The document discusses tooth mobility, defining it as the movement of a tooth away from its normal position due to various causes such as periodontal disease, trauma, or hormonal changes. It categorizes mobility into physiologic and pathologic types and outlines methods for assessing it, including radiographic changes. The conclusion emphasizes that effective management of periodontal disease can stabilize tooth mobility when inflammation is controlled and proper hygiene is maintained.

1. Good morning

2. Tooth mobility and
periodontal disease

3.  Introduction
 Causes of tooth mobility
 Types of mobility
 Tooth mobility curve
 Stages of tooth mobility
 Classifications of tooth mobility
 Methods of assesing tooth mobility
periodontometer
periotest
 Radiographic changes
 Reduction in tooth mobility
 Clinical studies
 Conclusion
 References
Contents:

4. Tooth mobility is defined as a visually perceptible movement
of the tooth away from its normal position when a light force
is applied.
( Gher 1996)
Tooth mobility
Introduction:
Physiologic mobility is movement up to 0.2 mm horizontally and
0.02 mm axially.
.

5. CAUSES
•Loss of tooth support
•Extension of inflammation from the gingival or from the periapex into the PDL.
•Periodontal surgery
•Tooth mobility increases in pregnancy
•Pathologies of the jaw
•Trauma from occlusion.

6. •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.
•One study has suggested that pockets around mobile teeth harbor higher
proportions of Campylobacter rectus and Peptostreptococcus micros and
possibly Porphyromonas gingivalis as compared with nonmobile teeth.
(CARRANZA 13TH
EDITION)

7. •MOBILITY CAN BE OF TWO TYPES:
1. PHYSIOLOGIC TOOTH MOBILITY
2. PATHOLOGIC TOOTH MOBILITY

8. 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 )

9. • 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

10. •A large number of assessments showed that this force/displacement relationship had a
typical pattern which could be illustrated by a double sloped curve, the so called tooth
mobility (TM) curve.
•The 2 parts of this curve were defined as "initial" (ITM) and "secondary" (STM) tooth
mobility components .
(Muhlemann 1954, 1960).

12. •In this 2nd phase, a comparatively larger force increment was needed to obtain a
certain additional tooth movement .
(Muhlemann 1954, 1960)
•"initial tooth mobility" (ITM), corresponded with a movement of the root within the
periodontal ligament space.
•The movement progressed until the complete elongation of the fibers was achieved. but
slower, root displacement (STM), obtained by the use of heavier (>100 g) forces, was
accompanied by the distortion of the marginal bone and compression of the soft tissues.

13. Factors affecting physiologic tooth mobility:
Daily variations:
• Tooth mobility will be greatest in the morning,which progressively decreases due to
slight extrusion of tooth & minimal during sleep.
• During walking hours mobility is reduced by chewing & swallowing forces which intrude
teeth into socket .
•Greater tooth mobility values were found in children and females than in adults and
males. (Mtlhlemann 1960)

14. Tooth contact during deglutition:
• functional forces received by teeth during deglutition resulted in tooth contact
which maintains the tooth in proper positions.
Effect of stress-inducing conditions:
• Habits like bruxism & clenching activities affect tooth mobility as well
• Females > males
• Pregnancy
It is increased in pregnancy & sometimes associated with menstrual cycle or
use of hormonal contraceptives . As a result of the hormonal influences on collagen
and vascular structures of the ligament tissues.
(Mtihlemann 1960, Mtihlemann et al. 1965, Rateitschak 1967)

15. 1. 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.
This initial movement occurs with forces of about 100 lb, and it is on the order of 0.05
mm to 0.10 mm (50 µm to 100 µm).
Tooth mobility occurs in TWO STAGES:

16. 2. SECONDARY STAGE :
 Occurs gradually & entails defomation of alveolar bone in response
to a increased horizontal forces.
When a force of 500 g is applied to the crown, the resulting
displacement is about
100 µm to 200 µm for incisors,
50 µm to 90 µm for canines,
8 µm to 10 µmfor premolars,
40 µm to 80 µm for molars.

17. •The recovery movement is pulsating, and it is apparently
associated with the normal pulsation of the periodontal vessels,
which occurs in synchrony with the cardiac cycle.
In two stages:
•The first is an immediate, springlike elastic recoil;
•The second is a slow, asymptomatic recovery movement.

18. PATHOLOGIC TOOTH MOBILITY:
• Refers to any degree of perceptible movement of faciolingually, mesiodistaly or axially
when a force is applied to tooth .
CAUSES OF PATHOLOGIC TOOTH MOBILITY:
• Extension of inflammation from gingiva or from periapex into periodontal ligament
results in changes that increases mobility.
• Tooth loss, when a large number of teeth have been lost,remaining tooth must assume all
functional demands.

19. •Trauma from occlusion-
When trauma from occlusion is the result of alterations in occlusal forces, it is called
primary trauma from occlusion.
When it results from the reduced ability of the tissues to resist the occlusal forces, it is known
as secondary trauma from occlusion.

20. A. Enlargement of the periodontal ligament space,
B. Osteoclastic alveolar bone resorption,
C. Vascular alterations and degenerative phenomena in the periodontal
membrane.
D. A reduced number of collagen fibers inserting in the root cementum, in the
alveolar bone proper and in the crest.
(Biancu et al.1995b).
 Effects of TFO

21.  Removal of causative agents results in a prompt recovery of
(i) Normal tooth mobility values and
(ii) Radiographic width of the PDL space accompanied by a complete
reorganisation of the soft and hard periodontal tissues.
(Lindhe & Ericsson (1982),Vollmer& Rateitshack (1975),
Poison et ai.(1976b)

22. • Pathologic process of jaws that destroys alveolar bone and roots of teeth can also result
in mobility.
• Periodontal surgery increases tooth mobility for a short period.
•Periodontal disease.
 Increased tooth mobiiity is a common symptom also of advanced forms of plaque
associated periodontal disease
(Muhlemann 1960. Lindhe & Nyman 1977, Lindhe & Nyman 1989).
 Muhlemann (1960, 1967) observed that at periodontally compromized teeth both
the "initial" (ITM) or "secondary" (STM) tooth mobility value were elevated.

23. CLASSIFICATION OF TOOTH MOBILITY:
• MILLER (1950)- 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.
Scoring criteria:
• Score 0 : no detectable
• Score 1 : distinguishable tooth
• Score 2 : crown of tooth moves 1mm in any direction
• Score 3 : movement of more than 1mm in any direction

24. 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.
Glickmans Index (1972)
 0- Normal mobility
 Grade I- Slightly more than normal
 Grade II- Moderately more than normal
 Grade III- Severe mobility faciolingually and / or mesidistally combined with vertical
displacement.

25. Lindhe (1997)
 Degree1: Movability of the crown 0.2- 1mm in horizontal
direction.
 Degree 2: Movability of the crown of the tooth exceeding
1 mm in horizontal direction.
 Degree 3: Movability of the crown of the tooth in vertical direction.

26. METHOD OF ASSESSING TOOTH MOBILITY:
• The instrument system {PERIODONTOMETER} permits reproducible
assessment of horizontal mobility of all types of both arches .
Conventional method
Clinical mesurements
Clinical indices.
Newer methods
Peridontiometer
Periotest.

27. Clinical mesurement
Indices
MILLER,s index (1950)
Glickmans Index (1972)
Lindhe (1997)

28. periodontometer
Instrument used to measure and assess the
severity of periodontal disease.
Periodontometry was developed by
Muhlemann(1957) to facilitate the clinical
diagnosis of the periodontal attach- ment
apparatus by measuring the mobility of the
teeth.
designed to measure hori-zontal mobility
of the anterior teeth.

29. •A dial gauge mounted on a metal arm that is secured to the base of a metal impres- sion
tray.
•The impression tray is anchored to the posterior maxillary teeth leaving the incisors and
canines free.
•The dial gauge is adjusted so that its spring-loaded pointer contacts the labial surface of
the tooth to be tested.
•Standardized labiopalatal and palato- labial loads are applied with a force meter (Correx
Gauge, Haag-Streit) to produce palatal and labial displace- ment, respectively, of the
tested tooth.
•This displacement of the tooth is measured in hundredths of a millimeter on the dial
gauge

30. PERIOTEST
PERIOTEST A new method for determining tooth mobility was invented by
Schulte and co-workers in 1987 and 1992.
The periotest device measures the reaction of the periodontium to a
defined percussion force which is applied to the tooth and delivered by a
tapping instrument.

31. •A metal rod is accelerated to a speed of 0.2 m/s with the device
and maintained at constant velocity Upon impact the tooth is
deflected and the rod decelerated .
•The contact time between the tapping head and tooth varies
between 0.3 and 2 milliseconds and is shorter for stable than
mobile teeth .

33. 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.

34. •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.

35. Reduced tooth mobility
•Root ankylosis which may occur after a failing tooth
reimplantation (Hammarstrom et al. 1989) or if autogenous
bone grafts are placed in contact with a detached root surface
(Bernard 1991)
•In such a situation, there is no "initial" intra-socket tooth
displacement and a movement of the tooth to be achieved only
"by elastic deformation of the root and the bone alveolus"
(Miihlemann 1967).

36. Reduced following occlusal Therapy
The removal of premature contacts at mobile teeth often results in a complete or partial
regression of
(i) Tooth hypermobility
(ii) Radiographic widening of the periodontal ligament space and
(iii) Dearranged periodontal ligament tissue
(Lindhe & Nyman 1989,VoUmer & Rateitschak 1975,Lindhe & Ericsson1982,)

37. Reduced from treatment of gingivitis and periodontitis
•The effect of periodontal therapy on tooth mobility has been studied in several
investigations. Treatment procedures restricted to supragingival debridement and resolution
of gingivitis fail to reduce tooth mobility in periodontitis patients. (Donze et al.1973).
•This finding is in agreement with the observation that gingivitis alone cannot cause
increased tooth mobility .
(Ferris 1966,Son et al.1971).
•From some clinical studies it was reported that a successful periodontal treatment results
in resolution of inflammation, bone regeneration and TM reduction.
(Lindhe & Nyman (1975),Persson (1980,198 la,b),
Poison et al.(1976b,1979),Giargia et al. (1994)

38. Overview of clinical studies evaluating the role of tooth mobility in relation to
severity, occurrence and progression of periodontal disease.
•Increased tooth mobility is not consistently associated with severe periodontal
breakdown .
(cross-sectional study done by Baelum et al.in (1988) study the prevalence and severity
of periodontal disease in subjects who never experienced oral health care).
•Increased tooth mobility resulted to be a risk marker for attachment loss during
maintenance.
(retrospective, long term study done by Ismail et al. (1990) evaluate risk markers for
further attachment loss during maintenance.)

39. •Not possible to determine if increased tooth mobility is the cause or just a
symptom of periodontal destruction caused by subgingival plaque accumulation.
(cross-sectional study done by Jin & Cao assess the existence of an (1992) Pihlstrom et
al. (19S6) association between clinical signs of traumatic occlusion/increased TM and
severity of periodontal disease.)

40. Overview of clinical studies evaluating the role of tooth mobility in
affecting the therapeutic management of periodontal disease.
Therapeutic management of periodoatal disease: clinical studies
•Bone regeneration (fill) occurred also at teeth which initially showed increased tooth
mobility.
(Polson & Heij] {1978)
•Pockets related to mobile teeth can be successfully treated and maintained, regardless,
of the severity and degree of mobility; however, the outcome at mobile teeth was less
favourable .
(Fleszar et al.(1980)

41. Splinting
Periodontal treatment had a stabilising effect while splinting had no additional
consequence.
(Kege! et al.(1979)
Splinting neither affected tooth mobility nor gingival attachment and supporting
bone over 24 week period after osseous surgery.
(Galler et al 1979)
Occurance and progression
Increased tooth mobility resulted to be a risk marker for attachment loss during
maintenance.
(Ismail et al.(1990)

42. Despite the fact that increased tooth mobility has been
described as risk factor for progressive periodontitis (Ismail et
al. 1990), it is not always found at teeth showing severe
periodontal breakdown.
(Shefter & Me Fall 1984, Baelum et ai, 1988);
•In the end, the role of tooth mobility and periodontal disease
has been reviewed and it seems it can be concluded that-
Conclusion:

43. •Initial phase of healing following treatment does not enhance the outcome of therapy .
(Kegel et al.1979,Galler et ai.1979).
•When the inflammatory process is controlled and an adequate oral hygiene performed,
teeth showing stable hypermobility respond in a proper way to treatment and may be
maintained in good function over long periods of time.
(Poison et al.1983, Poison & Heijl 1978,Rosiing et al.1976,
Lindhe & Nyman 1977);

44. REFERENCES:
•Baelum.V, Fejerskov. O. & Manji, F. (1988)Periodontai disease in adult Kenyans,Journal
of Clinical Periodontology 15.445-452.
•Bernard, G.W. (1991) Healing and repair of osseous defects. Denial Clinics of North
America 35.46977
•Ericsson, L & Lindhe, J, (1977) Lack of effect of trauma from occlusion on the
recurrence of experimental periodontitis.Journal of Clinical Periodontologv 4.115-127.
•Haramarstrom, L,, Blonalof, L, & Lindskog,S, (1989') Dynamics of dento alveolar
ankylosis and associated root resorption,Endodontic Dental Traumatology5, 163-175,