TRAUMA FROM OCCLUSION
CONTENTS:
✓ Introduction
✓ Definitions
✓ Diagnosis
✓ Classification
✓ Stages of tissue response
✓ Effect of insufficient occlusal force
✓ Reversibility of traumatic lesion
✓ Effect of occlusal force on dental pulp
✓ Trauma from occlusion and plaque associated periodontal disease
✓ Glickman concept
✓ Waerhaug concept
✓ Jiggling forces
✓ Theories proposed to explain the interaction of trauma and inflammation
✓ Effect of excessive occlusal forces on gingival recession
✓ Diagnosis
✓ Conclusion
✓ References
INTRODUCTION
Periodontium tries to accommodate the forces exerted on the crown.
The effect of occlusal forces on the periodontium is influenced by
1. Magnitude : Increase in magnitude of occlusal forces
• widening of the periodontal ligament space (PDL space),
• Increase in the number and width of PDL fibers
• Increase in density of alveolar bone
2. Direction: Changing direction of occlusal forces → reorientation of stresses and strains
within the periodontium. Lateral (horizontal) forces and torque (rotational) forces are more
likely to injure the periodontium
3. Duration: Constant pressure on the bone is more injurious than intermittent forces
4. Frequency of the forces : more the frequency, more the injury
✓ When occlusal force > adaptive capacity of the tissues = tissue injury. The resultant injury
is termed trauma from occlusion
✓ WHO defined trauma from occlusion (1978) as a damage in the periodontium caused by
stress on teeth produced directly or indirectly by teeth of opposing jaws
, ✓ An occlusion that produces injury is called traumatic occlusion. Earlier known as
Compound periodontitis
DEFINITIONS:
✓ Excessive occlusal force : occlusal force that exceeds the reparative capacity of the
periodontal attachment apparatus, which results in occlusal trauma and/or causes excessive
tooth wear (loss)
✓ Occlusal trauma: term used to describe injury resulting in tissue changes within the
attachment apparatus, including periodontal ligament, supporting alveolar bone and
cementum, as a result of occlusal force(s).
✓ Occlusal trauma may occur in an intact periodontium or in a reduced periodontium
caused by periodontal disease.
✓ Primary occlusal trauma: injury resulting in tissue changes from excessive occlusal forces
applied to a tooth or teeth with normal periodontal support. It occurs in the presence of
normal clinical attachment levels, normal bone levels, and excessive occlusal force(s).
✓ Secondary occlusal trauma: injury resulting in tissue changes from normal or excessive
occlusal forces applied to a tooth or teeth with reduced periodontal support. It occurs in the
presence of attachment loss, bone loss, and normal/excessive occlusal force(s).
✓ Fremitus: palpable or visible movement of a tooth when subjected to occlusal forces.
✓ Bruxism or tooth grinding: habit of grinding, clenching, or clamping the teeth. The force
generated may damage both tooth and attachment apparatus
CLASSIFICATION
1. Acute and Chronic Trauma
ACUTE CHRONIC
Etiology ✓ Abrupt occlusal impact, such ✓ develops from gradual changes
as that produced by biting on a in occlusion produced by tooth
hard object (e.g., an olive pit). wear, drifting movement, and
✓ Restorations or prosthetic extrusion of teeth, combined with
appliances that interfere with or parafunctional habits such as
alter the direction of occlusal bruxism and clenching
forces on the teeth (high points)
Signs ✓ Tooth pain
✓ Sensitivity to percussion
✓ Increased tooth mobility
✓ Also produces cemental tears
Treatment ✓ Removal of the hard object
✓ Correction of high points
✓ Basically shifting the tooth
away from source of injury
CONTENTS:
✓ Introduction
✓ Definitions
✓ Diagnosis
✓ Classification
✓ Stages of tissue response
✓ Effect of insufficient occlusal force
✓ Reversibility of traumatic lesion
✓ Effect of occlusal force on dental pulp
✓ Trauma from occlusion and plaque associated periodontal disease
✓ Glickman concept
✓ Waerhaug concept
✓ Jiggling forces
✓ Theories proposed to explain the interaction of trauma and inflammation
✓ Effect of excessive occlusal forces on gingival recession
✓ Diagnosis
✓ Conclusion
✓ References
INTRODUCTION
Periodontium tries to accommodate the forces exerted on the crown.
The effect of occlusal forces on the periodontium is influenced by
1. Magnitude : Increase in magnitude of occlusal forces
• widening of the periodontal ligament space (PDL space),
• Increase in the number and width of PDL fibers
• Increase in density of alveolar bone
2. Direction: Changing direction of occlusal forces → reorientation of stresses and strains
within the periodontium. Lateral (horizontal) forces and torque (rotational) forces are more
likely to injure the periodontium
3. Duration: Constant pressure on the bone is more injurious than intermittent forces
4. Frequency of the forces : more the frequency, more the injury
✓ When occlusal force > adaptive capacity of the tissues = tissue injury. The resultant injury
is termed trauma from occlusion
✓ WHO defined trauma from occlusion (1978) as a damage in the periodontium caused by
stress on teeth produced directly or indirectly by teeth of opposing jaws
, ✓ An occlusion that produces injury is called traumatic occlusion. Earlier known as
Compound periodontitis
DEFINITIONS:
✓ Excessive occlusal force : occlusal force that exceeds the reparative capacity of the
periodontal attachment apparatus, which results in occlusal trauma and/or causes excessive
tooth wear (loss)
✓ Occlusal trauma: term used to describe injury resulting in tissue changes within the
attachment apparatus, including periodontal ligament, supporting alveolar bone and
cementum, as a result of occlusal force(s).
✓ Occlusal trauma may occur in an intact periodontium or in a reduced periodontium
caused by periodontal disease.
✓ Primary occlusal trauma: injury resulting in tissue changes from excessive occlusal forces
applied to a tooth or teeth with normal periodontal support. It occurs in the presence of
normal clinical attachment levels, normal bone levels, and excessive occlusal force(s).
✓ Secondary occlusal trauma: injury resulting in tissue changes from normal or excessive
occlusal forces applied to a tooth or teeth with reduced periodontal support. It occurs in the
presence of attachment loss, bone loss, and normal/excessive occlusal force(s).
✓ Fremitus: palpable or visible movement of a tooth when subjected to occlusal forces.
✓ Bruxism or tooth grinding: habit of grinding, clenching, or clamping the teeth. The force
generated may damage both tooth and attachment apparatus
CLASSIFICATION
1. Acute and Chronic Trauma
ACUTE CHRONIC
Etiology ✓ Abrupt occlusal impact, such ✓ develops from gradual changes
as that produced by biting on a in occlusion produced by tooth
hard object (e.g., an olive pit). wear, drifting movement, and
✓ Restorations or prosthetic extrusion of teeth, combined with
appliances that interfere with or parafunctional habits such as
alter the direction of occlusal bruxism and clenching
forces on the teeth (high points)
Signs ✓ Tooth pain
✓ Sensitivity to percussion
✓ Increased tooth mobility
✓ Also produces cemental tears
Treatment ✓ Removal of the hard object
✓ Correction of high points
✓ Basically shifting the tooth
away from source of injury
