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This series of slides is based on Lindhe et al.s textbook Clinical Periodontology and Implant Dentistry, chapter 8.
Definition
Trauma from Occlusion:
Pathologic or adaptive changes which develop in the periodontium as a result of undue force produced by the masticatory muscles. Stillman (1917): A condition where injury results to the supporting structures of the teeth by the act of bringing the jaws into a closed position WHO (1978): Damage in the periodontium caused by stress on the teeth produced by the teeth of the opposing jaw. AAP (1986): An injury to the attachment apparatus as a result of excessive occlusal force.
Definition
Trauma from Occlusion
Primary TfO:
A tissue reaction, which is elicited around a tooth with normal height of the periodontium (no attachment loss!)
Secondary TfO:
Related to situations in which occlusal forces cause damage in a periodontium of reduced height (attachment loss present)
Stones (1938)
TfO is an etiologic factor in the production of that variety of periodontal disease in which there is vertical pocket formation associated with one or a varying number of teeth
Glickmans Concept
Pathway of spread of a plaque-associated gingival lesion can be changed if abnormally strong forces are acting on teeth with subgingival plaque Zone of irritation includes marginal and interproximal gingiva. Not affected by occlusal forces. Lesion propagates apically first by involving the bone then the periodontal ligament.
Glickmans Concept
Zone of co-destruction includes the ligament, cementum, bone, and the transseptal and dentoalveolar fibers Fibers can be affected from the lesion in the zone of irritation, or from trauma-induced changes in the zone of codestruction
Glickmans Concept
In teeth not affected by TfO, inflammatory lesion can spread into alveolar bone In teeth affected by TFO, inflammatory lesion spreads into periodontal ligament. This will create an angular bony lesion combined with an infrabony pocket.
Glickmans Concept
Waerhaugs Concept
Apical cells of the JE and the subgingival plaque are at different levels. Crest of marginal bone is slanting. It follows the location of the JE and plaque.
Waerhaugs Concept
Waerhaug measured distance between the subgingival plaque and
The perimeter of the associated inflammatory infiltrate The surface of the adjacent alveolar bone
He concluded that angular defects and infrabony pockets occurred equally frequently in teeth with TfO and in teeth without TfO Waerhaug postulated that loss of attachment and bone are the result of inflammation induced by subgingival plaque
Orthodontic Movements
T: tension zone
P: pressure zone
Recession or AL can occur at sites of gingivitis when tooth is moved through the envelope of the alveolar process.
Conclusions
In a healthy periodontium, neither unilateral nor jiggling forces can result in attachment loss or pocket formation TfO alone cannot induce periodontal tissue breakdown Bone resorption in TfO should be interpreted as an adaptation of the ligament and bone to the altered functional requirements In plaque-induced inflammation, TfO may enhance the disease progression