Outline1. Definition of TFO.2. Physiologic adaptive capacity of the periodontium to occlusal forces.3. Factors that help increase traumatic forces.4. Classification of TFO.5. Clinical features of TFO.6. Radiographic findings of TFO.7. Treatment of TFO.
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)
Physiologic adaptive capacity of 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 occlusal forces exceeds the adaptive and reparative capacity of the periodontal tissues, tissue injury results (trauma from occlusion)
Factors that help increase traumatic forces: (Magnitude, direction & duration)A) 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.
Cont…• B) Direction of the occlusal forces.• the 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.
Cont…• Duration and frequency of 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.
Classification• Acute and Chronic Trauma• Primary , Secondary and Combined TFO
Acute trauma from occlusion• results from an abrupt occlusal impact, such as that produced by 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. (CARRANZAS clinical periodntology 9th edition - 396)
Acute trauma from occlusion• Clinical features :1. Tooth pain.2. Sensitivity to percussion.3. Tooth mobility. (CARRANZAS clinical periodntology 9th edition - 396)
Chronic trauma from occlusion• is more common than the acute form and is of greater clinical significance.• It most often 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, (CARRANZAS clinical periodntology 9th edition - 396)
Primary trauma from occlusion• A tissue reaction, which is elicited around a tooth with normal height of the periodontium (no attachment loss!) (Clinical Periodontology and Implant Dentistry, 4th edition, 352)• It can caused by high filling. faulty restorations or fixed and removable prosthesis, causing large force on the abutment or opposing teeth. (CARRANZAS clinical periodntology 9th edition - 396)
Secondary trauma from occlusion• It is related to situations in which occlusal forces cause damage in a periodontium of reduced height (attachment loss present)
Combined TFO• 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.• (CARRANZAS clinical periodntology 9th edition – 397)
Clinical features of TFO• 1) Mobility (progressive)• 2) Pain on chewing or percussion• 3) Fremitus• 4) Occlusal prematurities/discrepancies• 5) Wear facets in the presence of other clinical indicators• 6) Tooth migration• 7) Chipped or fractured tooth (teeth)• 8) Thermal sensitivity
Radiographic findings of TFO• Increased width of periodontal ligament space.• Thickening of lamina dura.• Vertical or angular bone loss.• Radiolucency in furcation areas.
Treatment• A goal of periodontal therapy in the treatment of occlusal traumatism should be to maintain the periodontium in comfort and function.
Cont…• In order to achieve this goal a number of treatment considerations must be considered including one or more of the following :1. Occlusal adjustment2. Management of parafunctional habits3. Temporary, provisional or long-term stabilization of mobile teeth with removable or fixed appliances4. Orthodontic tooth movement5. Occlusal reconstruction6. Extraction of selected teeth
References• Clinical Periodontology and Implant Dentistry, 4th edition, Jan Lindhe, Thorkild Karring . Niklaus P. Lang . Thank• (CARRANZAS clinical periodntology• 9th edition Hallmon WW. Occlusal trauma: effect and impact on the periodontium. Ann Periodontol 1999 Dec;4(1):102-8. you• Parameter on occlusal traumatism in patients with chronic periodontitis. Parameters of Care. J Periodontol 2000 May;71(5 Suppl):873-5.