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Periodontal response to external forces

  1. 1. GOOD MORNING!!!!
  2. 2. PERIODONTAL RESPONSE TOEXTERNAL FORCESDEEPTHI P.R. FINAL YEAR BDS
  3. 3. CONTENTS• Introduction• Trauma from Occlusion-Definitions• Classifications• Extension of Gingival inflammation to bone• Different concepts of Periodontal Response toOcclusal Trauma• Stages of tissue response to increased occlusalforces
  4. 4. CONTENTS• Effects of Insufficient Occlusal Force• Reversibility of traumatic lesions• Effects of excessive Occlusal Forces on DentalPulp• Influence of Trauma from Occlusion onMarginal Periodontitis• Studies and researches in Occlusal trauma
  5. 5. CONTENTS• Signs of Trauma from Occlusion• Treatment Planning• Occlusal treatment• Physiologic & Pathologic Occlusion• Pathologic Tooth Migration• Conclusion• Bibliography
  6. 6. INTRODUCTION• Adaptive capacity of periodontium to forcesexerted is variableOcclusal forcesmagnitude direction duration frequency• Magnitude-widening of the PDL space-increase in the no. & width of PDL fibers-increase in the density of alveolar bone
  7. 7. INTRODUCTION• Direction-Reorientation of stress & strain-Principal fibers of PDL  Occlusal forcesalong the long axis of the tooth-Lateral/Horizontal & Torque/Rotational:Injure the periodontium• Duration-Constant pressure > intermittent• Frequency-Frequent application of intermittent force:injurious
  8. 8. TRAUMA FROM OCCLUSIONDEFINITIONS‘When occlusal forces exceed the adaptivecapacity of the tissues , tissue injury results.The resultant injury is termed as trauma fromocclusion’- Carranza‘A term used to describe pathological alterationsor adaptive changes which develop in theperiodontium as a result of undue force producedby the masticatory muscles’-Lindhe
  9. 9. TRAUMA FROM OCCLUSIONDEFINITIONS‘A condition where injury results to thesupporting structures of the teeth by the actof bringing the jaws into a closed position’-Stillman(1917)‘Damage in the periodontium caused by stresson teeth produced directly or indirectly byteeth of the opposing jaw’-WHO(1978)
  10. 10. TRAUMA FROM OCCLUSIONDEFINITIONS‘An injury resulting in tissue changes withinthe attachment apparatus as a result ofocclusal forces’- Rose & Mealey‘An injury to the attachment apparatus as aresult of excessive occlusal forces’-Glossary of Periodontal Terms(AAP in 1986)
  11. 11. TRAUMA FROM OCCLUSIONSYNONYMS• Traumatizing occlusion• Occlusal trauma• Traumatogenic occlusion• Periodontal traumatism• Overload• TraumatismNBOcclusal trauma: DiagnosisTraumatogenic occlusion: Etiology
  12. 12. TRAUMATIC OCCLUSION/TRAUMATOGENIC OCCLUSION‘An occlusion that produces forces that cause aninjury to the attachment apparatus’
  13. 13. TRAUMA FROM OCCLUSIONCLASSIFICATIONSI. Acute & ChronicII. Primary & Secondary
  14. 14. TRAUMA FROM OCCLUSIONACUTE TFOCauses :• An abrupt occlusal impact• Restorations/prosthetic appliancesManifestations :• Tooth pain• Sensitivity to percussion• Increased tooth mobility
  15. 15. TRAUMA FROM OCCLUSIONForce dissipatedi. Shift in tooth position healsii. Wearing &iii. Correction of restoration subsidesOr elsePeriodontal injury Necrosis+ perio. abscessor Cementum tears
  16. 16. TRAUMA FROM OCCLUSIONCHRONIC TFO• More common & significant• Gradual changes by:- tooth wears- drifting movement & extrusion- parafunctional habits• Malocclusion not necessarily TFO
  17. 17. TRAUMA FROM OCCLUSION• Traumatic Occlusal relationships-Effect of the occlusion on the periodontiumAlso known as:Occlusal disharmonyFunctional imbalanceOcclusal dystrophy
  18. 18. TRAUMA FROM OCCLUSIONPRIMARY TFODefinition:Injury resulting in tissue changes from excessiveocclusal forces applied to a tooth or teeth withnormal support• TFO – the only etiology in periodontaldestruction• Occlusion results in the only local alteration ofteeth• Parafunctional habits
  19. 19. TRAUMA FROM OCCLUSIONCauses• High filling• Prosthetic replacement• Drifting / extrusion• Orthodontic movement intofunctionally unacceptable positionsPrimary TFO no changes in connective tissueattachment level & no pocket formation
  20. 20. CLASSIFICATION OFPARAFUNCTIONAL HABITS Tooth to ToothBruxismClenching Oral musculature to toothLip bitingTongue thrusting Foreign objects to toothFinger nail bitingPipe/Cigar bitingOther objects
  21. 21. PARAFUNCTIONAL HABITS• Duration of tooth contact greatly increased• Magnitude of force during bruxism muchgreater• Bruxism / clenching involve most of the teeth• Occlusal appliances
  22. 22. PARAFUNCTIONAL HABITS• Foreign object biting – localized to few teeth• Encourage habit elimination• Distinguish between adaptive periodontium &one that is in trauma
  23. 23. TRAUMA FROM OCCLUSION• Normal bone levels & attachment levels• Excessive occlusal forces• Normal periodontium with normal boneheight• A state of stability through Adaptiveremodeling*mobility no longer increasing*clinical, radiographic, histologic changesdon’t worsen
  24. 24. TRAUMA FROM OCCLUSIONSECONDARY TFODefinitionInjury resulting in tissue changes from normal orexcessive occlusal forces applied to a toothwith reduced support• Adaptive capacity – impaired by bone loss dueto inflammation• Reduces periodontal attachment area• Alters the leverage on the remaining tissues
  25. 25. TRAUMA FROM OCCLUSION• More vulnerable to injury• Previously well tolerated forces becometraumatic• Normal periodontium/Marginal periodontitiswith reduced bone height• Tooth displaced into the remaining alveolus byany force
  26. 26. TRAUMA FROM OCCLUSION• Active periodontitis/ after resolution ofinflammatory periodontitis• Condition serious if- progressively increasingmobility, bone loss, widening of PDL• Splinting indicated- if teeth are to be retainedAlternate Mechanism for Secondary TFO• Systemic disease
  27. 27. TRAUMA FROM OCCLUSION• The distinction between primary & secondaryTFO – no meaningful purpose• The alterations in the periodontium are similar& independent of the height of the targettissue, i.e. the periodontium.
  28. 28. EXTENSION OF GINGIVALINFLAMMATION TO BONE• Gingival inflammation collagen fiberbundles blood vessels alveolar bone• Interproximally, through the vesselsperforating the crest of the interdentalseptum• Directly into the PDL & from there into theinterdental septum
  29. 29. EXTENSION OF GINGIVALINFLAMMATION TO BONE• Facially & lingually , spreads along the outerperiosteal surface & penetrates into themarrow spaces through vessel channels• Destroys the transseptal & gingival fibers onthe courseOnce bone is reached:• Spreads into the marrow spaces & replacesmarrow with exudate
  30. 30. EXTENSION OF GINGIVALINFLAMMATION TO BONE• Bone resorption proceeds from within themarrow spaces• Thinning of bony trabeculae & enlargement ofthe marrow spaces• Bone destruction & a reduction in bone height• Fatty bone marrow replaced with fibrousmarrow
  31. 31. GLICKMAN’S CONCEPT• Concept given in 1965,1967• The pathway of the spread of a plaque-associated gingival lesion can be changed ifforces of an abnormal magnitude are actingon teeth harboring subgingival plaque
  32. 32. GLICKMAN’S CONCEPT• Character of progressive tissue destruction ofperiodontium at a “traumatized” toothdifferent from that in a “non-traumatized”tooth
  33. 33. GLICKMAN’S CONCEPT• Even destruction of periodontium & bone-suprabony pockets & horizontal bone loss inuncomplicated plaque associated lesions• Angular bony defects & infrabony pocketswhen exposed to abnormal occlusal force +inflammation
  34. 34. GLICKMAN’S CONCEPTPeriodontal structures divided into two zones1. Zone of Irritation2. Zone of co-destruction
  35. 35. GLICKMAN’S CONCEPTZONE OF IRRITATION• Marginal gingiva & interdental gingiva• Soft tissues bordered by the hard tissue on oneside• Not affected by the occlusal forces• Gingival inflammation not induced by TFO;but byirritation from microbial plaque• Lesion in a non-traumatized tooth propagates inapical direction by first involving the alveolarbone & later the PDL
  36. 36. GLICKMAN’S CONCEPTZONE OF CO-DESTRUCTION• PDL, Root cementum & alveolar bone• Coronally demarcated by the transseptal &the dentoalveolar collagen fiber bundles• TFO may cause a lesion here
  37. 37. GLICKMAN’S CONCEPT• Fiber bundles separating the two abovementioned zones from two differentdirections:Inflammatory lesion by plaque in the zone ofirritationTrauma induced changes in the zone of co-destruction• Fiber bundles dissolved or oriented parallel tothe root surface
  38. 38. GLICKMAN’S CONCEPT• The spread of inflammation is from the zoneof irritation directly down into the PDL; notvia the interdental bone.• This altered pathway of spreadangular bony defects“TFO is an etiologic factor (co-destructivefactor) of importance in situations whereangular bony defects combined with infrabonypockets are found at one or several teeth ”-1967 Review Paper
  39. 39. WAERHAUG’S CONCEPT• Examined autopsy specimens(1979)• Distance between subgingival plaque &the periphery of the associatedinflammatory cell infiltrate in the gingivathe surface of the adjacent alveolar boneConclusion : Angular bony defects &infrabony pockets occur equally atperiodontal sites of teeth which are notaffected by TFO
  40. 40. WAERHAUG’S CONCEPT• The loss of connective attachment & boneresorption - exclusively due to inflammationassociated with subgingival plaque
  41. 41. WAERHAUG’S CONCEPT• Angular bony defects & infrabony pockets--subgingival plaque has reached a level moreapical than the microbiota on theneighbouring tooth--when the volume of the alveolar bonesurrounding the roots is comparatively large
  42. 42. WAERHAUG’S CONCEPT• Supported by findings by Prichard (1965) &Manson(1976)The pattern of loss of supporting structures: the form & volume of the alveolar bone the apical extension of the microbialplaque on the adjacent root surfaces
  43. 43. STAGES OF TISSUE RESPONSE TOINCREASED OCCLUSAL FORCES3 STAGES:INJURYREPAIRADAPTIVE REMODELLING OF THEPERIODONTIUM
  44. 44. INJURY• Excessive Occlusal forces: Tissue Injury• Repair of injury & Restoration of periodontiumif-i. Forces are diminishedii. Tooth drifts away from them• Chronic forces: Remodeling of periodontiumi. Widened at the expense of boneii. Angular bone defects without pocketsloose teeth
  45. 45. INJURY• Occlusal forces: Tooth rotation around aFulcrum/ Axis of RotationJunction of middle & apical third of clinicalroot• Areas of pressure & tension created onopposite sides of the fulcrum
  46. 46. INJURYSLIGHTLY EXCESSIVE PRESSURE• Resorption of the alveolar bone• Widening of the PDL space• Numerous blood vessels- reduced in sizeSLIGHTLY EXCESSIVE TENSION• Elongation of the PDL fibers• Apposition of alveolar bone• Enlarged blood vessels
  47. 47. INJURYGREATER PRESSUREGradation of Changes• Compression of fibers Areas of hyalinization• Injury to fibroblasts & other cells: Necrosis ofPDL• VascularWithin 30 minutes
  48. 48. INJURYImpairment & stasis of blood flow in 2-3 hoursBlood vessels packed with RBC’s fragment in1-7 daysDisintegration of blood vessel walls- contentsdischarged into the surrounding• Increased resorption of alveolar bone &tooth surface
  49. 49. INJURYSEVERE TENSION• Widening of PDL• Thrombosis• Haemorrhage• Tearing of the PDL• Resorption of the alveolar bone
  50. 50. INJURYSEVERE PRESSURE• Force the root against bone• Necrosis of the PDL & bone• Bone resorption from viable PDL & marrowspaces Undermining Resorption• Most susceptible areas of Injury- Furcations
  51. 51. INJURYInjury to Periodontium: Temporary depression• Mitotic activity• Proliferation & Differentiation of Fibroblasts• Collagen & Bone formation• Normal after dissipation of forces
  52. 52. REPAIR• Normal periodontium: Constant repair• TFO - increased reparative activity• Damaged tissues removed & formation of new Cells Fibers Bone Cementum
  53. 53. REPAIR• Forces : Traumatic as long as the damageexceeds the reparative capacity• Bone resorbed by excessive occlusal forces• Thinned bony trabeculae reinforced with newbone
  54. 54. REPAIRBUTTRESSING BONE FORMATION• Important feature of Repair after TFO• Inflammation• Osteolytic tumorsCentral Buttressing: Within the jaw New bone deposition
  55. 55. REPAIRPeripheral Buttressing: Facial & lingual surfaces of the alveolar plate LIPPING : Severe ‘shelf like’ thickening of thealveolar margin Pronounced bulge in the contour of the facial& lingual boneFollowing trauma:Cartilage like materialCrystal formation from RBC’s
  56. 56. ADAPTIVE REMODELING OF THEPERIODONTIUMRepair = Destruction: remodeled so that theforces are not injurious• PDL - Thickened & funnel shaped at the crest• Angular defects in the bone• No pockets• Teeth become loose
  57. 57. HISTOMETRIC DIFFERENTIATION• Injury phase: resorption formation• Repair phase: resorption formation• Adaptive remodeling: both return to normal
  58. 58. EFFECTS OF INSUFFICIENT OCCLUSALFORCE• Injurious to periodontium• Thinning of the PDL• Atrophy of fibers• Osteoporosis of the alveolar bone• Reduction in bone height
  59. 59. EFFECTS OF INSUFFICIENT OCCLUSALFORCECan result from:Open-bite relationshipAbsence of functional antagonistsUnilateral chewing habits
  60. 60. REVERSIBILITY OF TRAUMATIC LESIONS• TFO –Reversible• Artificially created TFO- extrusion & intrusion& repair on removal• Not always correct itself• Injurious force- relieved for repair
  61. 61. REVERSIBILITY OF TRAUMATIC LESIONS• Conditions not permitting adaptation toocclusal forces- damage worsens/persists• Plaque induced inflammation- impairs thereversibility of traumatic lesions
  62. 62. EFFECTS OF EXCESSIVE OCCLUSALFORCES ON DENTAL PULP• Not established• Disappearance of pulpal symptoms aftercorrection of excessive occlusal forces-reported• Pulpal reactions in animals subjected toincreased
  63. 63. INFLUENCE OF TFO ON PROGRESSIONOF MARGINAL PERIODONTITIS• Accumulation of plaque that initiates gingivitis& results in pocket formation affects themarginal gingiva, but TFO occurs in thesupporting tissues & does not affect thegingiva• Marginal gingiva unaffected by TFO• TFO doesn’t cause gingivitis
  64. 64. INFLUENCE OF TFO ON PROGRESSIONOF MARGINAL PERIODONTITIS• No effect on inflammatory process confined tothe gingiva• When gingivitis periodontitis;occlusion influencesIt is important to eliminate the marginalinflammatory component in case of TFObecause the presence of inflammation affectsbone regeneration after the removal of thetraumatizing contacts
  65. 65. INFLUENCE OF TFO ON PROGRESSIONOF MARGINAL PERIODONTITIS• No progressive destruction in regions kepthealthy after elimination of periodontitis• Change in the shape of the alveolar crest:Widening of the marginal PDL spaceNarrowing of the interproximal alveolar boneShelf like thickening of the alveolar margin
  66. 66. INFLUENCE OF TFO ON PROGRESSIONOF MARGINAL PERIODONTITIS• Thus there’s alteration in the architecture ofthe inflamed site• Inflammation absent: adaptation to increased forces• Inflammation present:Angular bone lossPockets become infrabony
  67. 67. INTERACTION OF TFO &INFLAMMATION• TFO alter the pathway of inflammation to theunderlying tissues collagen density & no.ofLeukocytesOsteoclasts increasingly mobileBlood vessels teeth
  68. 68. INTERACTION OF TFO &INFLAMMATION• Inflammation proceeds to PDL• Angular bone loss & infrabony pockets• Areas of root resorption exposed withoutgingival attachment – plaque & calculus
  69. 69. INTERACTION OF TFO &INFLAMMATION• Supragingival plaque SubgingivalOrthodontically tiltedMigration into edentulous areaSuprabony pocket becomes intrabony• Increased mobility : Pumping effect on plaquemetabolites  increase diffusion
  70. 70. STUDIES & RESEARCHES ON OCCLUSALTRAUMAEarly investigators - important role to TFO-etiology• High crowns & restorations in dogs & monkeys• High crown + orthodontic appliance ‘jigglingforces’• Interproximal wedging• Jiggling trauma + plaque inducedinflammation
  71. 71. STUDIES & RESEARCHES ON OCCLUSALTRAUMAEastman Dental Center• Squirrel monkeys• Repetitive interdental wedging• Mild to moderate inflammation• 10 weeks• No increase in attachment loss
  72. 72. STUDIES & RESEARCHES ON OCCLUSALTRAUMAUniversity of Gothenburg• Beagle dogs• Cap splints & orthodonticappliances• Severe inflammation• 1 year• Increase in the periodontal destructioninduced by periodontitis
  73. 73. STUDIES & RESEARCHES ON OCCLUSALTRAUMAWentz & coworkers• Monkeys- PDL widening up to 3 times more• ‘At one point , the damaging effect of jigglingtrauma was nullified by the extreme width ofthe PDL space & no future resorption occured’
  74. 74. STUDIES & RESEARCHES ON OCCLUSALTRAUMASvanberg & Lindhe• Jiggling trauma in dogs• Increased mobility• PDL space widening• Loss of crestal bone height• Series of cellular alterations
  75. 75. STUDIES & RESEARCHES ON OCCLUSALTRAUMA• Thrombosis• Haemorrhage• Increased vascular permeability• Collagen destruction & Bone resorption• Changes ceased after 60 days• Increased mobility & width of PDL remainedconstant• Physiologic adaptation in the absence ofplaque induced inflammation
  76. 76. STUDIES & RESEARCHES ON OCCLUSALTRAUMASvanberg & Lindhe- 2nd Swedish study• Physiologic adaptation didn’t occur- presenceof plaque induced periodontitis• ‘Attachment apparatus inhibited in its abilityto adapt to jiggling type trauma in thepresence of supracrestal plaque- inducedinflammation’
  77. 77. STUDIES & RESEARCHES ON OCCLUSALTRAUMA• ‘TFO combined with experimentalperiodontitis accelerated periodontalbreakdown characterized by continuousperiodontal pocket formation & loss of fiberattachment’
  78. 78. STUDIES & RESEARCHES ON OCCLUSALTRAUMANyman & coworkers• Experimental periodontitis – test & control teeth• Jiggling type trauma- test teeth• attachment loss in 80% of test teeth• ‘Excessive occlusal forces have the potential toincrease the degree of periodontal destruction’
  79. 79. STUDIES & RESEARCHES ON OCCLUSALTRAUMAPolson & coworkers• Monkey model• Traumatic forces without periodontalinflammation• Widening of the PDL space• Increased tooth mobility• Loss of crestal bone height & bone volume
  80. 80. STUDIES & RESEARCHES ON OCCLUSALTRAUMA• Changes ceased once physiologic adaptationcomplete• Withdrawal of traumatic forces – lost bonevolume restored• Persisting plaque induced inflammation
  81. 81. SIGNS OF TFOMOBILITY• Measurement of horizontal & vertical toothdisplacement created by the examiner’s force• Blunt ends of two dental instrumentsapproximately at the buccal & lingual heightof contour• Forces applied buccolingually• Assessed in mesiodistal direction whenpossible• Comparing a fixed point on the tooth against afixed point on the adjacent tooth
  82. 82. SIGNS OF TFOCLASS I : Less than 1mmbuccolingual/mesiodistalCLASS II : 1mm or more – buccolingual/mesiodistal , no abnormal mobility in anocclusoapical directionCLASS III : 1mm or more- buccolingual ormesiodistal & abnormal mobility in anocclusoapical direction
  83. 83. SIGNS OF TFOFREMITUS/FUNCTIONAL MOBILITY• Measurement of the vibratory patterns of theteeth when the teeth are placed in contactingpositions & movements• A finger – buccal & labial surfaces- maxillaryteeth• Tap the teeth together in the maximumintercuspal position• Grind symmetrically in lateral, protrusive &lateral-protrusive contacting movements
  84. 84. SIGNS OF TFO• Mandibular teeth assessed in edge to edgeocclusionCLASS I: Mild vibration detectedCLASS II: Easily palpable vibration but no visiblemovementCLASS III: Movement visible with the naked eye
  85. 85. SIGNS OF TFOFremitus vs Mobility:Tooth displacement created by patient’s ownocclusal force• Ability of patient to displace & traumatizeteeth• Mobility without fremitus: Probably noOcclusal Trauma
  86. 86. SIGNS OF TFORADIOGRAPHIC ASSESSMENT• Degree of bone loss from the CEJ to Apex• Width of the PDL space around each tooth• Examine for angular bony defects• But these findings not necessarily with TFO
  87. 87. SIGNS OF TFOOCCLUSAL SUMMARY CHART• Future treatment decisions & response totherapy• Minimum information• Assess the relation between occlusal forces &periodontal status
  88. 88. TREATMENT PLANNINGDecide whether occlusal treatment is needed:Surface adjustment/ApplianceSymptoms• Sensitive to temperature changes• Pain on chewing• Mobility• Wear facetsExtent of periodontal destructionPatient’s ability to function
  89. 89. TREATMENT PLANNINGOcclusal treatment indicated• Occlusal discrepancies• Periodontal diseaseX Occlusal treatment not indicated• Asymptomatic• No significant periodontal disease
  90. 90. TREATMENT PLANNINGDecision to treat made in the reevaluationappointment :• Non surgical treatment• Mobility & fremitus reduced• Need for treatment diminished
  91. 91. OCCLUSAL TREATMENT• After non surgical treatment• Exception: difficulty/ pain on chewing due toocclusal trauma2 APPROACHESBITE APPLIANCEALTERING OCCLUSAL RELATIONSHIPS OFTEETH
  92. 92. OCCLUSAL TREATMENTBITE APPLIANCE• Fits over the teeth• An artificial occlusal surface for the opposingdentition to contact• Hard acrylic: Cushions contact forces• Heat/cold cured hard acrylic over soft acrylic• Maxillary bite Appliance: Stabilise potentiallyloose maxillary teeth & prevent flaring
  93. 93. OCCLUSAL TREATMENTOCCLUSAL ADJUSTMENT• Permanent alteration:- Orthodontic therapy- Selective grinding• Permanent change – distribution of occlusalforces• Care & skill
  94. 94. PHYSIOLOGIC & PATHOLOGICOCCLUSIONDetermined after diagnosis of occlusal traumaPHYSIOLOGIC:• Survives despite deviations from the ‘ideal’occlusion• Maybe anatomic malocclusion• Free of occlusally induced disease
  95. 95. PHYSIOLOGIC & PATHOLOGICOCCLUSIONPATHOLOGIC:• Disease due to occlusal activity• Requires therapeutic alteration
  96. 96. PATHOLOGIC TOOTH MIGRATIONDEFINITION‘Tooth displacement that results when thebalance among the factors that maintainphysiologic tooth position is disturbed byperiodontal disease ’
  97. 97. PATHOLOGIC TOOTH MIGRATION• Common & early sign• Gingival inflammation• Pocket formation• Anteriors frequent• Any direction• Mobility & RotationExtrusion: Pathologic migration in the incisal/occlusal aspect
  98. 98. PATHOLOGIC TOOTH MIGRATIONPATHOGENESISHealth & normal height of the periodontiumForces exerted on the teeth: Occlusion &PressureForces of occlusionTooth morphology & cuspal inclinationFull complement of teethPhysiologic tendency towards mesialmigration
  99. 99. PATHOLOGIC TOOTH MIGRATIONNature & location of contact pointrelationshipsProximal, incisal & occlusal attritionAxial inclination of teeth
  100. 100. PATHOLOGIC TOOTH MIGRATIONWEAKENED PERIODONTAL SUPORT• Unable to maintain normal position• Moves away from opposing force unlessrestrained by proximal contact• Forces accepted by normal periodontiumbecome injurious
  101. 101. PATHOLOGIC TOOTH MIGRATION• Position change - subjected to abnormal force- aggravate periodontal destruction &migration• Continue after loss of antagonist• Forces from tongue, food bolus, granulationtissue• Also an early sign of Localized AggressivePeriodontitis
  102. 102. PATHOLOGIC TOOTH MIGRATIONCHANGES IN FORCES EXERTED ON THE TEETHA. Unreplaced missing teeth• Drifting into edentulous spaces• Not due to periodontal destruction• Conducive for periodontal diseases• Aggravates the tooth movement• Mesial with tilting / extrusion
  103. 103. PATHOLOGIC TOOTH MIGRATION• Premolars drift distally• Doesn’t always occur
  104. 104. PATHOLOGIC TOOTH MIGRATIONB. Failure to replace First Molars• Second & third molars tilt reducing the verticaldimension• Premolars - distally & mandibular incisors-driftlingually• Anterior overbite increased & mandibularincisors traumatize the gingiva
  105. 105. PATHOLOGIC TOOTH MIGRATION• Maxillary incisors pushed labially & laterally• Anterior teeth extrude because incisalapposition has largely disappeared• Diastemata created- anterior teeth
  106. 106. PATHOLOGIC TOOTH MIGRATIONProximal contacts disturbed:Food impactionGingival inflammationPocket formationBone lossMobilityAltered positions- traumatize supportingtissues- aggravate destruction
  107. 107. PATHOLOGIC TOOTH MIGRATIONOTHER CAUSESTFO: itself or combinationPRESSURE FROM TONGUE: absence ofdisease/ reduced periodontal supportPRESSURE FROM GRANULATION TISSUE OFPERIODONTAL POCKET: with periodontaldestruction ; may return after pocketelimination
  108. 108. CONCLUSION• Occlusal traumatic forces- the major externalforce encountered by the periodontium• Trauma from occlusion - no inflammation ofthe periodontium by itself• Alters the pathway of inflammation &aggravates the condition once theperiodontitis stage is reached
  109. 109. BIBLIOGRAPHY• Carranza’s Clinical Periodontology- 10th edition• Clinical Periodontology & Implant Dentistry- Lindhe,4thEdition• Periodontics –Medicine, Surgery &Implants -Rose ,Mealey, Genco, Cohen• Fundamentals of Periodontics- Wilson & Kornman, 2ndEdition -• www.google.com
  110. 110. THANK YOU YOU

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