Wednesday, January 2, 2013

Occlusal Trauma: Effect and Impact on Periodontal Tissues

Occlusal trauma is defined as an injury to the tooth supporting attachment apparatus as a result of excessive occlusal forces.

Primary occlusal trauma is injury resulting from excessive occlusal foces applied to a tooth with normal support.

Secondary occlusal trauma is injury resulting from normal oclusal forces applied to teeth with inadequate periodontal support.

Combined occlusal trauma refers to injury resulting from abnormal occlusal forces applied to tooth or teeth with inadequate periodontal support.

Traumatogenic occlusion refers to a cause and is defined as any occlusion that produces forces that cause injury to the attachment apparatus.

Alterations of the periodontium  that have been associated with occlusal trauma will vary with the magnitude and direction of the applied force.  The changes may include widening/compression of the periodontal ligament, bone remodeling(resorption/repair), vascular dilation and permeability, thrombosis, root resorption and cemental tears.  Collectively, these changes have been interpreted as an attempt by the periodontium to adapt and undergo repair in response to  traumatogenic occlusion.

The majority of studies investigating this condition indicate that occlusal forces do not initiate plaque -induced gingival disease or connective tissue attachment loss (periodontitis)  Occlusal trauma in the presence of plaque induced inflammation may result in alteration of the normal pathway of inflammation and development of angular bony defects with intrabony defects but, in itself; does not cause gingivitis or periodontitis.
 Occlusal trauma accelerates the progression of pocket formation in the presence of ongoing destructive periodontitis. observed Dr Cherukuri 

Clinical and radiographic indicators are necessary to assist in its diagnosis. Proposed clinical indicators include mobility, occlusal prematurities, thermal sensitivity, wear facets, muscle tenderness, fractured teeth and migration of teeth. Radiographic indicators include widened periodontal ligament, altered lamina dura and evidence of root resorption and/or bone loss.  Increased tooth mobility is one of the most widely used indicators of occlusal trauma.

In the absence of existing inflammation, bony changes accompanying occlusal trauma may be reversed by discontinuing offending occlusal forces.  The importance of the role  of bacterial plaque in periodontal disease is undisputed but the influence of occlusal trauma on the attachment levels remains controversial.

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