Occlusal trauma(1)

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Occlusal traumaWe know that our teeth are at function all the time and have attachment apparatus which is anatomically and histologically organized in a way to adapt the forces ( otherwise you cant work on them like if ankylosed or hard) but sometimes those teeth with this .criteria can get injury from occlusion

:In this lec. we want to knowThe definition of occlusal trauma -1 ? Who is susceptible to it -2 ? How to diagnose it -3 ? periodontium What are the effects of it on -4

: Note

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When we said occlusal trauma this is the diagnosis , but the etiology is

.""traumatogenic occlusion:DefinitionInjury that is resulting in tissue changes within the periodontal attachment apparatus as a result of occlusal forces (notice not excessive or . (abnormal just occlusal forces"" ... ...

* Attachment apparatus Consist of : periodontal ligament (the most affected) +bone(secondly affected after PDL)+ cementum (may be affected .(but slowly) + gingiva( not affected

FremitusA palpable or visible movement when .subjected to occlusal forcesAsk the patient to bite while you put your finger on the tooth that may be have2

fremitus, and you will feel it move so it's .called fremitus

It's different from occlusal trauma ** because if tooth has fremitus this tooth will be a big problem because every time patient bite, the tooth will shift , and we have to do something (take it out of bite or decrease the force ) because every single time it's moving from its socket , and will end by coming out so we must take it in our .consideration Fremitus "you feel it and/or see it , it " happens usually in anterior teeth or premolars , but in occlusal trauma you .can't see it move To differentiate between miller class ** 3 (which is mobility index ) from :fremitus Fremitus : tooth does not move a lot , only when the patient bites you can see . it and feel it move ....

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Class 3: tooth does not move even if the patient bites , the only way to detect it is by hard instrument not each tooth with class 3 index ** should have fremitus , e.g : there is tooth- with no opposing tooth- had supraerupted and moved, when you do mobility index to it, it will be class 3 index(even there is no opposing tooth) because there is no attachment .apparatus

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: To detect occlusal trauma Any patient for the first time has to run an occlusal evaluation for him :clinically and radiographiclly (facets :(clinically -1( Pic. slide 4 page 1 ( right pic

On the cusp itself or restoration (more rapid wear) ,everything is very flat, this is indicating that there is a force which cause this wear , by the time

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everyone will have facets so this is more .applicable for young patients mostly there are bone loss -2 (vertical) and furcation areas (involvement (radigrapgically(Pic. slide 4 page 1 (left pic

All periodontium is good except for the tooth that has excessive forces , patient will end with cracked tooth or root (when it has RCT and leave it without crown so pocket will have pus and root cracked, so it's preferable to put crown on the (tooth after RCT

centric relation vs. centric -3 occlusion.slide 5 page 1 (right pic) Pic

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Not all patients have an ideal centric relation or centric occlusion but if there is no deviation ,no clicking you consider it normal , otherwise if you notice that there is excessive forceetc ,you have to make sure that .this patient has trauma from occlusion5

excursive contacts -4 The common clinical signs of occlusal trauma increasing tooth mobility and -1 migration or drifting fremitus -2 : persistent discomfort on eating -3 Patient says: whenever I chew on this tooth, it cause pain for me , so we must .think of excessive force on this tooth

The common radiographic signs of : occlusal trauma discontinuity and thickening of lamina -1 dura widening of periodontal ligament -2 space

radiolucency and condensation of -3 alveolar bone or root resorption When there is a strong force the PDL will spread as much as possible , the6

bone protect itself by thickening and this is till a specific stage after it there will be bone loss (tooth will move from one side to other, there will be resorption from where it move and thickening to where it .move ),as the dr said

but in primary ( not chronic ) cases there will be widening and thickening of lamina dura (well defined around tooth) but in worst cases will be bone resorption and even root resorption will . happen

There is attrition on incisal edges and bone loss all over , so this is from occlusal trauma combined with periodontal disease ( this . ( called secondary occlusal trauma in the primary occlusal trauma the bone is) the same everywhere, only one side will have (changes,so it's not generalized as secondary .

(Pic. slide 2 page 2 (left Pic**

: Classification of occlusal trauma7

primary occlusal trauma ** Injury resulting in tissue changes from excessive occlusal forces(EOF) applied to a tooth or teeth with normal support :There will be normal bone levels-1

normal attachment levels-2 excessive occlusal force-3 So everything is perfect(normal bone levels, normal attachment levels) except excessive forces(could be iatrogenic

.(:high restoration ,or abnormal occlusion So periodontal ligament tissues can** respond with traumatic occlusion changes when a normal periodontium is affected by increased occlusal loading due to bruxicing clenching(which is a or high restoration secondary occlusal trauma **

habit , not a must to end with signs of occlusal trauma , may only muscles affected)

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Injury resulting in tissue changes from normal or EOF applied to tooth or teeth with reduced support bone loss-1 :There will be

attachment loss-2 normal/EOF-3

Not every perio patient must have** occlusal trauma but they are susceptible .if there is signs

But if the patient lost his teeth or has collapsed occlusion , this patient will never have a good forces on his teeth , it will hurt him due to the bite collapsebecause there is no posterior stops, so the anterior teeth will take excessive forces so they will procline , move and .lose bone quickly But if he had mild chronic periodontitis this doesnt mean he is really susceptible unless you see widenenig . and other clinical signs

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Clinical and radiographic signs for** primary and secondary are very much the same except that in primary (periodontium is normal ) but in secondary (dentition is not healthy and there is attachment apparatus loss so the normal forces will act as traumatic . (forces :Other classification

: Acute ** from occlusion occurs following an abrupt increase in occlusal load e.g. As a result of biting unexpectedly on a hard . object : Chronic ** from occlusion is more common and has greater clinical significance(takes time to happen ,it represents most of . (secondary occlusal traumaIn exam classification mean primary and :secondary note

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Role of occlusion in the pathogenesis of periodontal disease Many animal studies rats , monkeys and dogs evaluated the effect of occlusal . forces on periodontium

Periodontal disease is initiated by plaque which start at sulcus (gingiva --->supracrestal fibers --->. bone ) this is .the usual pathway but Occlusal trauma starts in bone and periodontal ligament , and if the sulcus stays intact (no pocket) it can't .cause gingival inflammation

So the plaque is in Zone of irritation (coronal part) but occlusal trauma is in Traumatic zone (co-destructive zone: mean both together : forces and (periodontal disease ...

:Pic. in slide 2 page 4**Zone of co-destruction occurs when plaque induced periodontitis, and occurs in a tooth that also has traumatic occlusion resulting in

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more severe bone loss than that seen with . periodontitis alone If zone of irritation goes to co-destruction zone there will be more bone loss( if go . (downward--->more destruction

Occlusal trauma is bad because most people have initial periodontal disease so if they have excessive force very quickly they can have advanced periodontal disease but never ever start periodontal disease just by occlusal trauma it's only enhance .(accelerate)the changes So the results of the studies do not support the concept that occlusal trauma was a causative agent of .periodontal destruction

In usual pathway: Infection of pocket** goes to blood vessels and destructs the .normal periodontium

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In trauma it looks for other spaces so the periodontal ligament spaces open .and the pathway completely changes The pathway of inflammation will not be as simple as when there is no trauma and there will be vertical bone loss( study using rhesus monkeys demonstrated a phenomenon described as "altered pathway of destruction" when EOF present, which means there is change in orientation of periodontal and gingival fibers which occurred in presence of EOF allowing gingival inflammation to extend along the PDL . (and lead to vertical bone loss Different schools of study * Scandinavian studies Done by Gothenberg on begagles dogs , excessive jiggling cap bar (splint(very high force American studies *

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Done by Roxchester on squirrel monkey , light force(really slow force), orthodontic lightures Variable Model periodontit is defect Force Force magnitude time Rochester monkey Mildtomoderate Supracrestal Mesio-distal Moderate Gotenberg Dog severe infrabony capsplaint severe

One year week 10 So Gotenberg said that occlusal trauma is bad and cause more diceases in the absence of inflammation , TFO -1 will not cause a loss of : connective tissue attachment Occlusal trauma could cause mobility but not attach