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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
vascularity.

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
mobility.

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
Occlusion.

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
arrangement.

Loss of Density of
Collagen

High power view. No collagen


fibers adjacent to bone and
loss of functional support of
Periodontium.

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
Occlusion

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
occlusion.

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
occlusion.

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
vascularity.

More Apical region with


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

Apical part of
plaque induced
Periodontitis

Traumtic
occlusion
changes deep in
periodontal
ligament

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
Occlusion

Abfraction type of root loss


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

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.