The adaptive capacity of the periodontium allows it to accommodate forces from occlusion. When occlusal forces exceed this capacity, trauma from occlusion occurs, potentially leading to periodontal injury. The magnitude, direction, duration and frequency of forces influence the periodontium's response. Signs of trauma from occlusion include pain, mobility, increased periodontal pocketing, bone loss and root resorption. Trauma can alter the progression of periodontal disease from a suprabony to an infrabony pattern and increase the rate of attachment loss. Pathologic tooth migration may result when the balance of factors maintaining normal position is disturbed by periodontal disease.

1. Dr Jaffar Page 1
TRAUMA FROM OCCLUSION
ADAPTIVE CAPACITY
“dynamics of the periodontium to accommodate the forces exerted on the
crown, which is called as adaptive capacity.”
Influenced by 4 factors

2. Dr Jaffar Page 2
a. Magnitude (the amount): When it is increased the periodontium responds
(a) with a thickening of the periodontal ligament,
(b) an increase in the number and width of periodontal ligament fibers
(c) an increase in the density of the alveolar bone.
b. Direction: Changes in the direction causes reorientation of the stresses and
strains within the periodontium (lateral or horizontal forces, torque or
rotational forces are more likely to injure the periodontium).
c. Duration: Constant pressure on the bone is more injurious than intermittent
forces.
d. Frequency: The more frequent the application of an intermittent force, the
more injurious to the periodontium.

3. Dr Jaffar Page 3
TRAUMA FROM OCCLUSION (TFO)
“when occlusal forces exceed the adaptive capacity of periodontal tissues, the
tissue injury results. This resultant injury is termed as trauma from occlusion.”
“damage in the periodontium caused by, stress on the teeth produced directly
or indirectly by the teeth of the opposing jaw”

4. Dr Jaffar
Types
ii. Depending on the cause:
a. Due to the alterations in the occlusal forces.
b. Reduced capacity of the periodontium.
iii. Depending on the onset and duration
a. Acute trauma from occlusion (TFO).
b. Chronic trauma from occlusion (TFO
a. Due to the alterations in the occlusal forces. (Primary)
b. Reduced capacity of the periodontium. (Secondry)
onset and duration:
a. Acute trauma from occlusion (TFO).
b. Chronic trauma from occlusion (TFO)
Page 4

5. Dr Jaffar Page 5
Signs and Symptoms
a. In acute situations:
Excessive tooth pain
tenderness on percussion,
increased tooth mobility (hypermobility)
periodontal abscess formation
cemental tears
infrabony pockets
furcation involvement
attrition
pathologic migration

6. Dr Jaffar Page 6
b. Fremitus test is positive.
c. Radiographic changes
i. Increase in the width of the periodontal ligament space
ii. Thickening of the lamina dura along the lateral borders of the root,
apical and bifurcation areas.
iii. “Vertical” rather than horizontal destruction of the interdental septum.
iii. Radiolucency and condensation of the alveolar bone.
iv. Root resorption.

7. Dr Jaffar Page 7

8. Dr Jaffar
ROLE OF THE TRAUMA FROM
PERIODONTAL DISEASE
Glickman’s concept.
pathway of the spread of plaque associated gingival
the forces of an abnormal magnitude are
plaque. teeth which are nontraumatized
horizontal bone loss, whereas teeth
and infrabony pockets.
According to him, the periodontal structures are divided
1. The zone of irritation
2. The zone of co-destruction
ROLE OF THE TRAUMA FROM OCCLUSION IN THE PROGRESSION
of plaque associated gingival lesion can be changed if
the forces of an abnormal magnitude are acting on teeth harboring subgingival
nontraumatized exhibit suprabony pockets and
bone loss, whereas teeth with trauma exhibit angular
According to him, the periodontal structures are divided into two zones
destruction.
Page 8
OCCLUSION IN THE PROGRESSION OF
can be changed if
oring subgingival
pockets and
angular bony defects
two zones:

9. Dr Jaffar Page 9
Four possibilities can occur when a tooth with gingival inflammation is exposed
to trauma.
1. Trauma from occlusion may alter the pathway of extension of gingival
inflammation to the underlying tissues. Inflammation may proceed to the
periodontal ligament rather than to the alveolar bone and the resulting bone
loss would be angular with infrabony pockets.
2. It may favor the environment for the formation and attachment of plaque
and calculus and may be responsible for development of deeper lesions.
3. Supragingival plaque can become subgingival if the tooth is tilted
orthodontically or migrates into an edentulous area, resulting in the
transformation of a suprabony pocket into an infrabony pocket.
4. Increased tooth mobility associated with trauma to the periodontium may
have a pumping effect on plaque metabolites increasing their diffusion.

10. Dr Jaffar Page 10

11. Dr Jaffar
PATHOLOGIC TOOTH MIGRATION
“tooth displacement that results when the
maintain physiologic tooth position
PATHOLOGIC TOOTH MIGRATION
t that results when the balance among the factors that
physiologic tooth position is disturbed by periodontal di
Page 11
among the factors that
by periodontal disease.”

12. Dr Jaffar Page 12
Pathologic migration occurs most frequently in the anterior region, but
posterior teeth may also be affected.
The teeth may move in any direction and the migration is usually accompanied
by mobility and rotation.
Pathologic migration in occlusal or incisal direction is called as “extrusion”

13. Dr Jaffar Page 13
Pathogenesis
factors play a role in maintaining the normal position of the teeth.
1. The health and normal height of the periodontium.
2. The forces exerted on the teeth.
3. Pressure from the tongue.
4.Pressure from the granulation tissue of periodontal pocket.

14. Dr Jaffar Page 14
Clinical Indicators for Trauma from Occlusion
a. Mobility.
b. Fremitus test being positive.
c. Malocclusion.
d. Wear facets.
e. Tooth migration.
f. Fractured tooth/teeth.
g. Thermal sensitivity.
h. Muscle hypertonicity.