Correct Answers

Trauma from Occlusion: Periodontal Tissues

Textbook:
Part 4, Chapters 16 and 17, pages: 313-323

Further reading:
Review article: "Passanezi E, Campos Passanezi Sant'Ana A. Role of occlusion in
periodontal disease. Periodontology 2000, 2019; 79: 129–150.

Question 1:
What is the definition of trauma from occlusion according to WHO?

Damage in the periodontium caused by stress on the teeth produced directly or

indirectly by teeth of the opposing jaw.

Question 2:
What knowledge did the human autopsy studies provide on the
etiopathogenesis of trauma from occlusion?

No cause-effect relationship between occlusion, plaque, and periodontal lesions.

Controversial conclusions drawn from this type of research.

Example:
Glickman’s concept vs. Waerhaug’s concept. Some clinicians have tended to
accept Glickman’s conclusion that trauma from occlusion is an aggravating factor
in periodontal disease, while others accept Waerhaug’s concept that there is no
relationship between occlusal trauma and the degree of periodontal tissue
breakdown.

Question 3:
What is a jiggling-type trauma (1) and how does it affect the gingiva and the
periodontal ligament (2)?

(1) When traumatic forces are extended on the crowns of the teeth,
alternately in the buccal/lingual or mesial/distal directions, and the teeth
are not allowed to move away from the force.

No clear-cut pressure and tension zones can be identified, but rather

there is a combination of pressure and tension on both sides of the jiggled
tooth.

(2) The combined tension and pressure zones (encircled areas) are
characterized by signs of acute inflammation, including collagen
resorption, bone resorption, and cementum resorption.

As a result of bone resorption, the periodontal ligament space gradually

increases in size on both of the teeth as well as in the periapical region
Correct Answers

When the effect of the force applied had been compensated for by the
increased width of the periodontal ligament space, the ligament tissue
shows no sign of inflammation. The supra-alveolar connective tissue is
not affected by the jiggling forces and there is no apical down-growth of
the dentogingival epithelium. After occlusal adjustment the width of the
periodontal ligament becomes normalized and the teeth are stabilized.

Question 4:
Does a healthy periodontium with reduced height have the capacity to
adapt to jiggling forces and to what extent?

With certain limits, a healthy periodontium with reduced height has a capacity
similar to that of a periodontium with normal height to adapt to altered
functional demands.

Removal of the jiggling forces (“occlusal adjustment”) with in this situation result
in a normalization of the width of the periodontal ligament

Question 5:
When may a trauma from occlusion enhance periodontal disease
progression?

In teeth with progressive periodontal disease. When the tissue changes occur in
a zone with inflammation. This may result to loss of connective tissue
attachment and epithelial down-growth.

Question 6:
Is occlusal adjustment necessary for the treatment of periodontitis?

No generally. In some cases, trauma may act as a co-factor. Immobilizing the

affected teeth without treating the plaque-associated lesion is not adequate
although it may reduce the mobility and enable some bone regrowth.

Occlusal therapy is able to reduce the long-term progression of periodontal

disease, and could be considered as an important adjunctive therapy in the
treatment of periodontal disease.

Most of the research to investigate the role of occlusion in periodontitis has been
performed in animal models or cadavers and hence does not reflect the real
influence of trauma from occlusion in humans.

As a consequence, aggregation of plaque-related inflammatory periodontal

disease by trauma from occlusion is still under question, and further
investigations are necessary to elucidate such an association.