Occlusal trauma: Difference between revisions

Traumatic occlusion may cause a thickening of the cervical margin of the alveolar bone<ref name="Carranza">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.</ref> and widening of the [[periodontal ligament]], although the latter is can also be caused by other processes.<ref>Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 5</ref>

*Progressive Toothtooth mobility

Primary occlusal trauma occurs when ''greater than normalexcessive occlusal forces'' are placed on teeth, as in the case of off axis loading, 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 threefour categories. Excesses of:<ref>Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 14</ref>

*Duration

*Frequency and

*Magnitude, and

Primary occlusal trauma will occur when there is aan normaladequate [[periodontium|periodontal attachment]] apparatus. and,It thus,is ''noreversible periodontalif the cause of the trauma is disease''corrected.<ref name="Bernard">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.</ref>

Secondary occlusal trauma occurs when ''normal or excessive occlusal forces'' are placed on teeth with ''compromised periodontal attachment'', thusThe contributingloss harmof tosupport anmust alreadybe damagedto system.the level Aswhereby stated,the secondarysigns of occlusal trauma occurssuch whenas theremobility remain even if the source of the trauma is acorrected. The compromiseddistinction [[periodontium|periodontalbetween attachment]]primary and, thus,secondary occlusal trauma is important because a ''pre-existingdiagnosis periodontalof condition''.<refsecondary name="Bernard"/>occlusal trauma implies the need for splinting.

In primary occlusal trauma, the cause of the mobility was the excessive force being applied to a tooth with aan normaladequate attachment apparatus, otherwise known as a ''periodontally-uninvolved tooth''. The approach should be to eliminate the cause 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 [[occlusion (dentistry)|hyperocclusion]]. It could also involve altering one's parafunctional habits, such as refraining from chewing on pens or biting one's fingernails. For a [[bruxism|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 partial denture|removable prosthesis]] or [[dental implant|implant]]-supported [[crown (dentistry)|crown]] or [[bridge (dentistry)|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 involvedcompromised. After splinting the teeth to eliminate the mobility, the cause of the mobility (in other words, the loss of [[periodontium|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 partial denture|removable prosthesis]] or [[dental implant|implant]]-supported crown or bridge.