TRAUMA FROM

OCCLUSION
 CONTENTS
1. Definition
2. Classification (acute ,chronic ,primary ,secondary)
3. Stages of tissue response when occlusal force is
increased.
A. Injury
B. Repair
C. Adaptive remodeling of periodontium
4. Effect of insufficient occlusal force.
5. Influence of trauma from occlusion on progression of
marginal periodontitis.
6. Diagnosis
7. Treatment
8. References
 TRAUMA FROM
OCCLUSION:-
Definition:-
Trauma from occlusion refers to a
condition where injury results to the supporting
structures of teeth by the act of bringing jaws into
a closed position. STILLMAN (1917)
Trauma from occlusion is defined
as damage in periodontium caused by stress on
teeth produced directly or indirectly by teeth of
opposing jaw. WHO (1978)
Occlusal trauma was defined as an
injury to the attachment apparatus as a result of
excessive occlusal force. AMERICAN ACADEMY
OF PERIODENTOLOGY(1986)
TRAUMA FROM OCCLUSION:-
Trauma from occlusion is defined
as when occlusal forces exceed the adaptive
capacity of tissue, tissue injury results. This injury
is termed trauma from occlusion. --CARRANZA
Other terms often used for trauma
from occlusion are:

1. Traumatizing occlusion.
2. Occlusal trauma.
3. Traumatogenic.
4. Periodontal traumatism.
5. Overload.
 Traumatic Occlusion

An occlusion that
produces such injury is called as a
traumatic occlusion.
Other terms used for traumatic
occlusion are:-
1. Occlusal disharmany.
2. Functional imbalance.
3. Occlusal Dystrophy.
 CLASSIFICATION:-

 Acute trauma from occlusion

 Chronic trauma from occlusion
 Primary trauma from occlusion
 Secondary trauma from occlusion
 ACUTE TRAUMA FROM CHRONIC TRAUMA
OCCLUSION FROM OCCLUSION
Less common More common

Definition:- Result from abrupt change in Result from gradual change

occlusal force in occlusion
Cause:- ●Biting on a hard object ●Tooth wear
●Restoration ●Drifting movement
●Prosthetic appliances
Clinical Features:- ●Tooth pain ●Tooth mobility
●Sensitivity to percussion
●Increased tooth mobility
●Cementum tears.

Management:- ●Dissipate the force by shift in the ●Removal of cause

position of tooth
●By wearing away or correction of
restoration.

Complications:- ●Periodontal injury may worsen & ●Periodontal injury may

develop into necrosis worsen & develop into
accompanied by periodontal necrosis accompanied by
abscess. periodontal abscess.
 PRIMARY TRAUMA FROM SECONDARY TRAUMA
OCCLUSION FROM OCCLUSION
Definition:- When trauma from occlusion is the When trauma from occlusion
result of alterations in occlusal results from reduced ability of
forces. tissue to resist occlusal forces.

Etiology:- ●Insertion of high filling ●Bone loss resulting from

●insertion of prosthetic marginal inflammation.
replacement
●Drifting movement or extrusion
of teeth into spaces created by
unreplaced missing teeth.
●Orthodontic movement of teeth
into functionally unacceptable
position.
Situation with excessive ●Normal periodontium ●Normal periodontium with
occlusal force can be with normal height of reduced height of bone
superimposed:- bone

●Marginal periodontitis with

reduced height of bone

Healing :- Reversible Irreversible

 STAGES OF TISSUE RESPONSE WHEN
OCCLUSAL FORCE IS INCREASED

Tissue response occur in 3 stages:-

1) Injury
2) Repair
3) Adaptive remodeling of the
periodontium
 STAGE I:- INJURY (increase in area of
resorption & decrease in bone
formation)
 Produced by excessive occlusal
forces
 Ligament is widened at the
expense of bone resulting in
1) Angular bone destruction
without periodontal pocket
2) Tooth become loose
3) Most susceptible site-Fulcrum
Due to the occlusal forces, tooth
rotates around a fulcrum.
 Different lesions produced due to
different degree of pressure:

1) slightly excessive pressure

a) resorption of alveolar bone
b) widening of PDL space
2) Increased pressure.
a) B.V. are numerous & reduced
3) Greater pressure
a) Compression of fibres
b) Increases resorption of alveolar bone
c) Increases resorption of tooth surface
4) Severe pressure
a) Necrosis of PDL and bone
STAGE II:- REPAIR ( increase resorption
& increase bone formation)

 Constantly occurring in healthy

periodontium by replacing of damaged
tissue to new tissues
۞ Buttressing bone formation
Definition:- when the bone is resorbed by
excessive occlusal force, the body
attempt to reinforce the thinned bony
trabeculae with new bone.
 BUTTRESSING BONE
FORMATION
Central Peripheral
●Endosteal cells deposit ●Occur on facial & lingual
in new bone. surface of alveolar plate.
●Restore bony ●Lipping- shelf like
trabeculae thickening of alveolar
margin.
●Reduces size of marrow
spaces ●Pronounced bulge.
 STAGE III:-
ADAPTIVE REMODELLING OF
PERIODONTIUM (resorption & formation
returns to normal)
 If repair process cannot keep pace with the
destruction cause by occlusion, the periodontium
is remodeled in an effort to create structural
relationship in which forces are no longer
injurious to the tissues.
 Results in :–
a) Thickened PDL which is funnel shaped at crest
b) Angular defects in bone with no pocket
formation
c) Involved teeth become loose
d) Increased vascularization
 EFFECTS OF INSUFFICIENT
OCCLUSAL FORCE
Etiology:

a) open bite relationship

b) absence of functional antagonist
c) unilateral chewing habits

Clinical features:

1) Thinning of PDL
3) Atrophy of fibres
4) Osteoporosis of alveolar bone
5) Reduction in bone height
 INFLUENCE OF TRAUMA FROM
OCCLUSION ON PROGRESSION OF
MARGINAL PERIODONTITIS:-

● Local irritant:- initiate gingivitis & periodontal pocket

(affect marginal gingiva)

● Trauma from occlusion:- affect only supporting tissue.

 Marginal gingiva is unaffected by trauma from occlusion

because its blood supply is sufficient to maintain it.

 When inflammation extends from the gingiva into the

supporting periodontal tissues{ when gingivitis become
periodontitis} plaque induced inflammation enter the zone
influenced by occlusion.

 It is important to eliminate the marginal inflammatory

component in case of trauma from occlusion because
presence or absence of inflammation affects bone
regeneration after removal of traumatizing contact.
 DIAGNOSIS:-
1) Increase tooth mobility.

2) Presence of excessive occlusal wear.

3) Tilting and migration of individual teeth or complete segment.

4) Hypertrophy diagnosed on palpation of muscles of mastication.

5) Palpation of TMJ and observation of any deviation of the mandible in

various path of closure.

6) Fremitus Test : Place wet index finger on the labial surface of

maxillary anterior teeth. Ask the patient to close his mouth in centric
relation position. Vibration felt on the finger due to prematurities
suggest fremitus test positive.
 RADIOGRAPHIC SIGNS OF TRAUMA
FROM OCCLUSION:-

A) Increase width of periodontal space.

B) Thickening of lamina dura :-
1) In bifurcation area
2) In apical region
3) Lateral aspect of root
C) Vertical rather than horizontal
destruction of interdental septum.
D) Radiolucence & condensation of
alveolar bone.
E) Root resorption.
Arrow shows
Widening of
periodontal ligament
space
 TREATMENT
CORONOPLASTY:-
Definition:-
Coronoplasty is the mechanical elimination of
occlusal supracontacts that may be present
during functional movement. It is achieved by
reshaping the crown surfaces and eliminating
undesirable occlusal supracontact and creation
of stable mandibular position.
۞ Coronoplasty is generally performed after the
gingival inflammation and periodontal pockets
have been eliminated.
۞ When infra bony defects associated with
trauma from occlusion are being treated
coronoplasty has to be performed prior to or at
the time of pocket elimination.
 SCHEDULE OF CORONOPLASTY:-

Step 1:- Remove retrusive prematurities and eliminate the

deflective shift from RCP to ICP.( the retrusive
pathway prematurities are eliminated)
[RCP-Retruded contact position; ICP-Intercuspal
position]

Step 2:- Adjust ICP to achieve stable, simultaneous,

multipointed, widely distributed contacts.

Step 3:- Test for excessive contact (fremitus) on the

incisor teeth.

Step 4:- Remove posterior protrusive supracontacts and

establish contacts that are bilaterally distributed on the
anterior teeth.
Step 5:- Remove or lessen mediotrusive
(balancing) interferences.

Step 6:- Reduce excessive, cusp steepness on

the laterotrusive (working) contacts.

Step 7:- Eliminate gross occlusal disharmonies.

Step 8:- Recheck tooth contact relationships.

Step 9:- Polish all rough tooth surfaces.

 CONCLUSION

Trauma from occlusion does not

initiate gingivitis or periodontal
pockets, but it may affect the
progress and severity of periodontal
pockets started by local irritation.
 REFERENCES:-
۞Clinical periodontology – Fermin Carranza
Michael Newman
Takei
۞ current concepts in
periodontics – B.R.R Verma
R.P. Nayak
۞Clinical periodontology
and implant dentistry - Jan Lindhe