NEWGIZA UNIVERSITY

BDS8107
Occlusion and periodontal disease
 NEWGIZA UNIVERSITY
Aims
The educational aims of this lecture are:
1. To explain the relationship between occlusion and
periodontal diseases
2. To explain implications for the management of trauma from
occlusion and periodontal diseases
 NEWGIZA UNIVERSITY
Objectives
On completion of this lecture, the student should have:
1. An understanding of the occlusion and trauma from
occlusion in the context of periodontal diseases
2. An understanding of the management of trauma from
occlusion and tooth mobility in presence of periodontal
disease
 Patient with periodontal NEWGIZA UNIVERSITY
condition
History and 1. Periodontal chart Patient with gingival
condition
Initial therapy
(Oral Hygiene instructions & supragingival scaling)
2. Periodontal chart, Diagnosis, Treatment plan

Yes Further treatment required No

Subgingival scaling and root planing
Anti-infective therapy

Re-evaluation (after 8-12 weeks)

No
Further treatment required

Yes
Surgical Corrective phase
Follow up for OH and supragingival
every 1-2 months

Supportive Periodontal
Re-evaluation (after 6 months) Re-evaluation
therapy
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Healthy periodontium?
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Trauma from occlusion

Definition:
-A condition where injury results to the
supporting structures of the teeth by the act of
bringing the jaws into a closed position (Stillman -
1917).

-Damage in the periodontium caused by stress on

the teeth produced directly or indirectly by teeth
of the opposing jaw (WHO in 1978).
 NEWGIZA UNIVERSITY

Trauma from occlusion

Injury to the attachment apparatus!

Physiologic adaptive capacity of NEWGIZA UNIVERSITY

the periodontium to occlusal

forces
-The periodontium attempts to accommodate the forces exerted on
the crown.

-This adaptive capacity varies in different persons and in the same

person at different times.

-When forces exceeds the adaptive and reparative capacity of the

periodontal tissues à tissue injury results (trauma from occlusion)
Factors that help increase NEWGIZA UNIVERSITY

traumatic forces: (magnitude,

direction & duration)
When magnitude of occlusal forces is increased:
1.The periodontium responds with a widening of the
periodontal ligament space.

2. An increase in the number and width of periodontal

ligament fibers.

3. Increase in the density of alveolar bone.

Direction of the occlusal NEWGIZA UNIVERSITY

forces
-Periodontal ligament fibers are arranged so that
the occlusal forces are applied along the long
axis of the tooth.

-Change in the direction of the occlusal forces

lead to change the orientation of periodontal
ligament fibers
Duration and frequency of NEWGIZA UNIVERSITY

occlusal forces
-Constant pressure on the bone is more injurious than
intermittent forces.

-The more frequent the application of an intermittent

force, the more injurious the force to the
periodontium.
Periodontal reactions to NEWGIZA UNIVERSITY

occlusal trauma
-Occlusal trauma CAN NOT initiate marginal inflammation or pocket
formation in the absence of bacterial plaque

-Bone changes due to occlusal trauma are reversible

-With pre-existing periodontitis rate of spread is increased

 NEWGIZA UNIVERSITY

Causes of occlusal trauma

1. Orthodontic treatment
2. Teeth extraction
3. Bruxism
4. Iatrogenic (partial denture, cusp
contouring)
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Orthodontic
-Pressure and tension zones
-Increase in the periodontal ligament
space resulting in mobility
-If within adaptive range tooth tends to
be displaced
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Jiggling forces
-Alternating buccolingual or mesiodistal directions
-If above adaptive response mobility will result
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Causes
Classification of occlusal NEWGIZA UNIVERSITY

trauma
I. Acute
II. Chronic
III. Primary
IV. Secondary
V. Combined
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Acute trauma from occlusion

-Abrupt occlusal impact, such as when biting

on a hard object (e.g., an olive pit).

-In addition, restorations or prosthetic

appliances that interfere with the direction of
occlusal forces on the teeth may induce acute
trauma.
 NEWGIZA UNIVERSITY

Acute trauma from occlusion

Clinical features :
1. Tooth pain.

2. Sensitivity to percussion.

3. Tooth mobility.
Chronic trauma from NEWGIZA UNIVERSITY

occlusion
-More common than the acute form and is of
greater clinical significance.

-Develops from gradual changes in occlusion

produced by tooth wear, drifting movement, and
extrusion of teeth, combined with parafunctional
habits such as bruxism and clenching
Primary trauma from NEWGIZA UNIVERSITY

occlusion
-A tissue reaction, which is elicited around a
tooth with normal height of the periodontium
(no attachment loss!)

-It can caused by high filling. faulty restorations

or fixed and removable prosthesis, causing large
force on the abutment or opposing teeth.
Secondary trauma from NEWGIZA UNIVERSITY

occlusion
It is related to situations in which normal occlusal
forces cause damage in a periodontium of
reduced height (attachment loss already present!)
Combined trauma from NEWGIZA UNIVERSITY

occlusion
It is the injury that occurs to the
periodontium resulting from abnormal
occlusal forces that are applied to a tooth or
teeth with abnormal periodontal support.
 NEWGIZA UNIVERSITY

Clinical features

-Mobility (progressive)

-Pain on chewing or percussion

-Fremitus (Palpable or visible

movement of a tooth when
subjected to occlusal forces)

-Occlusal discrepancies
 NEWGIZA UNIVERSITY

Clinical features

-Wear facets in the presence

of other clinical indicators

-Tooth migration

-Chipped or fractured teeth

Thermal sensitivity
Clinical features NEWGIZA UNIVERSITY

(radiographic)
-Increased width of periodontal ligament space.

-Thickening of lamina dura.

-Vertical or angular bone loss.

-Radiolucency in furcation areas.

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Treatment goal

A goal of periodontal therapy in the treatment of occlusal traumatism

should be to maintain the periodontium in comfort and function.
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Treatment goal
1. Occlusal adjustment

2. Management of parafunctional habits

3. Temporary, provisional or long-term stabilization of mobile teeth

with removable or fixed appliances

4. Orthodontic tooth movement

5. Occlusal reconstruction

6. Extraction of selected teeth

 NEWGIZA UNIVERSITY

Treatment
 Patient with periodontal NEWGIZA UNIVERSITY
condition
Patient with gingival
History and 1. Periodontal chart
condition
Initial therapy
(Oral Hygiene instructions & supragingival scaling)
2. Periodontal chart, Diagnosis, Treatment plan

Yes Further treatment required No

Subgingival scaling and root planing
Anti-infective therapy

Re-evaluation (after 8-12 weeks)

No
Further treatment required

Yes
Surgical Corrective phase
Follow up for OH and supragingival
every 1-2 months

Supportive Periodontal
Re-evaluation (after 6 months) Re-evaluation
therapy
 NEWGIZA UNIVERSITY
Aims
The educational aims of this lecture are:
1. To explain the relationship between occlusion and
periodontal diseases
2. To explain implications for the management of trauma from
occlusion and periodontal diseases
 NEWGIZA UNIVERSITY
Objectives
On completion of this lecture, the student should have:
1. An understanding of the occlusion and trauma from
occlusion in the context of periodontal diseases
2. An understanding of the management of trauma from
occlusion and tooth mobility in presence of periodontal
disease
 NEWGIZA UNIVERSITY

Reading material
• The dental reference manual, Geraldine M. Weinstein, springer 2017
(Chapters 1,2,19)
 NEWGIZA UNIVERSITY
Towards
unbounded
thinking.

Thank You