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  • Writer's pictureGustavo Gameiro

Understanding Occlusal Trauma

Occlusal trauma is a critical condition that all orthodontists must understand thoroughly to provide optimal patient care. This post will clarify essential terms, discuss key findings, and provide practical considerations for managing occlusal trauma, ensuring that orthodontists can identify and treat this condition effectively.


Defining Key Terms


  1. Occlusal Trauma: Injury to the periodontium caused by excessive occlusal forces exceeding the tissue's ability to repair itself. This can occur in both healthy and compromised periodontal conditions.

  2. Excessive Occlusal Forces: Forces beyond what the periodontium can withstand, leading to injury or trauma. These can be due to malocclusion, bruxism, or other factors causing abnormal pressure on the teeth.

  3. Fremitus: A palpable or visible movement of a tooth when subjected to occlusal forces, indicating mobility and potential trauma.

  4. Primary Occlusal Trauma: Excessive occlusal forces on teeth with normal periodontal support, leading to injury without prior periodontal disease.

  5. Secondary Occlusal Trauma: Normal or excessive forces on teeth with reduced periodontal support due to existing periodontal disease, exacerbating the condition.

  6. Chronic Occlusal Trauma: Gradual and persistent application of excessive forces over time, contributing to long-term periodontal damage.

  7. Acute Occlusal Trauma: Sudden onset of excessive occlusal forces, often due to abrupt changes in the occlusal scheme or accidental trauma.


Key Findings on Occlusal Trauma and Periodontal Disease


While occlusal trauma itself does not cause periodontal disease, it can significantly contribute to periodontal problems, including:


  • Tooth Mobility: Increased mobility due to the breakdown of periodontal ligament and supporting structures.

  • Bone Loss: Excessive forces can lead to bone resorption and reduced bone density.

  • Root Resorption: In severe cases, trauma can cause the root surface to resorb, leading to further complications.


Studies indicate that while occlusal trauma does not initiate periodontitis, it can accelerate attachment loss and bone destruction in the presence of periodontal disease. Therefore, managing occlusal trauma is crucial for patients with or at risk of periodontal disease.


Occlusal Aspects to be Analyzed


When assessing occlusal trauma, orthodontists should consider the following interferences, as highlighted in the literature:


  1. Premature Contacts: Early contacts during occlusion can lead to excessive forces on specific teeth, contributing to trauma and mobility.

  2. Interference in Excursive Movements: Contacts that interfere with the natural movement of the mandible can create abnormal stress on the periodontium.

  3. Centric Relation Discrepancies: Differences between centric relation and maximum intercuspation can result in uneven force distribution, leading to trauma.

  4. Parafunctional Habits: Behaviors such as bruxism (teeth grinding) or clenching can exacerbate occlusal trauma by increasing the frequency and intensity of occlusal forces.


Importance of Diagnosis and Clinical Management

Accurate diagnosis and effective management of occlusal trauma are vital. Orthodontists must work closely with periodontists to ensure comprehensive care. The following steps are recommended:


  1. Clinical Examination: Assess for signs of mobility, fremitus, discomfort on chewing, and other indicators of trauma.

  2. Radiographic Analysis: Evaluate for widened periodontal ligament spaces, bone loss, and root resorption.

  3. Occlusal Adjustment: Modify the occlusal loads through occlusal equilibration procedures or orthodontic treatment to distribute forces evenly and reduce trauma.

  4. Splinting: Temporary splinting can stabilize mobile teeth and help identify problematic occlusal contacts.

  5. Patient Education: Inform patients about parafunctional habits and provide strategies to mitigate them.


Conclusion

Occlusal trauma is a complex condition that requires careful attention from orthodontists. Understanding its implications, accurately diagnosing the condition, and implementing effective management strategies are crucial steps in mitigating its impact on periodontal health. By collaborating with periodontists and adopting a comprehensive approach, orthodontists can significantly improve patient outcomes and maintain periodontal stability.

It's important to point out that even in the absence of dental plaque, the non-physiological forces from malocclusions can deteriorate the periodontium. The non-physiological distribution of occlusal forces, especially in a dentition with reduced periodontium, will favor the continuous migration of teeth. Two main changes occur in these cases:


  1. The loss of marginal bone level displaces the center of resistance to the apical region.

  2. This increases the shearing forces caused by occlusal loads dissipated into a more oblique alveolar wall, favoring the tipping and extrusion of these teeth.


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Recommended Reading: 1- Davies SJ, Gray RJ, Linden GJ, James JA. Occlusal considerations in periodontics. Br Dent J. 2001 Dec 8;191(11):597-604.

2- Fan J, Caton JG. Occlusal trauma and excessive occlusal forces: Narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018.

3- Gameiro, Gustavo H., Dalstra, Michel and Cattaneo, Paolo M.. "The clinical benefits of orthodontic treatment to pathologically migrated teeth: A systematic review" Australasian Orthodontic Journal, vol.35, no.2, 2019, pp.184-194.



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