description about traumatic occlusion and pathologic tooth migrations.its pathogenesis, changes in the forces exerted on tooth, its treatment and prevention.

1. Traumatic Occlusion
and Pathologic Tooth
Migration
AyAm ChhAtkuli
ChitwAn mediCAl College(CmC)

2. Content
• Introduction to traumatic occlusion
• Tissue changes due to traumatic occlusion
• Introduction to pathologic tooth migration
• Pathogenesis
• Weakened periodontal support
• Changes in the Forces Exerted on the
Teeth
I. un-replaced missing teeth,
II.failure to replace first molars,
III. other causes
• Treatment and prevention

3. Introduction to Traumatic
occlusion
• When occlusal forces exceed the adaptive
capacity of the tissues, tissue injury results.
The resultant injury is termed trauma from
occlusion
• An occlusion that produces such injury is
called a traumatic occlusion.

4. Irritation factors are
plaque that induces
Gingivitis which
progresses to
Periodontitis.
Traumatizing factors
from occlusion
cause tissue
changes in
periodontal ligament
space.

5. • Zone of co-
destruction occurs
when plaque induced
Periodontitis occurs
in a tooth that also
has Traumatic
Occlusion resulting in
more severe bone
loss than that seen
with Periodontitis
alone.

6. Host parasite reaction
between bacterial
plaque and host
inflammatory
response is the cause
of pocket depth and
attachment loss. The
presence of Traumatic
occlusion can
accentuate the
damage when
Periodontitis proceeds
apically into the
Periodontal Ligament
Space.

7. Tissue Changes Due to
Traumatic Occlusion
• The first reaction to increased occlusal
loading is increased vascularity in the
Periodontal ligament space. No changes are
seen in gingival tissues.
• Normal Periodontal ligament with normal
occlusal forces showing dense collagen
fibers attached to bone and cementum with
minimal vascularity.

8. • With excessive
occlusal loading the
collagen fibers lose
their connections
between cementum
and bone ,and blood
vessels proliferate.
• This initial
increased
vascularity results in
a more compressible
periodontal ligament
and increased
clinical mobility.

9. • Changes in the apical periodontal
ligament vascular patterns can also result in
increased vasodilation of the pulp with
increased sensitivity and pain to Hot and Cold
stimuli secondary to Traumatic Occlusion.

10. Loss of Density
of Collagen
• Further effects of
Traumatic Occlusion
are seen with loss of
density of collagen
and absence of a
functional fiber
arrangement.

11. Advanced Traumatic
Occlusion with
minimal Periodontal
ligament tissue
– An advancing plaque
induced Periodontitis
can rapidly spread
apically in this
situation.

12. Normal Periodontium Result of Traumatic
Occlusion

13. First molar has
traumatic occlusion
causing the bone loss
in the furca. Clinically
there is no pocket
depth nor
Periodontitis in the
furcation and so the
diagnosis is
Traumatic Occlusion
and the treatment is
occlusal adjustment
to reduce occlusal
loading.

14. Both premolars have
traumatic occlusion
and there is an
addition Periodontitis
related bone loss and
pockets on the mesial
of the first premolar.

15. Introduction to Pathologic
Tooth Migration
• Pathologic migration refers to tooth
displacement that results when the
balance among the factors that
maintain physiologic tooth position is
disturbed by periodontal disease.
• May be an early sign of disease.

16. • May occur in association with gingival
inflammation and pocket formation as the
disease progresses
• occurs most frequently in the anterior region
• migration is usually accompanied by mobility
and rotation
• It is important to detect migration in its early
stages and prevent more serious involvement

17. Pathogenesis
• 2 major factors play a role in maintaining the
normal position of the teeth
 the health and normal height of the
periodontium and
 the forces exerted on the teeth
• Forces acting on teeth are from forces of
occlusion and pressure from the lips, cheeks,
and tongue.

18. • Factors that are important in relation to the
forces of occlusion include:-
1.tooth morphologic features and cuspal inclination
2.the presence of a full complement of teeth
3.a physiologic tendency toward mesial migration
4.the nature and location of contact point
relationships
5.proximal, incisal, and occlusal attrition and
6.the axial inclination of the teeth

19. • Alterations in any of these factors start an
interrelated sequence of changes in the
environment of a single tooth or group of
teeth that results in pathologic migration
• pathologic migration occurs under conditions
that weaken the periodontal support,
increase or modify the forces exerted on the
teeth, or both.

20. Weakened Periodontal
Support
Occlusalandmuscleforce
forcesmaintainingthe
toothinposition
inflammation

21. 1.Survey microscopic
section of the lateral
incisor. 2, Mesial surface
widening of the
periodontal space has
resulted from resorption
of alveolar bone
associated with pressure.
3,
Distal surface widening
of the periodontal space
has resulted from
thickening of the
periodontal ligament,
which is a favorable
response to increased
tension. 4 and 5, Thinned
periodontal ligament at
axis of rotation, one-third
the distance from the
apex.

22. • tooth with weakened support is unable to
maintain its normal position in the arch and
moves away from the opposing force unless it
is restrained by proximal contact
• The force that moves the weakly supported
tooth may be created by factors such as
occlusal contacts or pressure from the
tongue.
• Forces that are acceptable to an intact
periodontium become injurious when
periodontal support is reduced

23. Labial migration of maxillary central
incisors, especially the right incisor.
A, Frontal view. B,Lateral view.

24. • Abnormally located proximal contacts
convert the normal anterior component of
force to a wedging force that moves the tooth
occlusally or incisally.
• The wedging force causes the tooth to
extrude when the periodontal support is
weakened by disease
• As its position changes, the tooth is
subjected to abnormal occlusal forces, which
aggravate the periodontal destruction and the
tooth migration.

25. • Pathologic migration may continue after a
tooth no longer contacts its antagonist
• Pathologic migration is also an early sign of
localized aggressive periodontitis

26. Changes in the Forces
Exerted on the Teeth
• Changes in the magnitude, direction, or
frequency of the forces exerted on the teeth
can induce pathologic migration of a tooth or
group of teeth
• Changes in the forces may result from
I. un-replaced missing teeth,
II.failure to replace first molars,
III. other causes.

27. Unreplaced Missing Teeth
• Drifting of teeth into the spaces created by
unreplaced missing teeth
• Drifting differs from pathologic migration in
that it does not result from destruction of the
periodontal tissues.
• Drifting generally occurs in a mesial
direction, but the premolars frequently drift
distally
• it does not always occur

28. Failure to Replace First
Molars
1. The second and third molars tilt, resulting in
a decrease in vertical dimension
2. The premolars move distally, and the
mandibular incisors tilt or drift lingually.

29. Maxillary first molar
tilted and extruded
into the space created
by a missing
mandibular
tooth.
Maxillary incisors
pushed labially in
patient with bilateral
unreplaced
mandibular molars.
Note extrusion of the
maxillary molars.

30. 3. While drifting distally, the mandibular
premolars lose their intercuspating
relationship with the maxillary teeth and
may tilt distally.
4. Anterior overbite is increased. The
mandibular incisors strike the maxillary
incisors near the gingiva or traumatize the
gingiva.

31. 5. The maxillary incisors are pushed labially
and laterally
6. The anterior teeth extrude because the
incisal apposition has largely disappeared.
7. Diastema are created by the separation of
the anterior teeth

32. Other Causes
• Trauma from occlusion
• Pressure from the tongue
• pressure from the granulation tissue of
periodontal pockets

34. TREATMENT
• Treatment of severe PTM often involves
orthodontic therapy that is preceded by non-
surgical and surgical periodontal therapy and
prosthodontic treatment. (Duncan 1997)
• When PTM is in initial stages and localized,
the treatment may be greatly simplified for
the patient.

35. Correction of pathologic tooth
migration

36. • Spontaneous correction of PTM include patients
with severe gingival overgrowth.
• When enlarged tissue is removed surgically in some
cases migrated tooth move back into a more normal
position.
• When PTM is in the early stages, periodontal therapy
alone is sometimes effective in producing
spontaneous correction of the migration. This
correction has been reported after nonsurgical and
surgical treatment

37. • Light intrusive orthodontic forces are
effective in treating extrusion and flaring if
inflammation is controlled during all phases
of treatment.
• Most patients with PTM have moderate to
severe periodontitis. Several studies describe
successful orthodontic treatment in these
patients if inflammation is controlled.

38. PREVENTING PTM
• Control of periodontal disease- most effective
method to prevent
• Treatment of occlusal factors and habits.
• Early detection

39. Conclusion
• Severe PTM has significant psychological
effects and treatment is expensive and time
consuming, the importance of prevention
appears great
• Abnormalities in pathologic migration rest
with weakened periodontal support; the force
itself is not necessary abnormal