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  1. 1. • 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
  2. 2. • 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. 4. 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
  5. 5. • 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
  6. 6. 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
  7. 7. • During walking hours mobility is reduced by chewing & swallowing forces which intrude teeth into socketTooth contact during deglutition:• functional forces received by teeth during deglutition resulted in tooth contact which maintains the tooth in proper positions T
  8. 8. 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
  9. 9. 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
  10. 10. • SECONDARY STAGE :•• Occurs gradually & entails defomation of alveolar bone in response to a increased horizontal forces
  11. 11. PATHOLOGIC TOOTHMOBILITY:• Refers to any degree of perceptible movement of faciolingually,mesiodistaly or axially when a force is applied to tooth
  12. 12. 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
  13. 13. • 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
  14. 14. • 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
  15. 15. 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
  16. 16. 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
  17. 17. • 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
  18. 18. • 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
  19. 19. • LEONARD ABRANMS & POTASHNICK S.:• Class 1 : mobility less than 1mm• Class 2 : mobility within 1-2mm• Class 3 : mobility greater than 2mm
  20. 20. • 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
  21. 21. • 3 : clinical mobility greater than• 2mm buccolingually in addition to• mobility in an apical direction
  22. 22. • 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
  23. 23. • KIESER:• Grade 0 : physiologic mobility• Grade 1 : slight mobility• Grade 2 : moderate mobility• Grade 3 : marked mobility
  24. 24. • 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
  25. 25. METHOD OF ASSESSING TOOTH MOBILITY:• The instrument system {PERIODONTOMETER} permits reproducible assessment of horizontal mobility of all types of both arches
  26. 26. • 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
  27. 27. • 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
  28. 28. CLINICAL IMPACTION OFTOOTH MOBILITY:• Various degrees of gingival inflammation• Loss of attachment with pocketing• Gingival recession• Tooth with furcation involvement
  29. 29. SIGNS & SYMPTOMS:• Patient awareness of mobility: Mobility is detected quite incidentally when patient’s attention is brought to tooth by tenderness experienced on chewing••
  30. 30. • 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
  31. 31. 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
  32. 32. • 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
  33. 33. 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
  34. 34. Differential diagnosis:• Chronic inflammatory periodontal disease is the commonest cause of of increased tooth mobility
  35. 35. Treatment of increased tooth mobility:• Situation 1:• Increased mobility of tooth with increased width of periodontal ligament but normal height of alveolar bone
  36. 36. • 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
  37. 37. • 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
  38. 38. • 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
  39. 39. • “ SPLINT is an appliance designed to stabilize mobile teeth “• Fabricated in the form of joined composite fillings, fixed bridges, RPD’S etc.
  40. 40. • 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,
  41. 41. • 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
  42. 42. • 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