Occlusal trauma

Occlusal trauma

Occlusal trauma is a dental term that refers to the damage incurred when teeth are left in traumatic occlusion without proper treatment.[1]

When the maxillary and mandibular dental arches approach each together, as they do, for example, during chewing or at rest, the relationship between the opposing teeth is referred to as occlusion. If this occlusal relationship is not balanced properly it may result in pain, tenderness and even mobility of the affected teeth.[1]

When the natural course of trauma, disease and dental treatment alters an individual's occlusion by removing or changing the occlusal (biting) surface of any of the teeth, that individual's teeth will come together, or occlude, differently, and their occlusion will change.[2] When that change is detrimental to the manner in which the teeth occlude, the patient is said to possess a traumatic occlusion.[3] Traumatic occlusion may cause a thickening of the cervical margin of the alveolar bone[4] and widening of the periodontal ligament, although the latter is not pathognomonic for this condition.[5]

Contents

Histologic features associated with occlusal trauma

Microscopically, there will be a number of features that accompany occlusal trauma[6]:

It was concluded that widening of the periodontal ligament was a "functional adaptation to changes in functional requirements".[7]

Clinical signs and symptoms associated with occlusal trauma

Clinically, there are a number of physiologic results that serve as evidence of occlusal trauma[8]:

Primary vs. secondary occlusal trauma

There are two types of occlusal trauma, primary and secondary.

Primary occlusal trauma

Primary occlusal trauma occurs when greater than normal occlusal forces are placed on teeth, as in the case of parafunctional habits, such as bruxism or various chewing or biting habits, including but not limited to those involving fingernails and pencils or pens.

The associated excessive forces can be grouped into three categories. Excesses of[9]:

  • Duration
  • Frequency and
  • Magnitude

Primary occlusal trauma will occur when there is a normal periodontal attachment apparatus and, thus, no periodontal disease.[10]

Secondary occlusal trauma

An example of secondary occlusal trauma. This X-ray film displays two lone-standing mandibular teeth, #21 and #22, or the lower left first premolar and canine. As the remnants of a once full complement of 16 lower teeth, these two teeth have been alone in opposing the forces associated with mastication for some time, as can be evidenced by the widened PDL surrounding the premolar Because this trauma is occurring on teeth that have 30-50% bone loss, this would be classified as secondary oclcusal trauma.

Secondary occlusal trauma occurs when normal occlusal forces are placed on teeth with compromised periodontal attachment, thus contributing harm to an already damaged system. As stated, secondary occlusal trauma occurs when there is a compromised periodontal attachment and, thus, a pre-existing periodontal condition.[10]

Etiology and treatment

Teeth are constantly subject to both horizontal and vertical occlusal forces. With the center of rotation of the tooth acting as a fulcrum, the surface of bone adjacent to the pressured side of the tooth will undergo resorption and disappear, while the surface of bone adjacent to the tensioned side of the tooth will undergo apposition and increase in volume.[11]

In both primary and secondary occlusal trauma, tooth mobility might develop over time, with it occurring earlier and being more prevalent in secondary occlusal trauma. To treat mobility due to occlusal trauma, whether it be primary or secondary, the affected teeth are splinted together and to the adjacent teeth so as to eliminate their mobility.

In primary occlusal trauma, the etiology, or cause, of the mobility was the excessive force being applied to a tooth with a normal attachment apparatus, otherwise known as a periodontally-uninvolved tooth. The approach should be to eliminate the etiology of the pain and mobility by determining the causes and removing them; the mobile tooth or teeth will soon cease exhibiting mobility. This could involve removing a high spot on a recently restored tooth, or even a high spot on a non-recently restored tooth that perhaps moved into hyperocclusion. It could also involved altering ones parafunctional habits, such as refraining from chewing on pens or biting one's fingernails. For a bruxer, treatment of the patient's primary occlusal trauma could involve selective grinding of certain interarch tooth contacts or perhaps employing a nightguard to protect the teeth from the greater than normal occlusal forces of the patient's parafunctional habit. For someone who is missing enough teeth in non-strategic positions so that the remaining teeth are forced to endure a greater per square inch occlusal force, treatment might include restoration with either a removable prosthesis or implant-supported crown or bridge.

In secondary occlusal trauma, simply removing the "high spots" or selective grinding of the teeth will not eliminate the problem, because the teeth are already periodontally involved. After splinting the teeth to eliminate the mobility, the etiology of the mobility (in other words, the loss of clinical attachment and bone) must be managed; this is achieved through surgical periodontal procedures such as soft tissue and bone grafts, as well as restoration of edentulous areas. As with primary occlusal trauma, treatment may include either a removable prosthesis or implant-supported crown or bridge.

References

  1. ^ a b Bibb, CA: Occlusal Evaluation and Therapy in the Management of Periodontal Disease. In Newman, MG; Takei, HH; Carranza, FA; editors: Carranza’s Clinical Periodontology, 9th Edition. Philadelphia: W.B. Saunders Company, 2002. pages 698-701.
  2. ^ Hinrichs, JE: Occlusal The Role of Dental Calculus and Other Predisposing Factors. In Newman, MG; Takei, HH; Carranza, FA; editors: Carranza’s Clinical Periodontology, 9th Edition. Philadelphia: W.B. Saunders Company, 2002. page 192.
  3. ^ traumatogenic occlusion - definition of traumatogenic occlusion in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia
  4. ^ Carranza, FA: Bone Loss and Patterns of Bone Destructions. In Newman, MG; Takei, HH; Carranza, FA; editors: Carranza’s Clinical Periodontology, 9th Edition. Philadelphia: W.B. Saunders Company, 2002. page 362.
  5. ^ Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 5
  6. ^ Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 7
  7. ^ Wentz et al. J Perio, 1958
  8. ^ Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 12
  9. ^ Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 14
  10. ^ a b Carranza, FA; Bernard, GW: The Tooth-Supporting Structures. In Newman, MG; Takei, HH; Carranza, FA; editors: Carranza’s Clinical Periodontology, 9th Edition. Philadelphia: W.B. Saunders Company, 2002. page 53.
  11. ^ Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 4

Wikimedia Foundation. 2010.

Игры ⚽ Поможем написать реферат

Look at other dictionaries:

  • occlusal trauma — injury to any part of the masticatory system as a result of occlusal dysfunction. See also traumatic occlusion, under occlusion …   Medical dictionary

  • Trauma — Any injury, whether physically or emotionally inflicted. Trauma has both a medical and a psychiatric definition. Medically, trauma refers to a serious or critical bodily injury, wound, or shock. This definition is often associated with trauma… …   Medical dictionary

  • occlusal harmony functional — such occlusion of the teeth in all positions of the mandible during mastication as will provide the greatest masticatory efficiency without imposing undue strain or trauma on the supporting tissues …   Medical dictionary

  • Occlusion (dentistry) — Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.… …   Wikipedia

  • Bruxism — Infobox Disease Name = PAGENAME Caption = DiseasesDB = 29661 ICD10 = ICD9 = ICDO = OMIM = MedlinePlus = 001413 eMedicineSubj = eMedicineTopic = MeshID = Bruxism (from the Greek βρυγμός (brugmós), gnashing of teeth ) is the grinding of the teeth,… …   Wikipedia

  • Crown-to-root ratio — This X ray film reveals a poor crown to root ratio for tooth #21 (right), the lower left first premolar. The tooth exhibits 50% bone loss, adding roughly 5 7 mm to the clinical crown of what is actually anatomical root. The fulcrum, existing… …   Wikipedia

  • Dental caries — This article is about dental caries in humans. To read about dental caries in other animals, please see dental caries (non human). Dental caries Classification and external resources Destruction of a tooth by cervical decay from dental caries.… …   Wikipedia

  • Chronic periodontitis — is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by accumulation of profuse amounts of dental plaque. Chronic periodontitis Classification and external resources ICD 10 K05.3 ICD… …   Wikipedia

  • Combined periodontic-endodontic lesions — are localized, circumscribed areas of bacterial infection originating from either dental pulp, periodontal tissues surrounding the involved tooth or teeth or both.[1] Source of infection Combined periodontic endodontic lesions take the form of… …   Wikipedia

  • Alveolar process — Bone: Alveolar process Left maxilla. Outer surface. (Alveolar process visible at bottom.) …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”