Trauma from Occulsion in periodontology.pptx

Trauma from occlusion in periodontology and fremitus test powerpoint presentation

1. PERIO ANUSHKA WANANJE FINAL YEAR TRAUMA FROM OCCLUSION AND FREMITUS TEST

2. CONTENTS INTRODUCTION DEFINITION TYPES STAGES OF TISSUE RESPONSE INJURY CLINICAL AND RADIOGRAPHIC FEATURES OF TFO FREMITUS TEST GRADING OF FREMITUS TEST TREATMENT OF TFO

3. DEFINITION 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)

4. TYPES 1.DEPENDING ON THE ONSET AND DURATION ACUTE TFO CHRONIC TFO 2. DEPENDING ON THE NATURE OF THE CAUSE PRIMARY TFO SECONDARY TFO

5. 1.ACUTE TRAUMA FROM OCCLUSION • 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 CUSPS

6. 2. CHRONIC TRAUMA FROM OCCLUSION • 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

7. 3. PRIMARY TRAUMA FROM OCCLUSION IT IS A TISSUE INJURY WHICH IS ELICITED AROUND A TOOTH WITH NORMAL HEIGHT OF PERIODONTIUM • WHEN THE TRAUMA FROM OCCLUSION IS THE RESULT OF ALTERATION IN THE OCCLUSAL FORCES,IT IS CALLED PRIMARY TRAUMA FROM OCCLUSION • PREDISPOSES 1. INSERTION OF HIGH FILLINGS 2. INSERTION OF PROSTHETIC REPLACEMENT THAT CREATES EXCESSIVE FORCE ON ABUTMENTS 3. ORTHODONTIC MOVEMENT OF TEETH INTO FUNCTIONALLY UNACCEPTABLE POSITION

8. FEATURES- IT DOES NOT INITIATE POCKET FORMATION IT DO NOT ALTER THE LEVEL OF CONNECTIVE TISSUE ATTACHMENT. CHANGES PRODUCED BY PRIMARY TFO ARE REVERSIBLE. THIS IS BECAUSE SUPRACRESTAL GINGIVAL FIBERS ARE NOT AFFECTED AND THEREFORE PREVENT APICAL MIGRATION OF JUNCTIONAL EPITHELIUM

9. 4. 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 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.

10. CAUSES ALVEOLAR BONE LOSS DUE TO MARGINAL INFLAMMATION REDUCES THE PERIODONTAL ATTACHMENT AREA. THIS INCREASES THE BURDEN ON THE REMAINING TISSUES. SYSTEMIC DISORDERS MAY REDUCE TISSUE RESISTANCE AND FORCES PREVIOUSLY TOLERABLE MAY BECOME EXCESSIVE.

11. STAGES OF TISSUE RESPONSE TO INCREASED OCCLUSAL FORCES 1. STAGE 1:INJURY 2. STAGE 2 : REPAIR 3. STAGE 3 :ADAPTIVE REMODELLING OF PERIODONTIUM HISTOLOGICAL CHANGES

12. STAGE 1:INJURY • 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

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 THIS PHASE SHOWS AN INCREASE IN AREAS OF RESORPTION AND A DECREASE. IN AREAS OF BONE FORMATION.

14. STAGE 2:REPAIR • 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 .

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. THIS PHASE SHOWS INCREASE IN AREAS OF BONE FORMATION AND DECREASED RESORPTION.

16. STAGE III:ADAPTIVE REMODELLING OF PERIODONTIUM • IF THE REPAIR 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 THIS PHASE SHOWS RETURN OF NORMAL RESORPTION AND FORMATION

17. GLICKMAN CONCEPT GLICKMAN (1965, 1967) CLAIMED THAT THE PATHWAY OF THE SPREAD OF A PLAQUEASSOCIATED GINGIVAL LESION CAN BE CHANGED IF FORCES OF AN ABNORMAL MAGNITUDE ARE ACTING ON THE CONTAMINATED TOOTH . ROLE OF THE TRAUMA FROM OCCLUSION IN THE PROGRESSION OF PERIODONTAL DISEASE.

18. ZONE OF IRRITATION • 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 .

19. ZONE OF CO-DESTRUCTION • 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 .

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.

21. WAERHAUG'S CONCEPT (1979) • 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.

22. CLINICAL FEATURES 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 POSITIVE FREMITUS TEST

23. RADIOGRAPHIC FEATURES WIDENING OF PERIODONTAL LIGAMENT SPACE ANGULAR BONE LOSS CONDENSATION OF ALVEOLAR BONE ROOT RESORPTION THICKENING OF LAMINA DURA BUTTRESSING BONE FORMATION ON OCCLUSAL RADIOGRAPH

24. FREMITUS TEST • 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. GRADING OF FREMITUS TEST CLASS I : MILD VIBRATIONS OR MOVEMENTS DETECTED CLASS 2:EASILY PALPABLE VIBRATIONS BUT NO VISIBLE MOVEMENTS CLASS 3 :MOVEMENTS VISIBLE WITH NAKED EYE

26. TREATMENT OF TFO PROPOSED BY AAP(1996) REDUCE /ELIMINATE TOOTH MOBILITY ELIMINATE OCCLUSAL PREMATURITIES ELIMINATE PARAFUNCTIONAL HABITS PREVENT FURTHER TOOTH MIGRATION PERMANENT OR TEMPORARY SPLINT

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