontium respond to Tension at “Higher magnitude”?

A

PDL fibers tear
Alveolar bone resorption
Widening PDL space
Hemorrhage
Thrombosis

24
Q

Where do pressure zones occure during tipping forces?

A

Apical and Coronal

25
What 3 types of loading forces are there?
Tipping Bodily Jiggling
26
Citation for loading "within certain limits" and at "higher magnitude"
Fan and Caton 2018
27
3 stages of tissue response to increased occlusal forces
Injury Repair Adaptive Remodeling
28
Describe "Injury"
Initiated by excessive forces Body will attempt repair if forces decrease or if tooth drifts away Decrease in mitotic activity for fibroblasts and osteoid cells Chronic - body creates a cushion (widened PDL/Angular defect/No PDs/ Mobility)
29
What area is most susceptible to Injury from TFO?
Furcation
30
Describe "Repair"
Ongoing in the periodontium Damage \> Repair = traumatic forces Damaged tissues removed - new CT/Fibers/Bone/Cementum formed
31
How does reparative activity react to TFO?
it increases
32
Describe "Adaptive Remodeling"
Damage \> Repair = Adaptive remodeling Body creates structure to help avoid further damage
33
What kind of adaptations take place during Adaptive Remodeling?
Widened PDL Funnel Shaped defect Angular defects NO POCKET Increased vascularization
34
Gottlieb and Orban 1931
Dog study Histological analysis Axial forces = no mobility Lateral forces = mobility SOMETIMES ## Footnote **No evidence that TFO is the primary cause of Perio**
35
Stones 1938
Monkey Study Histological analysis **TFO is an etiologic factor fo vertical pocket formation** **TFO is not the ONLY factor - but may CONTRIBUTE to periodontitis**
36
Glickman 1963
TFO alone doe NOT cause gingivitis/perio/CAL ## Footnote **2 zones: Zone of Irritation and Zone of Co-Destruction**
37
Glickman, Stein et al. 1961
Rhesus Monkeys Effect of increased functional forces on splinted and non-splinted teeth **First study to show furcation is greatest area of risk for TFO** Splinted teeth had little change in furcation area Non-splinted showed resorption of crest in the furcation (mesio-apical and disto-apical forces)
38
What is the Zone of Irritation?
**Glickman 1963** * Contents:* interdental and marginal gingiva * Inflammation:* created by local irritants within the zone - degeneration and necrosis of epithelium/CT * Progression*: lesion will result in horizontal bone destruction ***TFO: DOES NOT affect this zone***
39
What is the Zone of Co-Destruction?
**Glickman 1963** * Contents*: Cementum/PDL/Alveolar bone * Inflammation:* When spreading apically into this zone, **TFO will accelerate tissue damage** * Progression:* angular defect **TFO: Etiologic factor** for angular defects with infrabony PD formation
40
Waerhaug 1979a
in response to Glickman 1963 Waerhaug tried to prove him wrong ## Footnote **Apical border of plaque - PDL = 0.96mm** **Apical border of plaque - Alveolar crest = 1.63mm**
41
Fan and Caton 2018
Thermal sensitivity Fremitus Occlusal discrepancies Cemental tears Root resorption Mobility Widened PDL Tooth migration Discomfort on chewing Fractured tooth Wear facets
42
How does mobility affect probing depth?
Probe will penetrate 0.5mm deeper ## Footnote **Neiderud, Ericsson et al. 1992**
43
Burgett, Ramfjord et al. 1992
RCT 50pts Perio Tx +/- occlusal adjustment **SSD: Patients who had OA had greater CALgain**
44
Harrel and Nunn 2001
Occlusal adjustment can decrease progression of periodontal disease
45
What are treatment options for TFO?
Occlusal adjustment Bite Splint Splinting
46
Articles to support Occlusal Adjustment
Burgett, Ramfjord et al. 1992 Harrel and Nunn 2001
47
What are the ideal characteristics of a bite splint
According to Ramfjord and Ash Maxillary bite plane with flat occlusal surface Centric stops for all teeth Cuspid rise to allow posterior disclusion while in lateral and protrusive movements
48
What are some indications for a bite splint?
TMD Severe bruxism TFO on any part of the masticatory system Stabilize maxillary mobile teeth to prevent mandibular hypereruption Holding teeth after ortho or after extraction of opposing teeth Tension headaches
49
Articles for Splinting
Ramfjord and Ash 1981 (Splinting will not eliminate the cause of mobility)
50
Alkan, Aykac at el. 2001
SRP alone vs SRP then splint vs Splint then SRP NSSD SRP alone had greatest decrease in mobility vs baseline
51
Signs of Successful treatment of TFO
Mobility decrease/absent Arrest migration Radiographic changes decrease/stabilize Pain relief/improved comfort Relief of premature contacts/fremitus/interferences Stable occlusion **AAP 2000**
52
What is the current understanding in terms of TFO's impact of perio
TFO cannot induce periodontal tissue breakdown, but with plaque-associated periodontal disease, trauma may enhance the rate of progressions **Lindhe and Lang 2015**
53
What is the plaque free zone and how large is it?
Zone where there is no buildup and no bone - 0.96mm apicocoronal and 1.63mm from tooth to crest (Waerhaug 1979)
54
How can the periodontium respond to TFO if someone is or is not susceptable?
Jin & Cao 1992
55
Name a study that shows numbers for boneloss and furcation having the most
Mohgaddas & Stahl 1980 Interradicular: 0.23mm Radicular: 0.55mm Furcation: 0.88mm

Classic Lit Fall 2021 (29 decks)

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