In this part, we will discuss: • Whether occlusal trauma is significant in the aetiology of periodontal disease • Whether occlusal treatment is indicated for patients suffering from periodontal disease • Making a diagnosis of trauma from occlusion • Tooth mobility • Occlusal equilibration and the splinting of teeth
Occlusal considerations in periodontics
S. J.Davies,1 R. J. M. Gray,2 G. J. Linden,3and J. A. James,4
Periodontal disease does not directly affect the occluding surfaces of teeth, consequently some may find a section on periodontics a surprising inclusion. Trauma from the occlusion, however, has been linked with periodontal disease for many years. Karolyi published his pioneering paper, in 1901 ‘Beobachtungen uber Pyorrhoea alveolaris’(occlusal stress and ‘alveolar pyorrhoea’).1 However, despite extensive research over many decades, the role of occlusion in the aetiology and pathogenesis of inflammatory periodontitis is still not completely understood.
Occlusal trauma Injury to the periodontium resulting from occlusal forces which exceed the reparative capacity of the attachment
Why should trauma from occlusion be considered tohave a role in the aetiology of periodontal disease? cclusal trauma has been defined as ‘injury to the periodontium resulting from occlusal forces which exceed the reparative capacity of the attachment apparatus’: ie the tissue injury occurs because the periodontium is unable to cope with the increased stresses it experiences. Compare this definition with the one for inflammatory periodontaldisease: ‘Periodontitis is the result of an interaction between a susceptible host and bacterial factors in dental plaque, which exceeds the inherent protective mechanisms of the host’.
Periodontitis The result of an interaction between a susceptible host and bacterial factors in dental plaque, which exceeds the protective mechanisms of the host
1*GDP, 73 Buxton Rd, High Lane,
Stockport SK68DR; P/T Lecturer in Dental Practice, University Dental Hospital of Manchester, Higher Cambridge St., Manchester M15 6FH; 2Honorary Fellow, University Dental Hospital of Manchester, Higher Cambridge St., Manchester M15 6FH 3Reader in Periodontology, Divsion of Restorative Dentistry, School of Dentistry, Queen’s University, Belfast BT12 6BP 4Lecturer in Oral Pathology and Periodontics, UniversityDental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH *Correspondence to : Stephen Davies email: firstname.lastname@example.org
Both processes result in injury to the attachment apparatus because the periodontium is unable to cope with the pathological insult which it experiences. It is quite right, therefore, that dentists should ask themselves two questions: 1.Does occlusal trauma have a role in the aetiology of periodontal disease? 2. Should occlusal treatment be considered for the patient with compromised periodontal attachment? Before attempting to answer these two questions, the different types of trauma from occlusion need to be defined. How is trauma from occlusion classified? Historically trauma from occlusion has been classified as eitherprimary or secondary. Primary occlusal trauma results from excessive occlusal
force applied to a tooth or to teeth with normal and healthy supporting tissues. Secondary occlusal trauma refers to changes which occur when normal or abnormal occlusal forces are applied to the attachment apparatus of a tooth or teeth with inadequate or reduced supporting tissues. Recently, the distinction betweenprimary and secondary occlusal trauma has been challenged as meaningless since the changes that occur in the periodontium are similar irrespective of the initial level of periodontal attachment. More usefully, occlusal trauma can also be described as acute or chronic. Acute trauma from occlusion occurs following an abrupt increase in occlusal load such as occurs as a result of biting unexpectedly on a...