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BRUXISM
4 Non functional contact of teeth
which may include grinding,
gnashing or clenching of teeth.
2 S
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4 monscious or subconscious grinding of teeth
usually during the day.

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4 „utonomic teeth grinding with rhythmic &
sustained jaw muscle contractions.
2IOLOG

. Local factors.
2. Systemic factors.
3. sychological factors.
4. Occupational factors.
  
4 Include occlusal interference, high
restoration or some irritating dental
conditions.
4 „ patient brux as a result of an unconscious
attempt to establish a greater number of teeth
in contact or to counteract the local irritating
situation.
4 In children bruxism may be related to growth
& development.
4 mhildren brux because their top & bottom teeth
don¶t fit together comfortably.
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4 Include GI disturbances, subclinical nutritional
deficiencies, allergies, or endocrine
disturbances.
4 Genetics has also been seen to play an
important role in the etiology of bruxism.
4 mhildren of bruxing parents have an increased
incidence of bruxism.
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4 Most common cause of bruxism.


4 „nxiety, stress or tension.
4 Suppresed anger or frustation.
4 „ggressive, competitive or hyperactive
personality type.
4 Mental disorders are also related to bruxism.

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4 Occupations in which the work must be
unusually precise, such as watchmakers are
more prone to cause bruxism.
4 „thletes often develop bruxism.
mLINIm„L F„2URS
4 Symptomatic effects of bruxism have
been divided in to 5 major categories :

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FFm2S ON 2 DN2I2ION

4 Severe wearing or attrition of the teeth may


occur.
4 not only occlusally, but also interproximally.
FFm2S ON 2
RIODON2IUM
4 Loss of the periodontal structures, resulting in
loosening or drifting of teeth or even gingival
recession with alveolar bone loss.
FFm2S ON 2
M„S2Im„2OR MUSmLS
4 ypertrophy of the masticatory muscles,
particularly the masseter muscle.
4 May interfere with maintenance of the rest
position, cause trismus & alter occlusion &
the opening & closing pattern of the jaw.
FFm2S ON 2
2MROM„NDIBUL„R JOIN2
4 ain present in the joints is usually dull &
unilateral.
4 mrepitation and clicking within the joint.
4 Restriction of the mandibular movements.
4 Jaw deviations can be observed.
„D„m
4 Bruxism may give rise to facial pain &
headache.
2R„2MN2 & ROGNOSIS
4 Underlying cause must be
corrected.
4 Removable occlusal splints may
be worn at night to immobilize the
jaws or to guide the movement.
FR„m2URS OF 22
mLINIm„L F„2URS
4 „G : May occur at any age. But children are
more prone.
4 SX : M > F
4 SI2 : 75 to 90 % of traumatized teeth are
maxillary teeth.
LLIS¶S mL„SSIFIm„2ION
4 It divides all the traumatized anterior teeth in to nine classes.
mL„SS  : Simple fracture of the crown, involving little or no dentin.
mL„SS 2 : xtensive fracture of the crown, involving considerable
dentin but not the dental pulp.
mL„SS 3 : xtensive fracture of the crown, involving considerable
dentin & exposing the pulp.
mL„SS 4 : 2he traumatized tooth becomes non-vital, with or
without loss of crown structure.
mL„SS 5 : 2eeth lost as result of trauma.
mL„SS 6 : Fracture of the root, with or without loss of crown
structure.
mL„SS 7 : Displacement of a tooth, with or without fracture of
crown or root.
mL„SS 8 : Fracture of the crown en masse & its replacement.
mL„SS 9 : 2raumatic injuries to deciduous teeth.
4 mlinical manifestation, treatment and
prognosis of the fractured tooth depend upon
whether the dental pulp is pierced by the
fracture and whether the crown or the root is
involved.
mROWN FR„m2UR WI2OU2
UL INVOLVMN2
4 Vitality of the tooth is usually maintained.
4 2here may be mild pulp hyperemia even
when the overlying dentin is relatively thick.
4 If the dentin is very thin, bacteria may
penetrate the dentinal tubules, infect the pulp
& produce pulpitis.
4 2ooth may be sore & slightly loose but severe
pain is usually absent.
mROWN FR„m2UR
INVOLVING UL
4 ulp exposure does not mean that death of
the pulp will occur.
4 xposure can be capped by calcium
hydroxide & a dentinal bridge will form as a
part of the healing reaction.
4 ulpotomy or pulpectomy may often be
necessary, however, since the pulp becomes
infected almost immediately after the injury.
ROO2 FR„m2UR
4 Uncommon in young children, since their roots are
not completely formed & the teeth have some
resilience in their sockets.
4 Occurs mostly as horizontal fractures in the middle
third of the root.
4 Most teeth become non vital immediately after the
root fracture.
4 Some root fractures may heal by forming an inner
layer of reparative dentin on the pulpal wall, or they
may replace the hard tissue along the fracture line
with granulation tissue that progresses to mature
connective tissue.
mMN2„L 2„RS
4 Small fractures of cementum, usually as a
result of sudden rotational forces.
4 Occurs if the trauma is not forceful enough to
fracture the tooth.
4 „symptomatic & not of any clinical
significance.
4 Occasionally observed as incidental findings
during histologic examination of periodontal
tissue removed for other purposes.
IS2OLOGIm F„2URS
4 ealing in such cases may be of several
types.
4 Most satisfactory form of healing is the union
of the two fragments by calcified tissue & this
is analogous to the healing of a bony fracture.
4 If the apposition between the two fragments is
not close, the union is by connective tissue
alone.
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4 „ „
4 DN2O„LVOL„R „N LOSIS
4 INFR„OmmLUSION
4 SmOND„R R2N2ION
4 SUBMRGNm
4 RIM„m2ION
4 RINmLUSION
4 „N LOSIS means fusion of a joint.

4 2ooth ankylosis means fusion of the


tooth to the alveolar bone.
4 Def: messation of eruption after
emergence occuring from an anatomic
fusion of tooth cementum or dentin to
alveolar bone.
2IOLOG
4 Unknown.
4 RDISOSING F„m2ORS
. 2rauma.
2. Injury.
3. mhanges in local metabolism.
4. mhemical & thermal irritation.
5. Local failure of bone growth.
6. „bnormal pressure from the tongue.
7. Genetically decreased DL gap.
mLINIm„L F„2URS
4 „nkylosed teeth appears
submerged because its roots
don¶t grow at the same rate as
other teeth.
4 Malpositioning of the teeth on
either side of it.
4 Super eruption of the opposing
teeth in the opposite dental arch.
4 Growth of permanent teeth will be
blocked by the ankylosed tooth
because the roots will not disolve.
4 RmUSSION
4 „n ankylosed teeth has a higher pitched or
dulled sound as compared to the more
cushioned sound of a normal tooth.
R„DIOGR„Im F„2URS
4 Loss of normal thin radiolucent line that
represents the periodontal ligament.
4 Mild sclerosis of the bone & apparent
blending of the bone with the tooth root.
IS2OLOGIm F„2URS
4 On microscopic examination, an area of root
resorption continuous with the alveolar bone
is seen which has been repaired by a
calcified material, bone, or cementum.
4 eriodontal ligament is completely
obliterated.
2R„2MN2
4 No specific treatment for ankylosis.
4 When an underlying permanent successor is
present, extraction of the ankylosed teeth is
recommended.
 SIm„L INJURIS OF BON
2R„UM„2Im m S2

„ka
4 Solitary bone cyst.
4 emorrhagic bone cyst.
4 xtravasation cyst.
4 Unicameral cyst.
4 Simple bone cyst.
4 Idiopathic cyst.
4 Ö Benign, empty, or fluid- containing cavity
within bone that is devoid of an epithelial
lining ´

4 Since this cyst does not have a true


epithelial lining its not considered as true
cyst.
2IOLOG
4 Unknown & controversial
4 Several theories have been proposed, but none
of them explains all of the clinical & pathologic
feature of this disease.
2rauma- aemorrhage 2heory
! $
„ccording to this theory
4 2rauma to the bone that is insufficient to
cause a fracture results in an intraosseous
haematoma.
4 If the haematoma does not undergo
organization & repair, it may liquify & result in
a cystic defect.
O2R 2ORIS
4 Origin from bone tumors that have undergone cystic
degenerations.
4 „ result of faulty calcium metabolism such as that
induced by parathyroid disease.
4 Origin from necrosis of fatty marrows due to
ischemia.
4 2he end result of a low grade chronic infection.
4 „ result of osteoclasis resulting from a disturbed
circulation caused by trauma creating an unequal
balance of osteoclasis & repair of bone.
4 Local disturbances in bone growth.
mLINIm„L F„2URS
4 „G : Most frequently between 0 & 20 years
of age.
4 SX :
M:F -3:2
4 SI2 : Mandible.
4 Usually asymptomatic & discovered when
radiographs are taken for some other
reason.
4 Swelling is occasionaly seen.
4 When the cavity is opened surgically,
it is found to contain either a straw coloured
fluid, shreds of necrotic blood clot,
fragments of fibrous connective tissue,
or nothing.
R„DIOGR„Im F„2URS

4 Smoothly outlined radiolucent area of variable


size.
4 Interradicular scalloping of varying degrees is
characteristic of this lesion.
4 Occasionally slight root resorption may be
noted.
IS2OLOGIm F„2URS
4 „ thin layer of loose & delicate connective
tissue lining the cavity.
4 Soft tissue luminal surface contains a thin
layer of fibrin.
2R„2MN2
4 Surgical entry to initiate bleeding & stimulate
healing.
4 Rarely second surgical procedure is required.
4 If a large space is present bone chips are
used.
FOm„L OS2OORO2Im
BON M„RROW DFm2
4 Lesions that are typically present as
asymptomatic, focal radiolucencies in
areas where hematopoeisis is
normally seen.
- „ngle of mandible & maxillary
tuberosity.
„2OGNSIS
2hree theories have been proposed :

. Marrow hyperplasia in response to


increased demand for erythrocytes.
2. „bberent bone regeneration after tooth
extraction.
3. ersistence of the fetal marrow.
mLINIm„L F„2URS
4 SX : 75 % of lesions occuring in women.
4 SI2 : 85 % in the posterior mandible.
most often in edentulous areas.
4 2ypically asymptomatic & detected as an
incidental finding on a radiographic
examination.
R„DIOGR„Im F„2URS
4 Radiolucent area varying in size from several
millimeters to several centimeters in
diameter.
4 oorly defined periphery
4 Indicative of lack of reactivity of adjacent

bone.
4 Fine central trabeculation may be observed in
IO„.
IS2OLOGIm F„2URS
4 monsists of normal red marrow &/or fatty
marrow.
4 Small lymphoid aggregate may be found.
4 Bone trabeculae included in the biopsy
specimen show no evidence of abnormal
osteoblastic or osteoclastic activity.
2R„2MN2
4 Because of nonspecific radiographic findings,
diagnosis by an incisional biopsy is generally
desirable.
4 Once the diagnosis has been established, no
additional treatment is necessary.
FFm2S OF OR2ODON2Im
2OO2 MOVMN2
4 Orthodontic tooth movement is possible
because the periodontal tissues are
responsive to the externally applied forces.
4 Bone under pressure responds by resorbing,
where as the application of tension results in
deposition of new bone.
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2IING MOVMN2
4 2he initial reaction on the pressure side is a
compression of the periodontal ligament, which, if
excessive & prolonged, may result in ischemia with
hyalinization and/or actual necrosis of tissue.
4 On the opposite side, under excessive force, there
may be actual tearing of the periodontal fibers &
small capillaries with hemorrhage into the area.
4 With the reasonable forces, the periodontal ligament
on the tension side of the tooth demonstrates
stretching & widening of the periodontal space.
X2RUSIV MOVMN2
4 xtrusion of a tooth by an orthodontic
appliance is similar to normal tooth eruption.
4 2he tissue changes induced by this form of
movement consist in deposition or apposition
of new bone spicules at the alveolar crest &
at the fundus of the alveolus arranged in a
direction parallel to the direction of force.
DRSSIV MOVMN2
4 2he application of orthodontic force in such a
manner as to cause depression of a tooth
results in tissue changes that are the
opposite of those found during extrusion, or
elongation.
4 Resorption of bone occurs at the apical area
& around the alveolar margin.
4 New bone formation is actually minimal.
2ISSU R„m2IONS DURING
R2N2ION RIOD
4 During this period there is gradual
reformation of the normal dense pattern of
the alveolar bone by apposition of bone
around the bony spicules until they meet,
fuse, & gradually remodel.
4 2he studies of oppenheim indicated that this
reformation is slower around teeth held in
position during the retention period by a
retaining appliance as compared to teeth,
which remained free during this time.
FFm2 OF DmIDUOUS
2OO2 MOVMN2 UON
RM„NN2 2OO2 GRMS

4 Studied by % in monkeys.


4 2hey found that when a deciduous tooth was
moved, the associated permanent tooth germ
followed this movement.