If it is accepted that increased occlusal forces could result in a further loss of attachment for teeth with an active inflammatory periodontitis, then it follows that a treatment plan aimed at preserving these teeth must address both problems. On the tooth level an occlusion may or may not be ideal for the attachment apparatus, and the same consideration must be given to the frequency of occlusal contact, ie Does parafunction occur? In addition, the ability of the attachment apparatus to withstand a less than ideal occlusion may be compromised by periodontal inflammation. Factors may range from a systemic disease such as rheumatoid arthritis to the debilitating effects of chronic long term stress. Also, it is widely accepted that some patients, at some times will have an articulatory system which is compromised by other factors which reduce their tolerance to a less than ideal occlusion. It has, however, been stressed that there is no such thing as an intrinsically bad occlusal contact, because the effect is a product of not only the'quality' of the contact or contacts but also the frequency at which the contact or contacts are made. On the system level ideal occlusion is or is not ideal for the rest of the articulatory system: the temporomandibular joints and the masticatory muscles.

This is because secondary referral units where the majority of clinically based studies are carried out, do not routinely monitor patients who maintain good plaque control. If trauma from occlusion exists there are obvious difficulties in assessing whether the rate of attachment loss is greater in patients with a continuing plaque induced periodontitis. A major problem with clinical studies of this type is the lack of a reliable index for measuring the degree of occlusal trauma to which a tooth is subjected. Or is an orthodontic force, created by a spring and is a unilateral force that results in the deflection of the tooth away from the force.įew clinical studies have identified a clear relationship between trauma from the occlusion and inflammatory periodontitis in humans. This is usually created in the animal by the provision of a supraoccluding onlay. The type of force that can be applied to the animal tooth is:Įither a jiggling force, which is produced by multi-directional displacement of a tooth in alternating buccolingual or mesiodistal directions. This is the experimental model equivalent of a post-periodontal therapy level The periodontal attachment level is one of three types:Ī healthy periodontal support but a reduced bone height. In the context of this paper occlusal trauma will mean chronic occlusal trauma. Chronic trauma from occlusion is more common and has greater clinical significance. More usefully, occlusal trauma can also be described as acute or chronic.Īcute trauma from occlusion occurs following an abrupt increase in occlusal load such as occurs as a result of biting unexpectedly on a hard object. Recently, the distinction between primary and secondary occlusal trauma has been challenged as meaningless since the changes that occur in the periodontium are similar irrespective of the initial level of periodontal attachment. Secondary occlusal trauma refers to changes which occur when normal or abnormal occlusal forces are applied to the attachment apparatus of a tooth or teeth with inadequate or reduced supporting tissues. Primary occlusal trauma results from excessive occlusal force applied to a tooth or to teeth with normal and healthy supporting tissues. Historically trauma from occlusion has been classified as either primary or secondary. Should occlusal treatment be considered for the patient with compromised periodontal attachment?īefore attempting to answer these two questions, the different types of trauma from occlusion need to be defined. It is quite right, therefore, that dentists should ask themselves two questions:ĭoes occlusal trauma have a role in the aetiology of periodontal disease? 'Periodontitis is the result of an interaction between a susceptible host and bacterial factors in dental plaque, which exceeds the inherent protective mechanisms of the host'.īoth processes result in injury to the attachment apparatus because the periodontium is unable to cope with the pathological insult which it experiences. Compare this definition with the one for inflammatory periodontal disease: Occlusal trauma has been defined as 'injury to the periodontium resulting from occlusal forces which exceed the reparative capacity of the attachment apparatus': ie the tissue injury occurs because the periodontium is unable to cope with the increased stresses it experiences.

Occlusal trauma signs