Trauma from occlusion: Natural Teeth

Question 1

Define “trauma from occlusion”

Answer 1

An injury to the attachment apparatus as the result of excessive occlusal forces

Question 2

What are the 2 conditions for Primary trauma from occlusion?

Answer 2

1. Excessive force (ex. high restoration of bruxism)

2. Normal periodontium

Question 3

What are the 2 conditions for Secondary trauma from occlusion?

Answer 3

1. Normal (or excessive) forces

2. Applied to a weakened periodontium

Question 4

What are the 6 possible Clinical signs of Trauma from occlusion?

Answer 4

1. Progressive tooth mobility
2. Fremetis
3. Functional mobility
4. Pathologic migration
5. Infaboney pockets (maybe?)
6. Buttressing bone (maybe?)

Question 5

What are infraboney pockets?

Answer 5

Defects around the tooth, epithelial migration, perio bone loss, loss of CT attachment going apical to bone.

Question 6

What is buttressing bone?

Answer 6

Build up of alveolar bone

Question 7

What 2 general categories of causation might possible radiographic signs of occlusal trauma represent?

Answer 7

1. May represent adaptation

2. May represent an extension of inflammatory periodontal disease without occlusal trauma as a factor

Question 8

What are the 5 possible radiographic signs of trauma from occlusion?

Answer 8

1. Widened PDL space
2. Thickened Radi. Lamina Dura
3. Thickened trabecular bone
4. Angular bone loss
5. Furcations

Question 9

What are 4 common consequences of a cantilever bridge?

Answer 9

1. Increased PDL space
2. Thickened Lamina Dura
3. No loss of crest of bone
4. Tooth mobilization

Question 10

What happens to trabecular bone when there is NO occlusion?

Answer 10

Hypofunction leads to Sparce Trabecular bone

Question 11

Clinically, what does angular bone loss result in?

Answer 11

A pocket

Question 12

Why is it controversial to say that furcations may be the result of trauma from occlusion?

Answer 12

Furcations are a pattern of progressive periodontal disease, and not necessarily due to occlusal forces

Question 13

What is the Co-Destruction Theory (Glickman)?

Answer 13

Occlusal trauma may be a co-destructive factor that alters the sensitivity and pattern of inflammatory periodontal disease

Question 14

Describe the “pathway of PD” according to the co-destruction theory

Answer 14

Proposed that inflammation is channeled into a pocket creating a new pattern where occlusion bears an influence on periodontal disease because it gets “channeled” to the PDL.

Question 15

What are the 2 “zones” according to the co-destruction theory?

Answer 15

1. Zone of irritation

2. Zone of co-destruction

Question 16

What occurs in the zone of irritation according to the co-destruction theory?

Answer 16

Host-parasite interaction

Question 17

Describe the “Advancing Plaque Front” Theory (Waerhaug)

Answer 17

Occlusal trauma has NO ROLE in the severity and pattern of inflammatory periodontal disease progression (says it is just a problem of advancing plaque front, not occlusion)

Question 18

In what way does trauma play a role in periodontal disease according to Dr. Claman?

Answer 18

Dr. Claman says that secondary causes pay a role in an already weakened periodontium, but occlusion does NOT play a major role as the cause…however, because trauma from occlusion effects treatment outcomes, it still needs to be addressed

Question 19

In trauma from occlusion, crushing of the tooth against bone causes what (and where)?

Answer 19

Crushing of tooth against bone causes injury to periodontal ligament at sites of pressure and of tension

Question 20

What are the 3 models for Role of Occlusal Trauma?

Answer 20

1. Trauma from occlusion without periodontitis
2. Trauma from occlusion with periodontitis: But NO co-destruction
3. Trauma from occlusion with periodontitis: co-destruction occurs

Question 21

What are the signs and symptoms of TFO without Periodontitis?

Answer 21

1. Injury results in acute (not plaque associated) inflammation (ie high restoration)
2. PDL collagen destruction
3. Cementum resorption
4. Bone loss
5. NO attachment loss
6. Jiggling movement
7. Adaption may occurL tooth may become mobile, but no further injury

Question 22

Describe Jiggling Movement/Forces in TFO without periodontitis

Answer 22

• Movement with excursive movements, including jiggling back and forth
• Jiggling causes injury to PDL and Cementum

Question 23

Describe “adaptation” in TFO without periodontitis

Answer 23

Mobility and widened PDL space, but no further injury

Question 24

Describe “occlusal therapy” for TFO without periodontitis

Answer 24

By occlusal reduction, splinting, or adding bite plates, there will NO longer be jiggling, with signs of occlusal trauma may diminish

Question 25

What are the 3 phases of TFO without periodontitis?

Answer 25

1. Injury Phase: initiated by crushing force, lead to bone resorption increasing and bone apposition decreasing 2. Repair phase: Bone absorption goes down and apposition does up 3. Adaptation phase: No longer under trauma

Question 26

Describe the consequences of TFO on reduced periodontium without periodontitis

Answer 26

- Reduced, but healthy, periodontium (weakened tooth) - TFO leads to breakdown of PDL -b/c of secondary occlusal trauma (weakened periodontium) - no further attachment loss

Question 27

Describe adaptation of reduced periodontium with TFO without periodontitis

Answer 27

Adaptation: mobility and widened PDL space

Question 28

What is the outcome of occlusal therapy in a tooth experiencing TFO on reduced periodontium without periodontitis?

Answer 28

Occlusal reduction may decrease the signs of occlusal trauma, but sometimes also need to splint to healthier teeth

Question 29

Describe the consequences of TFO with no inflammation in a tooth with previous attachment loss (reduced, but healthy)

Answer 29

- Tooth adapts - No influence on course of periodontal disease - No further attachment loss - No co-destruction - Bone thickens

Question 30

What is the key to no co-destruction with TFO w/o inflammation on reduced periodontium?

Answer 30

Good oral hygiene....control of inflammation

Question 31

Describe TFO with Periodontitis but No Co-destruction

Answer 31

- Injury from occlusion as well as Periodontal disease, however the 2 problems are occurring INDEPENDENTLY of one another - Do not potentiate each other - Destructive processes are occurring independently

Question 32

Describe adaptation to occlusal trauma in a tooth with supracrestal periodontitis

Answer 32

Widened PDL space and Thickened bone

Question 33

When should you perform occlusal therapy in a tooth with periodontitis?

Answer 33

NEVER PERFORM OCCLUSAL THERAPY UNTIL INFLAMMATION IS CONTROLLED....TX PERIODONTITIS FIRST!!!

Question 34

Why must you treat the periodontitis (control the inflammation) before performing occlusal therapy in a tooth experiencing both TFO and periodontitis?

Answer 34

Because the high occlusion may actually be being CAUSED by the inflammation, so if you drill first, you may be removing sound tooth structure for no reason

Question 35

Describe TFO with Periodontitis where Co-destruction occurs

Answer 35

Inflammation from periodontitis merges with the occlusal lesion and results in an ACCELERATED response.

Question 36

As far as location, how does a periodontal lesion in a tooth with co-destruction vs. no co-destruction differ?

Answer 36

-TFO & periodontitis w/o co-destruction = SUPRAcrestal periodontitis lesion Vs. -TFO & periodontitis w/ co-destruction = SUBcrestal (infrabony pocket) with inflammatory infiltrate

Question 37

How do periodontitis and TFO potentiate each other?

Answer 37

When the periodontitis MERGES with the increased TOOTH MOBILITY --> co-destruction occurs

Question 38

Can you do occlusal therapy on a tooth with SUBCRESTAL periodontitis lesion?

Answer 38

NO! Never do occlusal therapy until you first have ANY periodontitis under control

Question 39

If TFO and inflammatory periodontitis are _______ processes, ____ enhanced attachment loss

Answer 39

Independent processes --> NO enhanced attachment loss

Question 40

Describe the conditions under which there will likely be co-destruction

Answer 40

1. TFO with increasing mobility AND inflammatory infiltrate (periodontitis) at same site 2. Two lesions COULD merge 3. Downgrowth (apical migration) of pocket (junctional ) epithelium 4. Enhanced (accelerated) attachment loss = co-destruction

Question 41

Name 4 REVERSIBLE methods of occlusal therapy

Answer 41

1. Night guard (bite plane) 2. Extracoronal splints 3. Muscle relaxants (meds) 4. Muscle exercises

Question 42

Name 4 IRREVERSIBLE methods of occlusal therapy

Answer 42

1. Intracoronal splints (requires tooth preparation) 2. Occlusal adjustment by selective grinding 3. Orthodontics 4. Orthognathic surgery

Question 43

What are the 5 indications for occlusal adjustment by selective grinding?

Answer 43

1. Periodontal occlusal trauma 2. Post-orthodontics 3. Prior to extensive (?) 4. Certain types of TMD 5. Certain wear patterns

Question 44

What are the 5 CONTRAindications to occlusal adjustment?

Answer 44

1. Severe malocclusion 2. Non-ideal but tolerated occlusion 3. Severe wear 4. Patient in pain 5. If no suitable end point

Question 45

______ must be present for attachment loss to occur

Answer 45

Periodontitis (inflammation)

Question 46

Occlusal trauma in the absence of periodontitis may be ______ and may result in ______

Answer 46

May be REVERSIBLE and may result in ADAPTATION (a mobile but otherwise healthy tooth)

Question 47

No repair can occur unless inflammatory periodontal disease is first _____

Answer 47

Resolved

Question 48

Occlusal trauma superimposed on an existing periodontitis MAY under certain conditions ______

Answer 48

Accelerate attachment loss (but not always)

Question 49

When is occlusal therapy indicated with periodontal treatment?

Answer 49

When occlusal trauma is present with PD

Question 50

During the initial periodontal therapy, why should occlusal therapy not be done until after inflammatory PD is first controlled?

Answer 50

Because PD therapy helps decrease the inflammation and therefore decrease the tooth mobility

Question 51

What is unique about a treatment plan for periodontal regenerative therapy?

Answer 51

Occlusal therapy is especially indicated prior to regenerative therapy

Question 52

______ is not justified in the absence of periodontal disease as a PD preventative measure

Answer 52

Occlusal therapy