2. • TOOTH MOBILITY can be
defined as ‘ the degree of
looseness of a tooth’ KENRY
AAP 1986
• Mobility is recorded as a part
of the initial occlusal evaluation
& to monitor changes overtime

3. • In health, physiological or
functional mobility of tooth
exists & every tooth with
healthy periodontal support will
have a physiologic range of
mobility
Mobility is a measurement of
horizontal & vertical tooth
displacement in the socket

4. MOBILITY CAN BE OF TWO
TYPES:
•
PHYSIOLOGIC PATHOLOGIC
TOOTH MOBILITY TOOTH MOBILITY

5. PHYSIOLOGIC TOOTH
MOBILITY
• It refers to moderate force exerted
on the crown of tooth surrounded by
a healthy & intact periodontium &
tooth will show tipping movement until
a closer contact has been established
between root & marginal bony tissue
MUHLEMAN,1951
KORBER,1971
LINDHE ,1989

6. • Normal tooth mobility varies
between different types teeth:
Incisors - 10- 12 mm/ 100 mm
Canines - 5 - 9mm/100mm
Premolars - 8 - 10mm/100mm
Molars - 4 - 8mm/100mm

7. Factors affecting
physiologic tooth mobility:
• Daily variations:
• Teeth have a slight degree of
physiologic mobility which varies for
different teeth & at different
times of day
• It is greatest in the morning,which
progressively decreases due to
slight extrusion of tooth & minimal
during sleep

8. • During walking hours mobility is
reduced by chewing & swallowing
forces which intrude teeth into
socket
Tooth contact during deglutition:
• functional forces received by teeth
during deglutition resulted in tooth
contact which maintains the tooth
in proper positions T

9. Effect of stress-inducing conditions:
• Habits like bruxism & clenching
activities affect tooth mobility as
well
• Larger in children than in adults
• Females > males
• Increases during pregnancy

10. Tooth mobility occurs in
TWO STAGES:
• INITIAL STAGE OR INTRA
SOCKET STAGE:
• Tooth moves within confines
of periodontal ligament associated
with viscoelastic distortion of
ligament & redistribution of
periodontal fluids, inter-bundle
content & fibers

11. • SECONDARY STAGE :
•
• Occurs gradually &
entails defomation of
alveolar bone in response to
a increased horizontal forces

12. PATHOLOGIC TOOTH
MOBILITY:
• Refers to any degree of
perceptible movement of
faciolingually,mesiodistaly or
axially when a force is applied
to tooth

14. CAUSES OF PATHOLOGIC
TOOTH MOBILITY:
• Extension of inflammation from
gingiva or from periapex into
periodontal ligament results in
changes that increases mobility
• Loss of tooth support results in
tooth mobility. Amount of of
mobility depends on severity &
distribution of bone loss at
individual root surfaces,length,
shape & size of roots

15. • Trauma from occlusion, injury
produced by excessive occlusal
forces or abnormal habits such as
bruxism & clenching is a common
cause of tooth mobility
• Pregnancy, tooth mobility is
increased in pregnancy & sometimes
associated with menstrual cycle or
use of hormonal contraceptives

16. • Pathologic process of jaws that
destroys alveolar bone & roots of
teeth can also result in mobility
• Periodontal surgery increases tooth
mobility for a short period
• Tooth loss, when a large number of
teeth have been lost,remaining
tooth must assume all functional
demands

18. CLASSIFICATION OF
TOOTH MOBILITY:
• MILLER - has described the most
common clinical method in which
tooth is held in between handles of
two instruments & moved back &
forth or with one metallic
instrument & one finger

19. Scoring criteria:
• Score 0 : no detectable mobility
• Score 1 : distinguishable tooth
• mobility
• Score 2 : crown of tooth moves
• more than 1mm in any
• direction
• Score 3 : movement of more than
• 1mm in any direction

20. • CARANZA F.A. - described it as
normal mobility
• Grade 1 : slightly more than normal
• Grade 2 : moderately more than
normal
• Grade 3 : severe mobility
faciolingually & or mesiodistally
combined with vertical displacement

21. • GENCO R.- assessed mobility as:
•
• Degree 1 : horizontal mobility of
• crown is from detectable
• to 1mm
• Degree 2 : mobility of crown ranges
• from 1-2mm horizontally
• Degree 3 : mobility of crown is
• observed in vertical or
• apical direction

22. • LEONARD ABRANMS &
POTASHNICK S.:
• Class 1 : mobility less than 1mm
• Class 2 : mobility within 1-2mm
• Class 3 : mobility greater than 2mm

23. • SCHLUGER :
• 0 : clinical mobility with normal
• range
• {-} :clinical mobility slightly more
• than physiologic but less than
• 1mm buccolingually
• 1 : clinical mobility 2mm
• buccolingually but with no
• mobility in apical direction

24. • 3 : clinical mobility greater than
• 2mm buccolingually in addition to
• mobility in an apical direction

25. • GRACES & SMALES:
Grade 0 : no apparent mobility
• Grade 1 : mobility less than 1mm
buccolingually
• Grade 2 : mobility between 1-2mm
• Grade 3 : mobility more than 2mm
buccolingually

26. • KIESER:
• Grade 0 : physiologic mobility
• Grade 1 : slight mobility
• Grade 2 : moderate mobility
• Grade 3 : marked mobility

27. • Degree 1 : movability of crown of
• tooth less than 1mm in
• horizontal direction
• Degree 2 : movability of crown of
• tooth more than 1mm in
• horizontal direction
• Degree 3 : movability of crown of
• tooth in vertical direction
• as well

29. METHOD OF ASSESSING
TOOTH MOBILITY:
• The instrument system
{PERIODONTOMETER} permits
reproducible assessment of
horizontal mobility of all types
of both arches

30. • Instruments consists of:
• A CLUTCH
with a female receptable
for holding carrying vehicle
• A MULTIJOINTED
CARRYING VEHICLE
with a male
attachment that supports &
positioning a dial test

31. • A DYNAMOMETER
with which a standardized force can be
applied to tooth
• A SENSITIVE DIAL TEST
INDICATOR
with a diamond coated recording
point that can be positioned
against facial surface of tooth to
be measured

32. CLINICAL IMPACTION OF
TOOTH MOBILITY:
• Various degrees of gingival
inflammation
• Loss of attachment with pocketing
• Gingival recession
• Tooth with furcation involvement

33. SIGNS & SYMPTOMS:
• Patient awareness of mobility:
Mobility is detected quite
incidentally when patient’s
attention is brought to tooth by
tenderness experienced on chewing
•
•

34. • Functional discomfort:
• Pain may be expected following
• sudden tooth displacement when
• biting on hard foods or with
• inadvertent trauma
• Aesthetics:
• Anterior labial or lateral tooth
• displacement results in fanning
• & elongation of clinical crown
• with poor appearance

35. RADIOGRAPHIC CHANGES:
• Marked horizontal radiographic loss of
bony support may be associated with
minimal tooth mobility
• Modest degree of breakdown may be
associated with pronounced tooth
mobility

36. • Periodontally involved mobile units may
also display funneled periodontal
radiolucencies resulting from co-existing
angular bony defects
• Radiolucencies may be suggestive of
endodontic lesion
• Radiolucencies may be seen with
furcation at furcation involved mobile
teeth

38. OTHER FEATURES:
• A mobile teeth might sometimes
display a healthy periodontal
support, causes of mobility are:
• accidental trauma
• periapical endodontic
• lesion
• high filling
• orthodontic treatment

39. Differential diagnosis:
• Chronic inflammatory
periodontal disease is the
commonest cause of of
increased tooth mobility

40. Treatment of increased
tooth mobility:
• Situation 1:
• Increased mobility of
tooth with increased width of
periodontal ligament but normal
height of alveolar bone

41. • A proper correction of anatomy of
occlusal surfaces of tooth that is
occlusal adjustment will normalize
relationship between antagonizing
teeth in occlusion, thereby
eliminating excessive forces
• Apposition of bone will occur in
zones, periodontal ligament will
become normalized & tooth
stabilized , it assumes normal
mobility

42. • Situation 2:
• Increased mobility of tooth
with increased width of periodontal
ligament & reduced width of
alveolar bone
• - The width of
periodontal ligament is increased &
tooth becomes hyper-mobile
• -If excessive forces are
reduced by occlusal adjustment,
periodontal ligament will regain its
normal width & tooth will be
stabilized

43. • Situation 3:
• Increased mobility of a
tooth with reduced height of
alveolar bone & normal width of
periodontal ligament
• - This situation cannot be
eliminated by occlusal adjustment
• -if patient experiences tooth
mobility disturbing, it can only be
reduced by ‘SPLINTING’ by joining
mobile tooth/teeth with other teeth
in the jaw into fixed unit- SPLINT

44. • “ SPLINT is an appliance
designed to stabilize mobile
teeth “
• Fabricated in the form of
joined composite fillings,
fixed bridges, RPD’S etc.

45. • Situation 4:
• Progressive{increasing}
mobility of a tooth/teeth as a
result of gradually increasing
width of reduced periodontal
ligament
• - In case of advanced
periodontal disease, tissue
destruction may have reached a
level where extraction cannot
be avoided,

46. • Only by means of a SPLINT it
is possible to maintain such
teeth. In such a case FIXED
SPLINT has two objectives:
•
• - To stabilize hyper-mobile
• teeth
• - Replace missing teeth

47. • Situation 5:
• Increased bridge
mobility despite splinting
• -In case of extremely
advanced periodontal disease, a
CROSS-ARCH SPLINT may be
regarded as an acceptable
result of rehabilitation &
prevention of tipping or
orthodontic displacement of
tooth splint