Trauma from occlusion In Periodontics definition of trauma from occlusion by WHO (1978) and many more definitions by different authors Factors involved in the etiology of trauma from occlusion which includes 1.) precipitating factors : such as Magnitude, Direction, Duration of force applied, Frequency of force applied 2.) Predisosing factors : intrinsic factors & extrinsic factors # Terminologies which are used which have been used to describe occlusion trauma Glickmans theory of co-destruction occlusal forces during jaw movement classification of trauma from occlusion which includes acute , chronic , primary secondary Stages of tissue response to excessive occlusion forces stage 1 INJURY slightly excessive forces greater then slightly excessive forces severely high forces stage 2: REPAIR stage 3: ADAPTIVE REMODELLING OF THE PERIDONTIUM Examination And Diagnosis of trauma from occlusion signs of trauma from occlusion : tooth mobility tooth migration wear pattern abfraction V shaped or angled gingival recession Buccal bone dehisence fermitus test SYMPTOMS OF TRAUMA FROM OCCLUSION radiographic features of trauma from occlusion effects of insufficent occlusal forces reversibility of traumatic lesion effects of excessive occlusion forces on dental pulp Influence of trauma from occlusion on progression of marginal periodontitis pathological migration pathogenisis management of trauma from occlusion treatment of trauma from occlusion conclusion

1. TRAUMA FROM
OCCLUSION

2. DEFINITIONS
• TRAUMA FROM OCCLUSION
• When occlusal forces exceed the adaptive capacity of tissues, tissue injury results .
The resultant injury is termed as trauma from occlusion.
• According to world health organization (WHO),1978 trauma from occlusion is
damage in the periodontium caused by stress on the teeth produced directly or
indirectly by the teeth of the opposing jaw.
• Injury resulting in the tissue changes within the attachment apparatus as a result
of occlusal force.
• Trauma from occlusion can be defined as structural and functional changes in the
periodontal tissues caused by excessive occlusal forces.

3. • FACTORS INVOLVED INTHE ETIOLOGY OFTRAUMA FROM OCCLUSION
• PRECIPITATING FACTORS:The precipitating factors are the destructive occlusal
forces.The occlusal forces within the normal range can be well adapted by tooth
supporting soft tissues. But , when these forces exceed the adaptive capacity of
tooth supporting tissues, pathological changes can be seen in the soft tissues.
• THESE FORCES ARE USUALLY DESCRIBED INTERMS OF:
• MAGNITUDE: Magnitude of occlusal forces exceeds results in widening of
periodontal ligament space ; an increase in the number of PDL fibers, an increase
in the density of alveolar bone.
• DIRECTION:The PDL fibers are arranged so that the occlusal forces are applied
along the long axis of the tooth. If the direction of occlusal forces is changed,
these fibers are not able to efficiently bear the occlusal forces, hence injury results.

4. • Stress patterns around the roots
changed by shifting the direction of
occlusal forces (experimental model
using photoelastic analysis).
• A, Buccal view of an ivorine molar
subjected to an axial force.The shaded
fringes indicate that the internal stresses
are at the root apices.
• B, Buccal view of an ivorine molar
subjected to a mesial tilting force.The
shaded fringes indicate that the internal
stresses are along the mesial surface and
at the apex of the mesial root.

5. • DURATION OF FORCE APPLICATION: If the abnormal occlusal forces are
subjected to a tooth for a longer duration of time, they cause injury to the
periodontal tooth supporting structures, which can be seen histologically.
• FREQUENCY OF FORCE APPLICATION: frequent application of abnormal occlusal
forces results in more damage to the periodontal tooth supporting structures than
less frequent application.

6. • PREDISPOSING FACTORS:
• INTRINSIC FACTORS:The orientation of the long axis of the teeth in relation to
the forces to which they are exposed.The morphological characteristics of the
roots.The size, shape and number of the roots determine how occlusal forces are
dissipated. In general , short, conical, slender or fused roots are more vulnerable to
TFO.The morphology of the alveolar process, i.e the quality and the alveolar bone
play an important role in absorbing the occlusal forces.
• EXTRINSIC FACTORS: Local factors such as plaque which predisposes to the
alveolar bone loss. Fabrication of long span bridges on few teeth, thus overloading
them. Injudicious bone resection during surgical periodontal therapy or oral
surgical procedures. Parafunctional habits as a result of neurosis. Other factors
include food impaction, overhanging filling, poorly contoured crowns and bridges
and ill-fitting partial dentures.

7. • TERMINOLOGIES WHICH HAVE BEEN USEDTO DESCRIBE OCCLUSAL TRAUMA
• STILLMAN(1917) used the term “traumatic occlusion” to describe abnormal stresses
capable of producing injury to the dental or periodontal tissues.
• BOX(1930) used the term “traumatogenic occlusion” to describe these abnormal
occlusal stresses and used another term “traumatic occlusion” to describe the
functional contact relationship of occlusal surfaces which results in this trauma.
• GLICKMAN(1974) used the term “TRAUMA FROM OCCLUSION” to describe these
abnormal occlusal forces.
• MUHLEMANN(1956) used the term “traumatogenic occlusal situation” to address
the factors initiating the abnormal occlusal stresses and “occlusal trauma” to
describe the resulting microscopic lesion.
• ORBAN (1958) AND PRICHARD(1965) gave the term “periodontal traumatism” to
address the tissue injury caused by abnormal occlusal forces and not for the occlusal
forces themselves.
• The term “traumatic occlusion” was also used by RAMFJORD AND ASH(1972)

8. • GLICKMAN’STHEORY OF CO DESTRUCTION
• This theory suggested that occlusal trauma in the
presence of plaque induced inflammation may result in
alteration of the normal pathway of inflammation and
development of angular bony defects with intra bony
pockets, but that occlusal trauma , in and of itself, did
not cause gingivitis and periodontitis.
• ZONE OF IRRITATION:This zone consist of marginal and
interdental gingiva.This tissue is bordered by hard
tissue only on one side (tooth) and is unaffected by the
occlusal forces.The gingival lesion is the tissue response
to products from microbial plaque. Inflammation in the
zone of irritation causes horizontal bone loss.
• ZONE OF CO-DESTRUCTION:This zone includes trans-
septal / alveolar crest fibers, periodontal ligament,
cementum and alveolar bone. It is coronally demarcated
by trans-septal and dentoalveolar fibers.

9. • OCCLUSAL FORCES DURING JAW MOVEMENTS
• The forces exerted on the teeth during jaw movements such as chewing , swallowing and
performance of parafunctional habits including bruxism and clenching, are well tolerated
by the tooth supporting structures.
• During speech, the tooth contact is minimal, so there are hardly any forces exerted on the
teeth.
• During mastication in normal healthy adults the mandible typically follows a wide lateral
path during closure.
• The tooth contacts occur on the lateral guiding cusps, typically the cusps of canines and
premolars
• The forces exerted on teeth during these contacts are of low magnitude, averaging 81 N
lasting for small time period (20-50ms)
• At final closer in intercuspal position, the forces are much higher, averaging 262N for a
relatively longer duration of time (115ms)
• The occlusal forces during swallowing in the intercuspal position are averaging around
296N for duration of about 700ms.

10. • CLASSIFICATIONOFTRAUMA FROM OCCLUSION
• TheTFO can be classified as, acute/chronic trauma from occlusion and
primary/secondary trauma from occlusion
• ACUTETRAUMA FROM OCCLUSION: Caused due to abrupt occlusal
impact , such as due to biting on a hard object. Eg, biting on an olive pit.
• Another cause is high restorations or prosthetic appliances.
• Clinical signs and symptoms of the condition include tooth pain and
sensitivity to percussion , increased tooth mobility.
• CHRONICTRAUMA FROM OCCLUSION:Abnormal occlusal forces
exerted on the tooth supporting structures for a longer duration of time
• Develops from gradual changes in occlusion clinically seen as tooth wear,
tooth migration and extrusion of teeth
• This condition is usually associated with parafunctional habits such as
bruxism and clenching.

11. • PRIMARY TRAUMA FROM OCCLUSION: it refers to injury resulting from
excessive occlusal forces applied to a tooth or teeth with normal support.
• Examples includes high restoration, drifting or extrusion into edentulous spaces
and orthodontic movement.
• Once abnormal forces are removed , the tooth returns to complete health.
• There is no alteration in connective tissue attachment level and It does not initiate
the pocket formation.
• SECONDARY TRAUMA FROM OCCLUSION: Even normal occlusal forces
become deleterious to the tooth structure because periodontal support is reduced
and is not able to withstand the occlusal forces.
• Most common cause for secondaryTFO is periodontitis causing bone loss.

12. • Traumatic forces can occur on,
• A, normal periodontium with normal height of bone;
• B, normal periodontium with reduced height of bone;
• C, marginal periodontitis with reduced height of bone.
• The first case is an example of primary trauma from occlusion, whereas the last
two represent secondary trauma from occlusion

13. STAGES OFTISSUE RESPONSETO
EXCESSIVE OCCLUSION FORCES
• Carranza (1967,1970) has described three stages of tissue response to excessive occlusal
forces.
• STAGE I , INJURY
• The immediate results of excessive occlusal forces is the soft tissue injury.
• Occlusal forces may vary in their magnitude, being slightly excessive, greater than slightly
excessive or severely high.
• The center of rotation of single rooted teeth is located at the junction of middle third and
apical third of the tooth, where as the center of rotation of multirooted tooth lies near the
fulcrum area.
• When excessive occlusal forces are subjected to teeth, they rotate around the fulcrum of
rotation, there by moving away from the deleterious forces.
• Due to this rotation in the tooth socket, area of pressure and tension are created on the
opposite sides of the fulcrum.
• If the force is unidirectional ,these areas are created on the opposite surface, whereas in
the case of jiggling forces, these areas may coexist on the same surface.

15. Slightly excessive forces:
• The slightly excessive forces stimulate bone resorption in the areas of pressure,
causing the widening of periodontal ligament space.
• In area of tension, elongation of periodontal ligament fibers takes place.
• The blood vessels on the pressure side are compressed whereas on the tension
side they are enlarged.
• In the due course of time, slow remodeling of the alveolar socket takes place.

16. Greater than slightly excessive forces:
• Marked changes in the tooth supporting structures are seen in the case of greater occlusal
forces.
• The excessive compression of periodontal ligament produces areas of hyalinization.
• Areas of necrosis can be seen in periodontal ligament due excessive trauma to the
periodontal ligament fibers and connective tissue cells including fibroblast.
• Within 30 minutes of application of such traumatic forces on the tooth, vascular changes
can be seen.
• There is impaired and stasis of blood flow within 30 minutes.
• Within next 2-3 hours the blood vessels appear to be packed with erythrocytes which start
to fragment.
• During 1-7 days, the disintegration of the blood vessel walls and their content takes place.
• The defragmented products disperse in the surrounding tissues.

17. Severely high forces:
• Severely high occlusal forces results in thrombosis, hemorrahage, tearing of the
periodontal ligament, widening of periodontal ligament space and alveolar bone
resorption.
• Under severely high forces , on the pressure side, there is a disturbance of blood flow in
the compressed PDL and cell death in the compressed area of PDL.
• The 1st sign of hyalinization is the presence of pyknotic nuclei in the cells, followed by areas
of acellularity or cell-free zones.
• The resolution of this hyalinized area starts when cellular elements such as macrophages ,
foreign body giant cells and osteoclasts from the adjacent undamaged areas invade the
necrotic tissue.
• These cells also resorb the underside of the bone immediately adjacent to the necrotic
PDL area and remove it together with the necrotic tissue.This process is known as
undermining resorption.

18. • Due to injury caused by occlusal trauma, there is a temporary reduction of mitotic
activity of the cells, including fibroblasts and osteoblasts.
• In the presence of these excessive occlusal forces, all the above stated changes
take place, but if the forces are removed or tooth moves away from the forces ,
the periodontium is completely restored.

19. • STAGE II, REPAIR:
• Repair is a well-regulated mechanism in which the damaged tissues are replaced by new
connective tissue and cells.
• The extracellular matrix and certain inflammatory mediators play critical regulatory
functions, directly or indirectly, facilitating the healing process.
• Although the reparative activity is always going on in normal periodontium, it is increased
duringTFO.
• To withstand the heavy occlusal forces, the body tries to reinforce the trabeculae within
the new bone.This process is known as “buttressing bone formation”.
• When this process occurs within the bone, it is known as ‘central buttressing’ and when it
occurs on the facial or lingual surface of the alveolar bone it is known as ‘peripheral
buttressing’.
• In central buttressing the endosteal cells deposit bone on the trabecular walls, thereby
reducing the marrow spaces and strengthening the bone to bear increased occlusal load.
• In the peripheral buttressing, shelf like thickening of the bone can be seen on the lingual or
the buccal surface of the alveolar bone which is sometime referred to as “lipping”.

20. • STAGE III, ADAPTIVE REMODELING OFTHE PERIODONTIUM:
• If the repair process cannot keep pace with the destruction caused by excessive
occlusal forces, adaptive remodeling of the periodontium occurs.
• In this process of remodeling, a structural relationship is established in such a way
that the occlusal forces are no longer harmful to the periodontium.
• It includes thickening of the PDL, funnel shaped defect in the crestal portion and
vertical/angular bone loss.
• There is no pocket formation during this adaptive response.
• Involved tooth become loose.
• Increased vascularization of the involved areas of periodontium.

21. • EXAMINATION AND DIAGNOSIS OFTRAUMA FROM OCCLUSION
• SIGNS OFTRAUMA FROM OCCLUSION
• TOOTH MOBILITY: Increased tooth mobility result from bone loss
independent of occlusal forces.
• Common index used to classify tooth mobility is Miller’s index (1938)
• CLASS 0 – normal movement when force is applied.
• CLASS I – mobility greater than physiologic
• CLASS II – tooth can be moved up to 1mm or more in a lateral direction.
Inability to depress the tooth in a vertical direction
• CLASS III – the tooth can be moved 1mm or more in a lateral direction.
Ability to depress the tooth in a vertical direction

22. • TOOTH MIGRATION:To avoid occlusal forces, tooth tries to
move away from them. Loss of interproximal contacts and
migration of tooth from its stable position is one of the signs
ofTFO.
• WEAR PATTERNS: Bruxism causes the formation of wear
facets on the occlusal/ incisal surfaces of teeth which can be
identified as shiny and irregular areas.
• ABFRACTION, ESPECIALLY IN PREMOLARS: Due to excessive
lateral forces, abfraction can be seen especially in premolars.
The wear facets and abfraction appear before the gingival
recession.
• V-SHAPEDOR ANGLEDGINGIVAL RECESSIONS: Researchers
who are not in favor of the association ofTFO with recession
claim that recession results from marginal inflammation due
to the presence of plaque, whereas researchers in favor of
association of recession withTFO claim thatV-shaped or
angled gingival recessions with a small fissure in their most
apical extremely is directly associated with occlusal trauma
and is commonly associated with abfraction.

23. • BUCCAL BONE DEHISCENE: Buccal cortical bone is thin, especially in the canine
and premolar area.
• Loss of bone in the marginal area, the periosteum covering the bone persists for
an identified period.
• Later on, the periosteum due to lack of bone and blood vessels to nourish it , gets
restricted to the bone margins, leaving the root surface exposed to gingival and
periodontal connective tissues.

24. • FERMITUS TEST: Index finger is placed along the buccal and labial surfaces of the
maxillary teeth and the patient is asked to tap the teeth together in the maximum
intercuspal position and then grind systemically in the protusive and lateral
movement.Vibratory movement of teeth is the identified and graded. High
pressure point can be detected by the pattern of impressions made by registration
strips.
• CLASSIFICATION SYSTEM:
• CLASS I fremitus- mild vibration or movements detected
• CLASS II fremitus- easily palpable vibration, but no visible movement
• CLASS III fremitus- movement visible with naked eye

25. • SYMPTOMS OFTRAUMA FROM OCCLUSION
• PERSISTENT DISCOMFORT ON EATING:The patient complains of persistent
discomfort during eating, due to excessive occlusal forces on a teeth , patient is
not able to satisfactorily chew the food and teeth under high occlusion cause
discomfort.
• THERMAL SENSITIVITY: Change in vascular supply of pulp due to excessive
occlusal forces. It causes increased blood pressure in the pulp and hence tooth
becomes sensitive to thermal changes.
• MUSCLE HYPERTONICITY: Patient complains of tired jaws, Especially after rising
in the morning and at the end of the day. It is because of occlusal interferences
causing muscle spasm and discomfort.

26. • RAGIOGRAPHIC SIGNS OFTRAUMA FROM OCCLUSION
• Thickening of lamina dura.
• Irregular widening of PDL space.
• Vertical bone loss.
• Bone sclerosis in periapical area are in the interdental bone crest.
• Inflammatory root resorption, more common in advanced stages of occlusal
trauma.

27. • EFFECTS OF INSUFFICIENT OCCLUSAL FORCE
• Insufficient occlusal force may also be injurious to the supporting periodontal
tissues.
• Insufficient stimulation causes thinning of the periodontal ligament, atrophy of
the fibers, osteoporosis of the alveolar bone, and reduction in bone height.
• Hypofunction can result from an open-bite relationship, an absence of functional
antagonists, or unilateral chewing habits that neglect one side of the mouth.

28. • REVERSIBILITY OFTRAUMATIC LESIONS
• Trauma from occlusion is reversible.
• When trauma is artificially induced in experimental animals, the teeth move away
or intrude into the jaw.
• When the impact of the artificially created force is relieved, the tissues undergo
repair.
• Although trauma from occlusion is reversible under such conditions, it does not
always correct itself, nor is it therefore always temporary and of limited clinical
significance.
• The injurious force must be relieved for repair to occur.
• If conditions in humans do not permit the teeth to escape from or adapt to
excessive occlusal force, periodontal damage persists and worsens.
• The presence of inflammation in the periodontium as a result of plaque
accumulation may impair the reversibility of traumatic lesions

29. • EFFECTS OF EXCESSIVE OCCLUSAL FORCES ON DENTAL PULP
• The effects of excessive occlusal forces on the dental pulp have not been
established
• Some clinicians report the disappearance of pulpal symptoms after correction of
excessive occlusal forces.
• Pulpal reactions have been noted in animals subjected to increased occlusal
forces, but did not occur when the forces were minimal and occurred over short
periods

30. • INFLUENCE OFTRAUMA FROM OCCLUSION ON PROGRESSION OF MARGINAL
PERIODONTITIS
• The accumulation of bacterial plaque that initiates gingivitis and results in periodontal
pocket formation affects the marginal gingiva, but trauma from occlusion occurs in the
supporting tissues and does not affect the gingiva.
• The marginal gingiva is unaffected by trauma from occlusion because its blood supply is
sufficient to maintain it, even when the vessels of the periodontal ligament are obliterated
by excessive occlusal forces.
• When inflammation extends from the gingiva into the supporting periodontal tissues (i.e.,
when gingivitis becomes periodontitis), plaque-induced inflammation enters the zone
influenced by occlusion, which Glickman has called the zone of co-destruction.
• When trauma from occlusion is eliminated, a substantial reversal of bone loss occurs,
except in the presence of periodontitis.
• This indicates that inflammation inhibits the potential for bone regeneration.Thus it is
important to eliminate the marginal inflammatory component in cases of trauma from
occlusion because the presence of inflammation affects bone regeneration after the
removal of the traumatizing contacts.

31. • It also has been shown in experimental animals that trauma from occlusion does
not induce progressive destruction of the periodontal tissues in regions kept
healthy after the elimination of preexistent periodontitis
• Trauma from occlusion also tends to change the shape of the alveolar crest
• The change in shape consists of a widening of the marginal periodontal ligament
space, a narrowing of the interproximal alveolar bone, and a shelf-like thickening
of the alveolar margin.
• Therefore although trauma from occlusion does not alter the inflammatory
process, it changes the architecture of the area around the inflamed site
• Thus in the absence of inflammation, the response to trauma from occlusion is
limited to adaptation to the increased forces.
• However, in the presence of inflammation, the changes in the shape of the
alveolar crest may be conducive to angular bone loss, and existing pockets may
become intrabony.

32. • PATHOLOGICALTOOTH 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.
• It is relatively common and may be an early sign of disease, or it may occur in association
with gingival inflammation and pocket formation as the disease progresses
• It occurs most frequently in the anterior region, but posterior teeth may also be affected
• The teeth may move in any direction, and the migration is usually accompanied by
mobility and rotation.
• Pathologic migration in the occlusal or incisal direction is termed extrusion.
• All degrees of pathologic migration are encountered, and one or more teeth may be
affected.
• It is important to detect it in its early stages and prevent more serious involvement by
eliminating the causative factors.
• Even in the early stage, some degree of bone loss occurs.

33. PATHOGENESIS
• Two 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.
• The latter includes the forces of occlusion and pressure from the lips, cheeks, and
tongue
• The following factors are important in relation to the forces of occlusion:
• Tooth morphologic features and cuspal inclination;
• the presence of a full complement of teeth;
• a physiologic tendency toward mesial migration,
• the nature and location of contact point relationships
• proximal, incisal, and occlusal attrition,
• the axial inclination of the teeth.

34. • Weekened periodontal support:
• The inflammatory destruction of the periodontium in periodontitis creates an imbalance
between the forces maintaining the tooth in position and the occlusal and muscular forces on
which it is ordinarily called to bear.
• The 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.
• An example of this is the tooth with abnormal proximal contacts. Abnormally located proximal
contacts convert the normal anterior component of force to a wedging force that moves the
tooth occlusally or incisally.
• As its position changes, the tooth is subjected to abnormal occlusal forces, which aggravate the
periodontal destruction and the tooth migration.
• Pathologic migration may continue after a tooth no longer contacts its antagonist. Pressures
from the tongue, the food bolus during mastication, and proliferating granulation tissue
provide the force.
• Pathologic migration is also an early sign of localized aggressive periodontitis.
• Weakened by loss of periodontal support, the maxillary and mandibular anterior incisors drift
labially and extrude, creating diastemata between the teeth.

35. • Changes in the Forces Exerted on theTeeth
• 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.
• These forces do not have to be abnormal to cause migration if the periodontium is
sufficiently weakened.
• Changes in the forces may occur as a result of unreplaced missing teeth, failure to
replace first molars, or other causes.

36. • UNREPLACED MISSING TEETH
• Drifting of teeth into the spaces created by unreplaced missing teeth often
occurs.
• Drifting differs from pathologic migration in that it does not result from
destruction of the periodontal tissues.
• However, it usually creates conditions that lead to periodontal disease, and thus
the initial tooth movement is aggravated by loss of periodontal support.
• Drifting generally occurs in a mesial direction, combined with tilting or extrusion
beyond the occlusal plane.

37. • FAILURETO REPLACE FIRST MOLARS
• The pattern of changes that may follow failure to replace missing first molars.
• In extreme cases it consists of the following:
• The second and third molars tilt, resulting in a decrease in vertical dimension.
• The premolars move distally, and the mandibular incisors tilt or drift lingually.While
drifting distally, the mandibular premolars lose their intercuspal relationship with the
maxillary teeth and may tilt distally.
• Anterior overbite is increased.The mandibular incisors strike the maxillary incisors near
the gingiva or traumatize the gingiva.
• The maxillary incisors are pushed labially and laterally.
• The anterior teeth extrude because the incisal apposition has largely disappeared.
• Diastemata are created by the separation of the anterior teeth.
• The disturbed proximal contact relationships lead to food impaction, gingival
inflammation, and pocket formation, followed by bone loss and tooth mobility.
• Occlusal disharmonies created by the altered tooth positions traumatize the supporting
tissues of the periodontium and aggravate the destruction caused by the inflammation.
Reduction in periodontal support leads to further migration of the teeth and mutilation of
the occlusion.

38. • Other causes:
• Pressure from the tongue may cause drifting of the teeth in the absence of
periodontal disease or may contribute to pathologic migration of teeth with
reduced periodontal support.
• In tooth support weakened by periodontal destruction, pressure from the
granulation tissue of periodontal pockets has been mentioned as contributing to
pathologic migration.

39. • TRAUMA FROM OCCLUSION AROUND IMPLANTS
• An osseointegrated implant is in direct contact with the surrounding bone.
• There is no periodontal ligament around the dental implant.
• Functional load enhance osseointegration and doesnot result in marginal bone loss.
• Occlusal overload adversely affect osseointergration.
• Leads to implant failure.
• Key factors controlling bone remodeling at molecular level are:
• Strain change in length to the original length
• Modulus of elasticity : stiffness of material

40. • TREATMENTOFTRAUMA FROM OCCLUSION:
• Treatment involves removal of the excessive occlusal forces and bringing the tooth in a
comfortable position
• Treatment modalities have been advised to treatTFO includes:
• Occlusal adjustments
• Management of parafunctional habits
• Splinting of tooth
• Orthodontic tooth movement
• Occlusal reconstruction
• Extraction of selected teeth

41. • OCCLUSAL ADJUSTMENT
• Indication:(1989,WORLD WORKSHOP IN PERIODONTICS)
• To reduce traumatic forces to teeth that exhibits :
• Increasing mobility or fremitus
• Discomfort during occlusal contact or function
• To achieve functional relationships and masticatory efficiency in conjunction with
restorative treatment , orthodontic, orthognathic surgery, or jaw trauma when
indicated.
• As adjunctive therapy, that may reduce the damage from parafunctional habits.
• To reshape the tooth , which are contributing to soft tissue injury.
• To adjust marginal ridge relationships and cusps that are contributing to food
impaction.

42. • MANAGEMENT OF PARAFUNCTIONAL HABITS:
• Parafunctional habits such as bruxism cause excessive forces on the periodontum
resulting in injury to the periodontium
• Night guard is used to prevent night grinding of the teeth , it also helps in
relaxation of masticatory muscles.

43. • ORTHODONTIC TOOTH MOVEMENT
• Contraindications:
• A periodontally compromised tooth with little bone
support is not a good candidate for orthodontic tooth
movement.
• Moving tooth in a position which further compromise its
stability and long term prognosis is also not desirable

44. • OCCLUSAL RECONSTRUCTION
• It involve re-designing of occlusal contacts by giving crowns, bridges or implants
supported prosthesis.This kind of procedure requires a through knowledge of
occlusion.

45. • EXTRACTION OF SELECTED TEETH
• Rarely tooth is extracted to correctTFO.
• In certain situations extraction of selected teeth may be done to correctTFO, such
as tooth with extensive periodontal involvement with poor prognosis, the
extraction of which may improve the prognosis of the remaining teeth.

46. • CONCLUSION
• Trauma from occlusion does not cause gingival inflammation, but can modify the
spread of inflammation into the underlying connective tissue.
• Elimination of the abnormal occlusal forces along with stabilization of the involved
teeth is the primary treatments forTFO.
• Thus, it can be concluded that elimination of periodontal inflammation as well as
TFO is essential to achieve complete periodontal health and to improve the
prognosis of teeth.

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