Trauma from occlusion

presentation about trauma from occlusion

1. TRAUMA FROM OCCLUSION Muneeb Muhammed Ali Presented on:1-2-17 1

2. INTRODUCTION DEFINITION TYPES STAGES OF TISSUE RESPONSE TO INJURY CLINICAL AND RADIOGRAPHIC FEATURES OF TFO TREATMENT OF TFO CONCLUSION REFERENCE CONTENTS

3. Trauma from occlusion is a term used to describe pathologic alterations or adaptive changes which develop in the periodontium as a result of undue force produced by the masticatory muscles INTRODUCTION

4. “A condition where injury results to the supporting structures of the teeth by the act of bringing the jaws into a closed position”. ( Stillman 1917) When occlusal forces exceed the adaptive capacity of the tissues, tissue injury results. this resultant injury is termed TFO. ( Orban & Glickman 1968 Carranza ) “Damage in the periodontium caused by stress on the teeth produced directly or indirectly by teeth of the opposing jaw”. ( WHO1978) An injury to the attachment apparatus as a result of excessive occlusal force. ( Glossary of periodontic terms ,1992 ) DEFINITION

5. results from an abrupt occlusal impact, such as that produced by biting on a hard object In addition, restorations or prosthetic appliances that interfere with or alter direction of occlusal forces on the teeth may induce acute trauma Clinical features : Tooth pain. Sensitivity to percussion. Tooth mobility. Fractured Cusp TYPES 1.ACUTE TRAUMA FROM OCCLUSION

6. develops from gradual changes in a) occlusion produced by tooth wear, b) drifting movement c) extrusion of teeth, d) combined with parafunctional habits such as bruxism and clenching . 2.CHRONIC TRAUMA FROM OCCLUSION

7. When the trauma from occlusion is the result of alteration in the occlusal forces,it is called Primary Trauma from occlusion Predisposes Insertion of High fillings Insertion of prosthetic replacement that creates excessive force on abutments Orthodontic movement of teeth into functionally unacceptable positions 3.PRIMARY TRAUMA FROM OCCLUSION

8. Features:- It does not Initiate pocket formation It do not alter the level of connective tissue attachment This is because supracrestal gingival fibers are not affected and therefore prevent apical migration of junctional epithelium

9. Secondary trauma from occlusion occurs when the adaptive capacity of the tissues to withstand occlusal forces is impaired by bone loss resulting from marginal inflammation This reduces the periodontal attachment area and alters laverage on remaining tissues This periodontium become more vulnerable to injury,and previously well tolerated occlusal force become traumatic 4.SECONDARY TRAUMA FROM OCCLUSION

10. Predisposes:- Normal periodontium with reduced bone height Marginal periodontitis with reduced bone height 10

11. Stage I:Injury Stage 2:Repair Stage 3:Adaptive remodelling of periodontium 11 Stages of Tissue Response to Increased occlusal forces

12. When a tooth is exposed to excessive occlusal forces,the periodontal tissues are unable to withstand and hence they distribute,while maintaining the stability of the tooth This may lead to certain well defined reactions in the periodontal ligament and alveolar bone,eventually resulting in adaptation of periodontal structures to altered functional demand 12 Stage I:INJURY

13. When the tooth is subjected to horizontal forces the tooth rotates or tilts in the direction of force . this tilting results in the pressure and tension zones,within the marginal and apical parts of the periodontium 13

14. TFO stimulates increased reparative activity.when bone is resorbed by excessive occlusal forces,the body attempts to reinforce the thinned bony trabeculae with new bone This attempt to compensate for the lost bone is called buttressing bone formation which is an important feature of reparative process associated with Trauma from occlusion 14 Stage II:Repair

15. Buttressing bone formation can occur within the jaw called central buttressing and on bony surface called as peripheral buttressing It usually occurs on the facial and lingual plates of the alveolar bone,if it produces a shelf like thickening of alveolar bone it is referred to as lipping 15

16. If the process cannot keep pace with the destruction caused by occlusion,the periodontium may get remodeled in order to maintain the structural relationship This may result in thickened periodontal ligament,angular defects in the bone with no pocket formation,loose teeth and increased vascularization 16 Stage III:Adaptive remodelling of periodontium

17. Glickman (1965, 1967) claimed that the pathway of the spread of a plaque‐associated gingival lesion can be changed if forces of an abnormal magnitude are acting on the contaminated tooth. ZONE OF IRRITATION ZONE OF CO DESTRUCTION 14/31 GLICKMAN CONCEPT

18. The zone of irritation includes the marginal and interdental gingiva which is affected by microbial plaque This gingival lesion at a “non‐traumatized” tooth propagates, in the apical direction by first involving the alveolar bone and only later the periodontal ligament area The progression of this lesion results in an even (horizontal) bone destruction. Zone of irritation

19. As long as inflammation is confined to gingiva,the inflammatory process is not affected by occlusal forces When inflamation extends from gingiva into supporting periodontal tissues plaque induced inflammation enters the zone influenced by occlusion which is known as zone of co destruction 19 Zone of Co-destruction

20. The tissues in the zone of co destruction become the seat of a lesion caused by trauma from occlusion Here the spread of infection is from the zone of irritation directly down into periodontal ligament and hence angular bony defects with infra bony pockets are seen 20

21. The loss of connective attachment and bone around teeth is, according to Waerhaug , exclusively the result of inflammatory lesions associated with subgingival plaque Waerhaug concluded that angular bony defects and infrabony pockets occur when the subgingival plaque of one tooth has reached a more apical level than the plaque on the neighbouring tooth, and when the volume of the alveolar bone surrounding the roots is comparatively large. WAERHAUG’S CONCEPT (1979)

22. Tooth mobility Pain on chewing or percussion Attrition Pathological migration Furcation Involvement Gingival Recession In severe cases, Periodontal abscess formation Cemental tears can be seen Presence of infrabony pockets Clinical features

23. Widening of periodontal ligament space Angular Bone loss Condensation of alveolar bone Root resorption Thickening of lamina dura Buttressing bone formation on occlusal radiograph 23 Radiographic Features

24. Fremitus Test Miller’s tooth mobility test Percussion test Articulating paper test Checking wear facets 24 Diagnostic Test

25. It is the measurement of vibratory pattern of the teeth when teeth are placed in contacting positions and movements Wet the ungloved finger and place it partially on the gingiva and partially on teeth and ask the patient to bite repeatedly Observe the vibration produced in lateral protrusive movements and positions Grade the movement according to fremitus test scale 25 Fremitus Test

26. Class I : Mild vibrations or movements detected Class 2:Easily palpable vibrations but no visible movements Class 3:Movements visible with naked eyes 26 Grading of fremitus test

27. PROPOSED BY AAP(1996) 1. Reduce /eliminate tooth mobility 2. Eliminate occlusal prematurities 3. Eliminate parafunctional habits 4. Prevent further tooth migration 5. Permanent or Temporary splint TREATMENT OF TFO

28. Periodontal structures depend on functional occlusal forces to activate the periodontal mechanoreceptors in the neuromuscular physiology of the masticatory system. A traumatic occlusion on a healthy periodontium leads to an increased mobility but not to attachment loss. In inflamed periodontal structures traumatic occlusion contributes to a further and faster spread of the inflammation apically and to more bone loss. Abnormal forces on the tooth can increase tooth mobility.the elimination of plaque and prevention of its formation can helps to maintain periodontal health even if traumatic forces are allowed to persist,however the elimination of trauma may increse chance for bone regeneration and gain of attachment CONCLUSION

29. Carranza’s Clinical Periodontology 11 th Edition “Trauma from occlusion:a review’’-Dave Rupprecht (January 2004) “Association of Trauma from occlusion with localized gingival recession in mandibular anteriors’’-Prathiba Panduranga (2009) “Trauma from occlusion-An orthodontist’s perspective’’-R Saravanan (June 2010) “ Periodontitis and TFO’’-Adriana Campos passenazi 29 REFERENCE

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