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Basic Concepts Of Occlusion

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CONTENTS INTRODUCTIONTERMINOLOGIESMASTICATORY SYSTEMTYPES OF OCCLUSION FORCES OF OCCLUSION BRUXISM PATHOLOGICAL TOOTH MIGRATIONTRAUMA FROM OCCLUSIONCONCLUSIONREFERENCES

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INTRODUCTIONRamjford and AshLatin word OccupClusionclosing

Meaning : Contact relationship of teeth resulting from neuromuscular control of masticatory system

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Evidence based decision making Nunn and Harrell 2001retrospective study ---periodontitis patients ---loss of attachment---presence/absence of occlusal interferences---Result positive influence of occlusal correction on surgical/non-surgical outcome

11th edn car4

Occlusal forces----broad spectrum

Biological basis of occlusal function

Consider components as a functional unitnot in isolation

10th edn car5

TERMINOLOGIESMaximum intercuspation(centric occlusion and intercuspal position)Centric relationInitial contact in centricExcursive movementLaterotrusion Working sideNon-working side ( balancing side )ProtrusionRetrusionGuidance Interference

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MASTICATORY SYSTEM

14235

Teeth did not cum until jaw to jaw relationship was established therefore teeth fit into established max-man relnshp

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2431DYNAMICS OF EQUILIBRIUM

Dynamics of occlusion--comfortable and stable TMJSAnterior guidanceNon-interfering posterior teeth

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2431DYNAMICS OF EQUILIBRIUM

Dynamics of occlusion--comfortable and stable TMJSAnterior guidanceNon-interfering posterior teeth

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Primary requirements of a successful occlusal therapy

Comfortable and stable TMJSAnterior teeth in harmony with the envelope of functionNon interfering posterior teeth

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Formula for a perfected occlusion

Simultaneous equal intensity contacts on all teeth---condyle disk assembly completely seated

Dots in back,lines in front

In their respective sockets----dawson funcnal occln pg 3212

Posterior teeth ---centric and eccentricAnterior guidance + condyles---disclussion of posteriorsREASON Elevator muscles shut off---reduce forces on TMJ and anterior teeth Bruxers

ANTERIOR GUIDANCE STABLE AND TMJ HEALTH---GOAL OF A PERFECTED OCCLUSION13

TYPES OF OCCLUSION

ANTERIOR GUIDANCE STABLE AND TMJ HEALTH---GOAL OF A PERFECTED OCCLUSION14

FUNCTIONAL CLASSIFICATION OF OCCLUSIONPhysiologic occlusionis present when no signs of dysfunction or disease are present and no treatment is indicatedNon-physiologic(or traumatic) occlusionis associated with dysfunction or disease caused by tissue injury, and treatment maybe indicated.(criteriawhether it contributes to tissue injury,not how teeth occlude) Therapeutic occlusionis the result of specific interventions designed to treat dysfunction or disease.It is an occlusal scheme employed in restoring or replacing occlusal surfaces so that minimum physiologic and anatomic adaptation is required

car 10th edn + ld No occln related pathosis15

ORGANISATION OF OCCLUSION

1)Bilateral balanced occlusion: works of Von Spee and Monson Maximum number of teeth contact in all excursive movementsConcept :distribution of stressesComplete denture--non-working side contactstipping preventedDemerit :excessive frictional wear of teeth

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Unilateral balanced occlusion(group function): Shyyler et alConcept :Natural teeth cross-arch balance not necessary --Elimination of non-working contactsRestorative dentistryLateral excursions---working sideall teeth in contactGroup function of teeth on working side distributes the occlusal loadAbsence of non-working side contacts prevents the those teeth from being subjected to obliquely directed forces found in non-working interferencesSaves the centric holding cusps

i.e mandibular buccal and maxillary palatal from excessive wear---maintenance of occlusion i.e mandibular buccal and maxillary palatal from excessive wear---maintenance of occlusion

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Mutually Protected Occlusion (canine protected occlusion or organic occlusion ): DAmico, Stuart, Stallard et alConcept :Observation Posterior teeth contactcentric relation onlyIncisor contact protrusion onlyCanine contactlateral excursionsWhy canine?????--greater no of pressurecoeptors/mechanorecptors--good crown-root ratio--position in the arch

Members of the gnathological societypg 229 dawson redirectt any functional pattern dat wud b destructive.far frm fulcrumconvex n very steep lingual inclines18

Cases its not possible

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FORCES OF OCCLUSION Antagonistic forces: muscle of mastication and counteracting oral musculatureInclined planes of the teeth and the anterior component of force

ACF pushes teeth mesially in their sockets---release of force---previous position--proximal contact flatenned by wear--physiological mesial migration--overall reduction of 0.5cm in length of arch by 4o yrs of age

Car 6th edn(ld) balance between antagonistic forces of occlusion

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Proximal contacts: malpositioned contacts(cervico incisal or faciolingual)----deflect forces of occlusion---dispacement of teeth and create abnormal forces on the periodontiumDesign and inclination of teeth: Maxillary central incisorinclined mesiallyprovide maximim efficiency of cutting edgein functiondriven mesiallyroot shapedgreater areas of attachment on the palatal and distal sidecounteracts tendency towards facial and mesial displacement during function. Molars inclined mesially---to transmit component of vertical occlusal forces to premolars and caninesAtmospheric equilibrium during breathing and swallowing

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Intraoral Occlusal Evaluation

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BRUXISM

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Bruxism :Definition:An oral habit consisting of involuntary rhythmic or spasmodic non-functional gnashing, grinding, or clenching of teeth, in other than chewing movements of the mandible, which may lead to occlusal trauma

(Glossary Of Prosthodontic Terms) Clenching :Definition :The pressing and clamping of the jaws and teeth together, frequently associated with acute nervous tension or physical effort

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Evaluation : Bite guard

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Etiology :OCCLUSAL INTERFERENCES :

1901 Karolyipostulated that occlusal interference in combination with psychic stresses---important factor

Also without stressPremature contacts---activate high levels of muscle activity

1961 Ramfjord Ramfjord and Ash 1983, Williamson 1983EMG studies Result : marked reduction in muscle tonus and harmonious integration of muscle action follows the elimination of occlusal disharmony

He observed that minor occlusal interferences cud b a trigger for grinding habits in neurotic patients)karolyi)Ramjdevry bruxer a]has a occlusal interference27

Trigger parafunctional jaw movement which were not present earlier to interference

Erasure mechanism Coarse food of premodern man---abrasive enough to wear away interfering cusps and inclines when the bruxism mechanism was triggered and adjust occlusion within tolerable limits

Modern diet

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Rugh and Solberg 1975Habitual nocturnal bruxism continued despite removal of occlusal interferences.EMG recordings---same masticatory muscle contraction before and after occlusal correctionEqually in children as in adults

Children of bruxers are more pronePeriods of emotional peacefulness seem to result in less masticatory muscle activity29

Satoh and Harada 1971 Nocturnal bruxism---from a deeper stage of sleep to a lighter stage

REM stage---most damaging

Olkinuora 1972 divided bruxers1)Stress associated 2)Non-associated with stressConclusion :heriditary bruxism more common in the non-stress group

Stress bruxers-----more muscular symptoms and more emotionally disturbedStress causing stimulidirectly correlated with time of muscle contractionClenching(increased muscle tonus) physical demands eg. heavy lifting

Previous days events correlateChildren of bruxers are more pronePeriods of emotional peacefulness seem to result in less masticatory muscle activity30

Bruxism Clenching Severe attrition, Split teethHypermobilityUlcer associated sometimes Adaptive changes in TMJflattening of condyles,gradual loss of convexity of ementiaeFractured fillingsscreeching ,grating sound at nightMasseter muscle enlargedLateral pterygoid tenderOccluso-muscle pain

Tooth wear not common

Linea alba seen sometimes

Lateral indentations on tongue

Temporalis affected

335 dawson31

Evaluation : EMG

Bite strip

0-No sleep bruxismless than 40 events 1-Mild sleep bruxism40-74 events2-Moderate sleep bruxism75-124 events 3-Severe sleep bruxism125 or more events

Compare muscle activity b4 n aftr treatment32

PATHOLOGICAL TOOTH MIGRATION

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Definition : Tooth displacement that results when the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease.

May be an early sign of disease and associated with gingival inflammation and pocket formation

Anteriors > Posteriors

Any direction---Associated with mobilty and rotation

Refers to34

In occlusal/incisal direction termed as extrusion

Prevalence : Martinez-Canut et al 1997 55.8% Towfighi et al 1997 30.03%

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Etiologic factors for pathologic migration

Destruction of periodontal supporting tissuesOcclusal factorsSoft tissue pressure of the tongue, cheek and lipsPeriodontal and periapical inflammationExtrusive forcesHabits

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Destruction of periodontal supporting tissuesSelwyn S 1973 Bone loss in 30 patients with periodontitis + incisal migration v/s no migration Conclusion: more bone loss in PTM teeth

Martinez-Canut et al 1997 852 periodontitis patients Conclusion: Bone loss, tooth loss and gingival inflammation : PTM 2.95 to 7.97

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Role of transseptal fibresMoss and Picton 1982

Abnormal proximal contacts---Anterior component of force

Wedging force

Car and pg861 brusvold wedge force moves teeth occlusaly and incisaluabnormal forces inc aggraate perio destrn n migration38

Occlusal factorsPosterior bite collapse unreplaced first molars

Arch integrity Interproximal contacts destroyed during tooth loss, dental caries, faulty restorations & severe attritionClass II malocclusion Selwyn 1973, class II malocclusion 17/30 PTM pts

Occlusal forces distributed to teeth by interproximal contacts39

Occlusal interferences supracontacts --Thielmans law

Occlusal factors may become more destructive in patients who have lost significant alveolar bone

Occlusal forces distributed to teeth by interproximal contacts40

Protrusive pattern of masticationYaffe et al 199227/131 patients had protrusive mastication16/27 patients---anterior attrition and flaring of incisorsConclusion: etiologic factor for anterior PTM

Using sagittal tracingsof mastication41

Soft tissue pressure of the tongue, cheek, and lipsCan move teeth especially after loss of periodontal support---long duration

Light forces even1.0 gm by facial muscles at restinitiate displacement of incisors

Stable dentition is the result of an equilibrium between tongue and cheek pressures is disproven

Proffit stated that the forces of the tongue, cheek, and lips together with the forces of the periodontal tissues are the important factors that determine the tooth position (Proffit W et al. 1975)

Othodontic research42

Periodontal and periapical inflammationHirschfeld 1933--PTM of teeth is due to pressure of inflammatory tissue

Movement occurs in a direction opposite to the deepest part of the pockets

Sutton P (1985) Hydrodynamic and hydrostatic forces within the blood vessels and inflamed tissues in the pocket

Spontaneous correction following periodontal treatment Verendra kumar SC ,Anita S, SN Thomas 2009

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Extrusive forcesEruption forces are 2 to 10 gms and present throughout life

No direct association links eruptive forces to PTM

Extrusion of incisors is very common, eruptive forces can be said to be a contributing factor

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Habits Lip and tongue habits, fingernail biting, thumb sucking, pipe smoking, bruxism

Martinez et al ---no association between oral habits and PTM Out of 475 PTM cases only 11% had oral habits

Duration of force more imp. than magnitude (Proffit 1973)

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Basic Concepts Of Occlusion

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CONTENTS INTRODUCTIONTERMINOLOGIESMASTICATORY SYSTEMTYPES OF OCCLUSION FORCES OF OCCLUSION BRUXISM PATHOLOGICAL TOOTH MIGRATIONTRAUMA FROM OCCLUSIONCONCLUSIONREFERENCES

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TRAUMA FROM OCCLUSION Introduction Historical perspectiveDefinitions Classification Clinical and radiographic signsStages of tissue response to increased occlusal forcesReversibility of traumatic lesionsInfluence on progression of marginal periodontitisClinical and animal experiments

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INTRODUCTION

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Increase in the magnitude of occlusal force

Widening of the periodontal ligament space

Number and width of periodontal ligament fibers

Density of alveolar bone

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Changing the direction of occlusal forces causes a re-orientation of the stresses and strains within the periodontium.Principal fibers- arranged--accommodate occlusal forcelong axis of toothLateral (horizontal) forces and torque (rotational) forces..INJURYDuration and frequency of occlusal forces affect response of alveolar bone.Constant pressuremore injurious...than intermittent forces.Frequent application of intermittent force, injurious to the periodontium.

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HISTORICAL PERSPECTIVE

In 1901, Karolyi indicated that there appeared to be a correlation between excessive occlusal forces and periodontal destruction.

Karolyi effect

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In 1917 and 1926, Stillman stated that excessive occlusal forces were the primary cause of periodontal disease and that occlusal therapy was mandatory for the control of periodontal disease. Orban & Weinman, in 1933, used the histologic observation of human autopsy material

Occlusal forces did not have a major effect on periodontal destruction and gingival inflammation

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Definition:- Trauma from occlusion refers to a condition where injury results to the supporting structures of teeth by the act of bringing jaws into a closed position. STILLMAN (1917) Trauma from occlusion is defined as damage in periodontium caused by stress on teeth produced directly or indirectly by teeth of opposing jaw. WHO (1978) Occlusal trauma was defined as an injury to the attachment apparatus as a result of excessive occlusal force. AMERICAN ACADEMY OF PERIODONTOLOGY(1986)

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Trauma from occlusion is defined as when occlusal forces exceed the adaptive capacity of tissue, tissue injury results. This injury is termed trauma from occlusion. (CARRANZA) Other terms

1. Traumatizing occlusion. 2. Occlusal trauma. 3. Traumatogenic. 4. Periodontal traumatism.

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Traumatic occlusion An occlusion that produces such injury is called as a traumatic occlusion. Other terms 1. Occlusal disharmony. 2. Functional imbalance. 3. Occlusal Dystrophy.

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CLASSIFICATION 1)Acute trauma from occlusion2)Chronic trauma from occlusion

1)Primary trauma from occlusion2)Secondary trauma from occlusion

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ACUTE TRAUMA FROM OCCLUSIONCHRONIC TRAUMA FROM OCCLUSIONLess commonMore commonDefinition:-Result from abrupt change in occlusal forceResult from gradual change in occlusionCause:-Biting on a hard objectRestorationProsthetic appliancesTooth wear Drifting movement withParafunctional activityClinical Features:-Tooth painSensitivity to percussionIncreased tooth mobilityCementum tears. Tooth mobilityManagement:-Dissipate the force by shift in the position of toothBy wearing away or correction of restoration.Removal of cause

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PRIMARY TRAUMA FROM OCCLUSIONSECONDARY TRAUMA FROM OCCLUSIONDefinition:-Result of alterations in occlusal forces.Results from reduced ability of periodontium to resist occlusal forces.Etiology:-Insertion of high fillinginsertion of prosthetic replacementDrifting movement or extrusion of teeth into spaces created by unreplaced missing teeth.Orthodontic movement of teeth into functionally unacceptable position.Bone loss resulting from marginal inflammation.

Reduction PDL attachment area

Alteration of leverage on remaining tissue

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CLINICAL SIGNS OF OCCLUSAL TRAUMA1) Mobility (progressive)2) Pain on chewing or percussion3) Fremitus4) Occlusal prematurities/discrepancies5) Wear facets in the presence of other clinical indicators6) Tooth migration7) Chipped or fractured tooth (teeth)8) Thermal sensitivity

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RADIOGRAPHIC SIGNS OF TFO

Increased width of the periodontal ligament space, with thickening of the lamina dura along the lateral aspect of the root, in the apical region, and in bifurcation areasA vertical rather than horizontal destruction of the interdental septum.Radiolucency and condensation of the alveolar bone.Root resorption

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Increased width of the PDL spaceIncreased density of alveolar boneRadiographic signs of TFO

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Tissue response occur in 3 stages:-1)Injury2)Repair3)Adaptive remodeling of the periodontiumSTAGES OF TISSUE RESPONSE WHEN OCCLUSAL FORCE IS INCREASED

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Stage I: Injury.Tissue injury .. excessive occlusal forces.The body then attempts to repair the injury and restore the periodontium.. if the forces are diminished or if the tooth drifts away from them. Force is chronic, the periodontium is remodelled to cushion its impact. The ligament is widened at the expense of the bone, Angular bone defects without periodontal pockets,Tooth becomes loose.

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Stage I: InjurySlight excessive pressure-- Resorption of alveolar bone(direct bone resorption) Widening of periodontal ligament space -- Blood vessels numerous and reduced in sizeSlight excessive tension-- Elongation of periodontal ligament fibersapposition of bone -- blood vessels --Enlarged

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Greater pressure Compression of PDL fibers Areas of hyalinization Fibroblasts & other connective tissue cellsnecrosis

Vascular changes Impairment & stasis of blood flow Fragmentation of RBCs Disintegration of bv Increased resorption of alveolar bone

Stage I: Injury1-7 days30 mins2-3 hours

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Stage I: InjuryWidening of the periodontal ligament Tearing of the periodontal ligamentSevere tension Thrombosis, hemorrhage Resorption of alveolar bone

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Stage I: Injury Pressure severe enough to force the root against bone

Necrosis of the PDL & bone

The bone is resorbed from viable PDL adjacent to necrotic areas & from marrow spaces Undermining resorption

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Stage I: Injury Furcation most susceptible to injury Injury to the periodontium produces a temporary depressionin mitotic activity and the rate of proliferation and differentiation of fibroblasts,in collagen formation,in bone formationThese return to normal levels after dissipation of the forces.

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Stage II: RepairTFO stimulates increased reparative activity. Damaged tissues are removed, and new connective tissue cells and fibers, bone, and cementum are formed to restore the periodontium

Forces remain traumatic only as long as the damage produced exceeds the reparative capacity of the tissues.

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Stage II: RepairExcessive occlusal forces. resorption of bone. Body reinforces the thinned bony trabeculae with new bone Buttressing bone formation

Central buttressing Endosteal cells deposit new bone , Restores bony trabeculae & reduces the size of marrow spaces

Peripheral buttressingShelf like thickening of the alveolar margin Lipping-bulge in the contour of facial/lingual bone

Cartilage like material and formn of crystals from erthroctes72

Stage III: Adaptive Remodeling of the Periodontium.Periodontium is remodeled in an effort to create a structural relationship in which the forces are no longer injurious to the tissues. Thickened periodontal ligament, which is funnel shaped at the crestAngular defects in the bone, with no pocket formation. The involved teeth become loose.Increased vascularization

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Carranza FA1970

Vertical axis---percentage of bone surface undergoin respn or frmn74

Reversibility of traumatic lesionsTrauma from occlusion is reversible. When the impact of the artificially created force is relieved, the tissues undergo repair It does not correct itself..not always temporaryPresence of inflammation may impair the reversibilityInjurious forces relieved for repair to occur--if not periodontal damage persists & worsens

Polson M 1976

Trauma atri in expi animals teeth move away or intrude75

Thinning of the periodontal ligament Atrophy of the fibersOsteoporosis of the alveolar boneReduction in bone height

Effects Of Insufficient Occlusal Force

Effect of excessive occlusal forces on dental pulp..

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Effect on progression of marginal periodontitisBlood supply of marginal gingivanot affected

Accumulation of bacterial plaque that initiates gingivitis and results in periodontal pocket formation affects the marginal gingiva, but trauma from occlusion occurs in the supporting tissues and does not affect the gingiv77

Important to eliminate the marginal inflammatory component in cases of trauma from occlusion because the presence of inflammation affects bone regeneration after the removal of the traumatizing contacts.

No inflammationthe response to trauma from occlusion is limited to adaptation to increased forces. However, in the presence of inflammation, the changes in the shape of the alveolar crest may be conducive to angular bone loss, and existing pockets may become intrabony.

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Glickmans concept

Claimed that the pathway of the spread of a plaque-associated gingival lesion can be changed if forces of an abnormal magnitude are acting on teeth harboring subgingival plaque.Plaque-associated lesionssuprabony pockets & horizontal bone loss.Sites also exposed to abnormal occlusal forceangular bony defects & infrabony pockets

Traumatized tooth diff from non-traumatized tooth79

Zone of irritationZone of co-destruction

Glickman (1967), trauma from occlusion is an etiologic factor of importance in situations where angular bony defects combined with infrabony pockets are found at one or several teeth.Marginal & interdental gingivaSoft tissue bordered by hard tissue only on one side & is not affected by forces of occlusionPlaque-associated lesion at a non-traumatized tooth propagates in apical direction by first involving the alveolar bone & only later the periodontal ligament area.Even bone destruction.Zone of co-destruction:Includes periodontal ligament, the root cementum & the alveolar boneCoronally demarcated by transseptal and the dentoalveolar collagen fiber bundlesFiber bundlesseparate zone of co-destruction from the zone of irritation can be affected fromThe inflammatory lesion maintained by plaque in the zone of irritationTrauma-induced changes in the zone of co-destruction

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Glickman divided periodontal structures into two zones:The zone of irritation andThe zone of co-destruction

Zone of irritation:Marginal & interdental gingivaSoft tissue bordered by hard tissue only on one side & is not affected by forces of occlusionPlaque-associated lesion at a non-traumatized tooth propagates in apical direction by first involving the alveolar bone & only later the periodontal ligament area.Even bone destruction.

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Zone of co-destruction:Includes periodontal ligament, the root cementum & the alveolar boneCoronally demarcated by transseptal and the dentoalveolar collagen fiber bundlesFiber bundlesseparate zone of co-destruction from the zone of irritation can be affected fromThe inflammatory lesion maintained by plaque in the zone of irritationTrauma-induced changes in the zone of co-destruction

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exposure from two different directions the fiber bundles may become dissolved and/ or oriented in a direction parallel to the root surface.Alteration of the normal pathway of spread of plaque-associated inflammatory lesion results in the development of angular bony defects.

Glickman (1967), trauma from occlusion is an etiologic factor of importance in situations where angular bony defects combined with infrabony pockets are found at one or several teeth.

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Waerhaugs conceptWaerhaug (1979) examined autopsy specimens similar to Glickmans.Measured in addition the distance between the subgingival plaque andPeriphery of the associated inflammatory cell infiltrate in the gingiva andThe surface of the adjacent bone

Refuted the hypothesis that TFO played role in the spread of a gingival lesion into the zone of co-destruction.

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Loss of connective tissue attachment & the resorption of bone around teeth are, exclusively the result of inflammatory lesions associated with subgingival plaque.

Relationship of the plaque level between adjacent teeth (either at the same of different apico-coronal levels) would yield either horizontal or vertical interproximal bone loss.

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Excessive occlusal forces had no relationship to the underlying bony defect and that vertical defects were found equally around traumatized and non-traumatized teeth. Bone loss was always associated with the down growth of plaque and there was no relationship between excessive occlusal forces and vertical bone loss.

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Conclusion : Angular defects and infrabony pockets occur when the subgingival plaque of one tooth has reached a more apical level than the microbiota on the neighbouring tooth, and when the volume of the alveolar bone surrounding the roots is comparatively large

Prichard 1965 and manson 1976 accordance wid em87

Theories of trauma and inflammationAlters the pathway of inflammation

Reduced collagen density, increased number of leukocytes, osteoclasts, and blood vessels in the coronal portion of tooth Inflammation. periodontal ligamentbone loss would be angularpockets could become intrabony

Trauma from occlusion

Glickman I. 1965

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Trauma-induced areasfavorable environmentplaque and calculus development of deeper lesions

Sottosanti JS. 1977Theories of trauma and inflammationOther theories of trauma and inflammation

Of root resoption uncovered by apical migratn if the inflammed gingival attachmnt89

Orthodontic tooth movementDrifting into edentulous space

Transformation of suprabony pocket into infrabonySupragingival plaqueSubgingival plaque

Ericsson I 1977Theories of trauma and inflammation

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Increased tooth mobilitypumping effect on plaque metabolitesIncreasing their diffusion

Vollmer WH 1975Theories of trauma and inflammation

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Clinical and Animal Trials

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EASTMAN DENTAL CENTER GROUP-ROCHESTER NY---SQUIRREL MONKEYSREPITITIVE INTERDENTAL WEDGINGMILD TO MODERATE GINGIVAL INFLAMMATIONUPTO 10 WEEKSRESULT:PRESENCE OF TRAUMA DID NOT INCREASE LOSS OF ATTACHMENT INDUCED BY PERIODONTITIS

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UNIVERSITY OF GOTHENBURG GROUP IN SWEDENBEAGLE DOGSCAP SPLINTS AND ORTHODONTIC APPLIANCESMILD TO MODERATE GINGIVAL INFLAMMATIONUPTO 1 YEARRESULT:PRESENCE OF TRAUMA INCREASED PERIODONTAL DESTRUCTION INDUCED BY PERIODONTITIS

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Rosling et al. (1976) infrabony pocket located at hypermobile teeth exhibited the same degree of healing as those adjacent to firm teeth.Fleszar et al. (1980) pockets of clinically mobile teeth do not respond as well to periodontal treatment as do those of firm teeth exhibiting the same disease severity.Burgett et al. (1992) Probing attachment gain was on the average about 0.5mm larger in patients who received the combined treatment, i.e. scaling and occlusal adjustment.

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Orthodontic type traumaTipping movement

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JIGGLING- TYPE TRAUMA Healthy periodontium with normal height

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Healthy periodontium with reduced height

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Suprabony pockets and advanced bone loss

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Infrabony pocket and advanced bone loss

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The conclusions of these studies are as follows:Occlusal trauma does not initiate gingival inflammation.

2) In the absence of inflammation, a traumatogenic occlusion will result inincreased mobility, widened PDL, loss of crestal bone height and bonevolume, but no attachment loss.

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3) In the presence of gingival inflammation, excessive jiggling forces did not cause accelerated attachment loss in squirrel monkeys but increasing occlusal forces may accelerate attachment loss in beagle dogs.

4) Treating the gingival inflammation in the presence of continuingmobility or jiggling trauma will result in decreased mobility and increasedbone density, but no change in attachment level or alveolar bone level.

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CONCLUSION

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References Functional occlusion :From TMJ to Smile design : Peter DawsonRamfjord and Ash. Occlusion. 3rd edition. Clinical Periodontology Carranza 8th ,10th,11th EditionClinical update-Trauma from occlusion: a review;Commander R. Dave Rupprecht, DC, USN 2004

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Clinical Periodontology and Implant Dentistry Jan Lindhe 4th Edition.Pathologic tooth migration;Brunsvold 2008

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Thank u!!!!!

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