This document defines and discusses trauma from occlusion (TFO). It describes the physiologic capacity of the periodontium to adapt to occlusal forces. Factors that can increase traumatic forces include magnitude, direction, and duration of forces. TFO is classified as acute, chronic, primary, secondary, or combined. Clinical features may include mobility, pain, fremitus, and radiographic findings like increased periodontal ligament space. Treatment aims to maintain the periodontium in comfort and function through approaches like occlusal adjustment, parafunctional habit management, stabilization, orthodontics, reconstruction, or extractions.

1. Trauma From Occlusion
Amin Abusallamah

2. Outline
1. 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.

3. 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)

4. 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)

5. 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.

6. 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.

7. 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.

8. Classification
• Acute and Chronic Trauma
• Primary , Secondary and Combined TFO

9. 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.
(CARRANZA'S clinical periodntology 9th edition - 396)

11. Acute trauma from occlusion
• Clinical features :
1. Tooth pain.
2. Sensitivity to percussion.
3. Tooth mobility.
(CARRANZA'S clinical periodntology 9th edition - 396)

12. 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,
(CARRANZA'S clinical periodntology 9th edition - 396)

13. 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.
(CARRANZA'S clinical periodntology 9th edition - 396)

14. Secondary trauma from occlusion
• It is related to situations in which occlusal forces
cause damage in a periodontium of reduced height
(attachment loss present)

15. 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.
• (CARRANZA'S clinical periodntology 9th edition – 397)

16. 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

17. Radiographic findings of TFO
• Increased width of periodontal ligament space.
• Thickening of lamina dura.
• Vertical or angular bone loss.
• Radiolucency in furcation areas.

18. Treatment
• A goal of periodontal therapy in the treatment of
occlusal traumatism should be to maintain the
periodontium in comfort and function.

19. Cont…
• In order to achieve this goal a number of
treatment considerations must be considered
including one or more of the following :
1. Occlusal adjustment
2. Management of parafunctional habits
3. Temporary, provisional or long-term
stabilization of mobile teeth with removable
or fixed appliances
4. Orthodontic tooth movement
5. Occlusal reconstruction
6. Extraction of selected teeth

20. References
• Clinical Periodontology and Implant
Dentistry, 4th edition, Jan
Lindhe, Thorkild Karring . Niklaus P.
Lang .
Thank
• (CARRANZA'S 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.