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Many clinicians believe Traumatic

occlusion causes Intrabony

Periodontal defects but this is not so.
This defect is caused by dental plaque
with accentuation due to the open
contact region and poor subgingival
margin of Restoration.

Histology of Intrabony defect due

to plaque induced Periodontitis.
Arrows show sub gingival plaque
on root surface

Irritation factors are plaque that

induces Gingivitis which
progresses to Periodontitis.
Traumatizing factors from
occlusion cause tissue changes in
periodontal ligament space.

Zone of co-destruction occurs when

plaque induced Periodontitis occurs in
a tooth that also has Traumatic
Occlusion resulting in more severe
bone loss than that seen with
Periodontitis alone.

Host parasite reaction between

bacterial plaque and host
inflammatory response is the cause
of pocket depth and attachment loss.
The presence of Traumatic occlusion
can accentuate the damage when
Periodontitis proceeds apically into
the Periodontal Ligament Space.

Tissue Changes Due to

Traumatic Occlusion

The first reaction to increased

occlusal loading is increased
vascularity in the Periodontal
ligament space. No changes
are seen in gingival tissues.

Normal Periodontal ligament

with normal occlusal forces
showing dense collagen fibers
attached to bone and
cementum with minimal

With excessive occlusal

loading the collagen fibers lose
their connections between
cementum and bone ,and
blood vessels proliferate.

This initial increased

vascularity results in a more
compressible periodontal
ligament and increased clinical

Changes in the apical

periodontal ligament vascular
patterns can also result in
increased vasodilation of the
pulp with increased sensitivity
and pain to Hot and Cold
stimuli secondary to Traumatic

In Traumatic Occlusion after

the initial change of increased
vascularity, there is a
stimulation of osteoclasts
which cause bone loss and a
widened periodontal ligament
space. This also causes
increased tooth mobility.

Further effects of Traumatic

Occlusion are seen with loss of
density of collagen and
absence of a functional fiber

Loss of Density of

High power view. No collagen

fibers adjacent to bone and
loss of functional support of

Advanced Traumatic Occlusion

with minimal Periodontal
ligament tissue. An advancing
plaque induced Periodontitis
can rapidly spread apically in
this situation.

Normal Periodontium

Result of Traumatic

Periodontal ligament tissues

can respond with Traumatic
Occlusion changes when a
normal periodontium is
affected by increased occlusal
loading due to bruxing
clenching or a high restoration

These changes are called

Primary Occlusal Trauma or
Primary Trauma from

In teeth with bone loss due to

periodontal disease previously
well tolerated occlusal loading
can become traumatic and
cause changes in the
periodontal ligament tissues.

These changes are called

secondary occlusal trauma or
secondary trauma from

Coronal portion of plaque

induced Periodontitis with
pocket formulation

Region of crestal bone showing

intrabony pocket due to plaque
this is blending with Traumatic
Occlusion induced Periodontal
ligament changes of loss of
collagen and increased

More Apical region with

Traumatic Occlusion changes
seen deep in Periodontal
tissues apical to Periodontitis.

Apical part of
plaque induced

changes deep in

Radiograph of lower Molar with

Traumatic Occlusion. Widened
Periodontal ligament space on
Mesial all the way around the
apex with beginning bone loss
in furcation (arrows).

There is also thickened lamina

dura and this tooth has
increased mobility.

First molar has traumatic occlusion

causing the bone loss in the furca.
Clinically there is no pocket depth
nor Periodontitis in the furcation
and so the diagnosis is Traumatic
Occlusion and the treatment is
occlusal adjustment to reduce
occlusal loading.

Both premolars have traumatic

occlusion and there is an
addition Periodontitis related
bone loss and pockets on the
mesial of the first premolar.

Gingival recession is not

caused by Traumatic Occlusion
but is related to inadequate
Keratinized Gingiva and
excessive tooth brushing.

Wedge shaped defect in root

of lower first premolar is due
to traumatic toothbrushing
and is not related to Traumatic

Abfraction type of root loss

like this has not been shown
to occur clinically in
association with heavy occlusal

At time of Periodontal surgery

large hyperplastic bone
response to heavy occlusal
load called Buttressing Bone

Buttressing Bone removed

during periodontal surgery to
facilitate normal contour of
gingival tissues.