27 Trauma from Occlusion. Perio anatomypdf

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Trauma from
occlusion
Occlusal Trauma
Occlusal trauma has been defined asinjury to the periodontium resulting from occlusal forces that exceeds the adaptive capacity of the attachment apparatus.

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Factors which affect the adaptive capacity of periodontium to occlusal forces

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Tissue response to increased occlusal forces
3 stages
1.injury,
2.repair,
3.adaptive remodeling of the periodontium.
Stage I. Injury
Tissue injury is produced by excessive occlusal
forces.
The ligament is widened at the expense of the
bone, resulting in angular bone defects without
periodontal pockets, and the tooth becomes loose.
The areas of the periodontiummost susceptible to
injury from excessive occlusal forces are the
furcations.
Stage II: Repair.
Repair is constantly occurring 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 cementumare formed in an attempt to restore the
injured periodontium.
Stage III: Adaptive Remodeling of the Periodontium.
●If the repair process cannot keep pace with the destruction caused by the occlusion, the periodontiumis remodeled in an effort to create a structural relationship in which the forces are no longer injurious to the tissues.
●This results in a thickened periodontal ligament, which is funnel shaped at the crest, and angular defects in the bone, with no pocket formation.
●The involved teeth become loose.
●Increased vascularization has also been reported.

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Treatment
A goal of periodontal therapy in the
treatment of occlusal traumatism should be
to maintain the periodontiumin comfort and
function.
In order to achieve this goal a number of treatment considerations must be considered including one or more of the following :
qOcclusal adjustment
qManagement of parafunctionalhabits
qTemporary, provisional or long-term stabilization of mobile teeth with removable or fixed appliances
qOrthodontic tooth movement
qOcclusal reconstruction
qExtraction of selected teeth