Clinical diagnosis of trauma from L. J. Jtn^ ^ and C. F.

'Deparlment of Periodontology, School of

Stomatology, Beijing Medical University,

occlusion and its relation with

Beijing, P, R. China; ^Department of
Periodontology, School of Dentistry,
Karolinska Institute, Stockholm, Sweden

severity of periodontitis
Jin LJ and Cao CF: Clinical diagnosis of trauma from occlusion and its relation
with severity of pcriodomitis. J Clin Periodontol 1992: 19: 92-97.

Ab.straci. The purpose of the present study was to determine the reliability of
several selected signs of trauma from occlusion and their relations with severity
of periodontitis. 32 moderate to advanced chronic periodontitis patients partici-
pated in the study. All teeth present were evaluated for various abnormal occlusal
contacts, signs of traurna from occlusion, and the severity of periodontitis.
Standardized periapicai radiographs were also taken for each tooth. The results
demonstrated that: (1) no significant difference occurred in probing pocket depth
(PD), chnica! attachment ioss (AL), or percentage of alveolar bone height (BH)
between teeth with and without various abnormal occlusal contacts, i,e., premature
contacts In centric relation occlusion, non-working contacts in lateral excursions,
premature contacts of anterior teeth or posterior protrusive tooth contacts; (2)
teeth with either significant mobility, functional tuobility, or radiographicaily
widened periodontal ligament space (PDLS) had deeper' PD. more AL and '
lower BH than teeth without these signs, while teeth with pronounced wear or
radiographically thickened lamina dura had less AL than teeth without these
findings: (3) 2 combined indices, i.e.. the trauma from occlusion index (TOI) and
the adaptability index (Al). were proposed for the identification of occlusa! trauma
and the response of periodontium to excessive biting forces in heavy function,
respectively; TOI-positive teeth exhibit deeper PD. more AL and less osseous ^
support than TOI-negative teeth; however, ,41-positive teeth had less AL and
more osseous support than Al-negative teeth; (4) with identical attachment levels. Key words: occlusai contacts; trauma from
TOI-positive teeth had less osseous support than TOI-negative teeth while the occlusion; periodontitis.
magnitude of difference became greater with an increase of attachment loss. Accepted for publication 15 November 1990

The role of occlusal trauma in the
pathogenesis of periodontal disease has
been a topic of speculation and investi-
gation since the beginning of this cen-
tury when Karoiyi (1901) first postu-
lated an interaction between excessive
occlusal stress and alveolar pyorrhea
{Hanamura et al. 1987), Although there
have been quite a number of animal and
human histoiogic studies (Waerhaug
1955, Wentz etal. 1958. Ghckman 1963,
Glickman & Smuiow i 968, Comar et al,
1969, Kenney 1971, Rygh 1973, Lind-
he & Svanberg 1974, Zachrisson & Al-
naes 1974, Meitner 1975, Ericsson &
Lindhe 1982. Poison 1986, Chascns
1990), clinical studies showing the re-
lation of trauma from occlusion and
periodontitis are sporadic (Pihistrom et
al. 1986), Lack of established and re-
liable criteria for identifying trauma
from occlusion was the main problem
which limited the clinical studies
(Ramfjord & Ash 1981). Various clinical
and radiographic indications currently
used for trauma from occlusion, such as
recession of gingiva, unfavorable crown
and root ratio, increased tooth mobility,
crown and/or root fractures, widened
periodontal ligament space, angtilar
bone loss and alterations in root morph-
ology etc, (Poison 1980, Ramfjord &
Ash 1981, Carranza 1984, Cripps 1984,
Chasens 1990), are solely based upon
clinical impressions rather than substan-
tiated evidences, and therefore regarded
to be uncertain and insufficient in diag-
nosis of occlusal trauma. The purpose
of this study was to determine the re-
liability of several selected signs of trau-
ma from occlusion and their relations
with the severity of periodontitis.
Materiar and Methods
32 chronic adult periodontitis patients
(17 male, 15 female; age range 25-50
years, mean 37,6 years) were selected
from the periodontal clinic at the School
of Stomatology, Beijing Medical Uni-
versity, Criteria for selection were the
presence of at least 13 natural teeth in
each jaw, without removable dentures
and cross-arch bridges, and with no his-
tory of periodontal therapy, occlusal ad-
justment or orthodontic treatment.
None of the patients had any significant
systemic disease nor had received any
antibiotic therapy during the previous 3
months.
Each patient received a complete
periodontal examination, including oc-
clusal analysis. The periodontal examin-
ation comprised assessments of probing
pocket depth (PD), bleeding index (BI)
(Mazza et al. 1981), gingival index (GI)
(Loe & Silness 1963). clinical attach-
ment loss (AL) as measured from the
cemento-enamcl junction to the deepest
point of probing, plaque index (PLI)
 Diagnosis of trauma from occlusion 93

Tahle 1. Comparison of probing depth (PD), clinical allachment loss (AL) and % of alveolar mm ultra-thin articulating strip (Bausch
bone height (BH) between leeth wiih { + ) and without ( - ) various occlusal contacts; N^
Co. Germany) between the occluding
number of tCLih
tooth surfaces and then guiding the sub-
PD (mm) \L (mm) "/. of BH jects through various appropriate man-
Occlusa! Ktatus n mean P n mean n mean dibuiar movements to determine
premature contacts - 341 5.0
whether occlusal contacts occurred
344 4.2 337 71,5
> 0.05 > 0,05 > 0,05 (Pihlstrom et al. 1986).
in CRO + 7.5 5,4 74 4,4 70 70,3
Data were analyzed by several
non-working contacts - 342 5,1 357 4.4 347 71,8
>0,05 > 0.05 >0,05 methods. The Student /-test was used to
in lateral excursions + 67 4,9 60 4,5 56 72,7
compare the mean values of PD, AL
posterior protrusive - 383 4,8 383 3.9 380 75.8 and % of BH between the teeth with
> 0.05 >0,05 >0.05
tooth contacts + 27 4.7 27 3.8 27 73,3 and without clinical or radiographic
premature contacts ol" - 32 4,6 32 4.9 32 60,8 sign of trauma from occlusion. From
> 0.05 >0,05 >0,05
anterior teeth + 16 4,3 16 5.5 16 54,1 the various clinical or radiographic
signs, 2 combined criteria were then
formed and their relationships with ciin-
(Quigley & Hein 1962). toolh mobility radiographs were taken by an experi- icai parameters and radiograpliic % of
(Hanamura el aj. 1987), modified tooth enced technician. The radiographic par- BH were tested. The 2 criteria were (1),
wear index (TWl) (Smith & Knight ameters included: (!) % of alveolar functional tooth mobility plus radio-
1984). and ftmctional tooih mobility. bone height (BH). i.e.. the "/u of mesial graphically widened PDLS, and (2).
The functional mobility was detected by and distal osseous support for each pronounced tooth wear plus radio-
placing the index finger on the buccal tooth was determined using the tech- graphically thickened lamina dura. The
surfaces o( maxillary teeth while regis- nique of Schei et al. (1959), and the combined criteria were then used to
tering for tooth mobility during re- mean bone height of each tooth was classify the teeth into the respective two
peated habitual centric closure and ex- recorded: (2) presence or absence of groups, e.g., with and without the com-
cursive mandibular movements (Pihl- widened periodontal ligament space bined signs. An unpaired ?-test was used
strom ct ai. 1986). It was recorded for (PDLS) around the zones of root: (3) to determine the statistically significant
each maxillary tooth in accordance with state of lamina dura: — 1 =thickened: differences between the 2 groups. Fur-
the following scale: 0 = no tooth mo- O = normal; 1 = loss of continuity or ab- thermore, a speciai self-paired design
bility during habitual centric closure sence. Each was recorded based on a was carried out and a regression analy-
and excursive mandibular movements: subjective evaluation of the radiographs sis was performed for teeth with same
I = tooth mobility detected only in cen- projected at magnification x 6.0. Exam- AL, as well as similar inflammation in-
tric closure or excursive movements; iner reproducibility for each radio- dices. The purpose of this was to deter-
II = significant tooth mobility detected graphic fmding was detemiined by re- mine if the teeth with the combined cri-
during both eenttic closure and excur- peated but nonconsecutive scoring by teria of functional tooth mobiiity and
sive mandibular movements. PD and another examiner in a random subset of radiographicaily widened PDLS had
AL were measured at the buceal and 81 radiographs. The oeclusal analysis lower % o^ BH than those without the
Hngual sides of each intcrproxima! sur- comprised the determinations of the fol- combined criteria.
face in order to accord with the corre- lowing occlusal contacts by scoring for
sponding measurements on radio- their presence or absence, i.e., prema- Results
graphy. However, the other indices (BL ture contacts in centric relation oc-
GI and PLI) were recorded from 6 sites clusion (CRO). non-working contacts in .According to the examiner reproducible
around each tooth, i.e.. mesiobuccal, lateral excursions, posterior protrusive data of each radiographic parameter, all
midbuccal, distobuccal, mesiolingual. tooth contacts, and premature contacts of the selected signs occurred with
midlingual and distolingual. of anterior teeth. These occlusal con- greatly appreciable frequency. The in-
Standardized full-mouth periapical tacts were identified by placing an 0.020 tra-examiner agreement for scoring the
presence or absence of widened PDLS
was 96" 0, while the agreement for the
Tahle 2. Comparison of width of PDLS for leeth with (-I-) and without (— 1 various occlusal presence or absence of thickened lamina
contacts: A' = number of teeth dura, as well as disappeared lamina
Width of PDLS dura, was 93% and 89%, respectively.
widened normai The intra-examiner reproducibility for
"/) of BH, using the radiographic mea-
Occlusal status A' A' ("/<)) F surement method of Schei et al. (1959),
premature contacts 114 57 84 43 was 87'%,.
in CRO 44 79 12 21
<0.01
+
non-working contacts 114 57 84 43
<0.05 Association between various abnormal
in lateral excursions 42 72 16 28
occlusal contacts and severity of
posterior protrusive 114 57 84 43 periodontitis
>0.05
tooth contacts + 16 70 7 30
A comparison using unpaired ?-test for
premature contacts 26 93 2 7 occlusa! fmdings with respect to PD. AL
-1-1

>0,05
of anterior teeth 10 76 3 24
and % of BH is shown in Table 1. No
 94 Jifi & Cao

Table 3. Comparison of probing depth (PD), clinical attachmenl loss (AL) and % of alveolar PDLS were assigned as control group.
bone height (BH) for leeth with different scale of mobility, functional mobility, tooth wear The clinieal parameters and bone sup-
index and different status of width of PDLS as well as lamina dura: A'= number of teeth
port were then compared between the
PD (mm) AL (mm) of BH two groups. Table 4 shows that TOl-
Scale or .
Parameters status N mean P .'V mean F N mean P positive teeth had more severe destruc-
0-i 227 4,4
tion and inflammation of the perio-
223 3,0 98 79,4
mobihty Il-IIi 285 5,4
<0.01
288 5,8
<O,OI
142 63,2
<0,0i dontal tissues than TOI-negative teeth
functional O 151 4,6 i55 3.5 147 74,3
mobility 11
<0,01 <0,01 <0,0] To judge the adaptive capacity of the
84 5.5 84 5,7 78 62,0
periodontium to excessive biting forces,
tooth wear O-I 52 4,8 73 4,2 71 73.0 we proposed an adaptability index {Al).
index >0,05 <0,05 >0,05
>n 358 4,6 337 3.4 339 74,5 It is composed of pronounced tooth
width of PDLS normal 266 4.5 259 3,0 262 76,5 wear and radiographicaliy thickened
<0,OI <O.OI <0.OI
widened 439 5,1 432 4,7 432 67,2 lamina dura. 47 teeth which met the
thickened iOO 4,9 100 3,8 98 73,5 criteria were selected as positive group,
lamina dura indistinct or while 40 teeth without these signs were
<0,05 <0,OI <0,01
absence 283 5.5 274 5,4 268 64,2 designated as negative group. Table 4
shows that Al-positive teeth had signifi-
cantly (yxO.Ol) less AL and more bone
Statistically significant difference (P> support than Ihose of the negative
those without mobility. Teeth with pro-
0.05) was found for PD, AL or % of group.
nounced wear had less AL than the
BH between teeth with and without the teeth with insignificant wear (/•<0.05), In order to further test the reliability
abnormal occlusal contacts, i.e.. prema- Teeth with widened PDLS had deeper of the proposed trauma from occlusion
ture contacts in CRO, non-working PD, greater AL and lower % of BH than index (TOI) in analysing the relation-
contacts in lateral excursions, prema- teeth with the normal width of PDLS ship between bone support and occlusal
ture contacts o{ anterior teeth or pos- (/'<0.0i). However, teeth with thick- trauma, a strictly controlled study using
terior protrusive tooth contacts. The re- ened lamina dura had less PD, less AL the split-mouth design was performed.
sults also revealed that teeth with and more osseous support than those Each pair of teeth with or without oc-
premature contacts in CRO or non- with indistinct or disappeared lamina clusal trauma, as detemiined by the
working contacts in lateral excursions dura (/'<0.05), TOI, was symmetrically selected from
had significantly widened PDLS than the posterior areas of the same perio-
teeth without these contacts. However, dontitis patient, excluding the third mo-
there was no significant difference in the Association between tiie proposed lars. The test and control teeth from
combined criteria for trauma from the same subjects had to be matched in
width of PDLS for the posterior teeth occiusion and severity of periodontitis
possessing or lacking protrusive con- similar attachment loss, gingival index,
tacts as well as those anterior teeth with According to the results shown in bleeding index, as well as plaque index.
or without premature contacts (Table Tables 3. we hypothesized that the com- Among 58 periodontitis patients, only
bination of some parameters could be 11 pairs of teeth from 11 subjects met
used as diagnostic indices for occlusal all of the above mentioned criteria.
trauma as well as adaptive capacity of Thus, the 2 groups were similar with
Association between each ciinical or
the periodontium to occlusal forces. concern to attachment leveL perio-
radiographic sign of trauma from dontal inflammation as well as local
occlusion and severity of periodontitis
Using the trauma from occlusion index
(TOI), which comprises apparent func- plaque index value. The two groups
Table 3 shows that the teeth with signifi- tional mobility and radiographicaliy were dissimilar only with respect to the
cant mobility or functional mobility had widened PDLS, 63 teeth were assigned combined criteria of trauma from oc-
statistically (P < 0.01) deeper PD, to the trauma group, and 68 teeth with clusion. According to the normality test,
greater AL and lower % of BH than neither functional mobilitv nor widened data from the two groups presented a
normal distribution. Then, the linear re-
gression equations of the two groups
Table 4. Clinical parameters differentiated by trauma from occlusion index (TOI) and adapta- were determined as follows:
bility index (Al): « = number of teeth Y{trauma group) - 96.4] - 10.47 X (r-
Traum a from occlusion index (TOI)
-0.90),
Adaptability index {AI)
y {control group) = 88.96-4.66 X {r =
positive negative positive negative
(n~ = 63) (n = 68)
-0,86).
{« = 47) { « - ' W)
(X, clinical attachment loss, AL; Y, '^
Parameters mean SD mean SD mean SD mean SD of BH; r. correlation coefficient). The
PD (mm) 5.7 1,6 < = > 4.2 1.0 4.8 1.1 < -> 4.7 1.3 results indicated that there was signifi-
AL (mm) 6.1 2.1 < = > 2.7 1.7 3.5 1.8 <-> 5.2 1.7 cantly negative correlation between AL
BH (%) 61.4 14.9 < = > 72.3 20.8 74,5 8.0 < => 63.4 15,3 and % of BH in both the trauma group
BI 3.1 0.9 < = > 2.6 0.9 and the control group (yxO.Ol). Fig. 1
Gl 2,2 0.5 < - > 1,9 0.6 demonstrates that for given attachment
PLI 3.2 0.8 < - > 2.6 0,8
level, teeth with occlusal trauma had
5; < = >i ; <->p>0,05. less osseous support than those of the
 Diagtiosis of trauma from occlusion 95

90
AConlrol Group occlusion, and Al for evaluation of the
• Trauma Group periodonta] tissue adaptation to excess-
ive occlusal forces.
ea
The regression analysis was incorpor-
ated to show the possible effect of
70.
trauma from occlusion on alveolar bone
support with pre-existing periodontai
60. infiammation. The two matched groups
had identical attachment loss and in-
50. flammation, except for the differenee in
the presence of occlusal trauma. The
4o: results demonstrated that for identical
attachment ]oss, teeth with occlusa!
30. trauma had less osseous support than
teeth without trauma. Furthermore, the
magnitude of difference in alveolar bone
20.
0 1 2 3 4 5 6 7 8 support between traumatic and non-
AL(mm) traumatic teeth was amplified when
Fifr. L Regression of "/<• alveolar bone height (BH) on elinical attachment loss {AL) for the
attachment loss increased. This suggests
Irauma group and control group matched for equal AL, similar plaque index and periodontal that trauma from occlusion is positively
inflammation. related to ioss of osseous support in
moderate to advanced periodontitis pa-
tients. The present resuits are consistent
controi group. Furthennort;, the magni- teeth in the arch as well as the different with some histoiogica] studies in human
tude of difference between the 2 groups distribution of occlusal forces. and anima] mode]s (G]ickman & Smu-
became greater when the loss of atiach- Data from the present study also in- ]ow 1967, Lindhe & Svanberg ]974.
ment increased (/7<0.01). dicated that teeth with either significant Meimer ]975. Poison et a]. ]976, Nym-
mobility, functional mobility, or wid- an et ai. ]978). So far. a]though there is
Discussion ened PDLS had deeper PD. more AL no agreement on requisites for occ]usa]
and less osseous support than teeth adjustment in periodonta] patients, the
So far. the effects of various abnormal without these findings. In addition, present study supports the consider-
occlusa] contacts on the periodontium teeth wilh pronounced wear or radio- ation of Ramfjord & Ash (]98]). Ab-
remain poorly defined (Ingle 1957, graphically thickened lamina dura had rams & Potashnick (1990) and Chasens
Burch 1980. Shefter & McFall 1984. less AL. These results agreed with a pre- (]990J, e.g., that occ]usa] adjustment
Chasens 1990). Youdelis& Mann (1965) vious clinical report (Pihistrom et al. should be performed with evidence of
indicated that teeth with contacts on 1986). occiusa] Irauma in advanced perio-
non-working side had significantly A variety of clinical and radiographic dontitis patients, after inflammation has
deeper pocket depth, more alveolar signs of trauma from occlusion have been controlled.
bone loss and greater mobility. But. been suggested in the past (Poison 1980.
The present results differ in one as-
some recent investigations (Shefter & Carranza 1984. Cripps 1984). However,
pect from those reported by Pihistrom
McFail 1984. Pihistrom etal. 1986) were there have been few scientific clinical
et al, (1986). They stated that for any
unable to show a significant association reports to evaluate these signs. In the
given attachment leve]. teeth with a wid-
between the various abnormal occlusal present study, two combined indices,
ened periodontal ligament space and
contacts and the severity of perio- i.e., trauma from occlusion index (TOI)
functional mobility had about ]0% less
dontitis. Similarly, data from the pres- and adaptability index (AI), were pro-
osseous support than teeth without
ent study demonstrated that no signifi- posed respectively, for identification of
these parameters. However, the magni-
cant differences concerning PD. AL and occlusal trauma and the response of
tude of difference in osseous support
alveolar bone support existed be(ween periodonta! structure to occlusal forces
between the test and control groups did
those teeth possessing and lacking vari- in heavy function. Results from the
not become greater with increased
ous abnormal occlusal contacts. How- present study revealed that TOI-positive
attachment loss. The difference between
ever, the results did indicate that the teeth showed more severe inflammation
the present result and Pihlstrom's might
posterior teeth with premature contacts and destruction of the periodontium
be due to the following reasons: our
in centric relation occlusion (CRO), or than TOI-negative teeth. The adapta-
study used various posterior teeth from
non-working contacts in lateral excur- bility index (AI) may reflect tbe ability
moderate to severe periodontitis pa-
sions, were subject to causing widened of the periodontal tissues to adapt and
tients, while Pihistrom et al used only
PDLS. But the anterior teeth with or resist the altered or excessive biting
maxiHary first molars; furthermore, in
without premature contacts in pro- forces in heavy function. The results in-
our present study, a stricter criterion
trusion, were all related to widened dicated that Al-positive teeth had more
was employed in selecting the paired-
PDLS. The reasons for the different ef- alveolar bone support and less attach-
teeth from the same subjects. However,
fects of the abnormal occlusal contacts ment ioss than Al-negative teeth. These
the present conclusions have been
on the width of PDLS among anterior results have demonstrated the justifi-
drawn from a re]ative]y sma]l sample
and posterior teeth may be related to cation for using TOI as a clinical criteria
size. Further investigations are warrant-
the anatomy of tooth, location of the for the determination of trauma from
 96 Jin & Cao
ed to confirm these findings in the
future.
Acknowledgments
The authors wouid iike lo thank Pro-
fessor Jan Lindhe, Department of Perio-
dontology, Gothenburg University, and
Professor Per-6sten Soder, Department
of Periodontology. Karolinska Insti-
tute, for their valuable comments on the
manuscript. The authors also wish to
thank Dr. Paul Khamesi for improving
the standard of English of the text.
Zusammenfassung
Die klinische Diagno.ne des okklii.salen Trau- periapicales standardisies de toutes les dents
mas und ihre Verbindung mit der Schwere der
Parodontitis
Der Zweck der vorliegenden Studie war es,
die Zuverlassigkeit von verschiedenen ausge-
wahllen Anzeichen eines okklusaien Traumas
und ihre Verbindung mit der Schwere der
Parodontitis zu besiimmen, 32 Patienien mit
maBiger bis fortgeschriltener chroniseher Pa-
rodontnis nahmen an der Studie teil, Alle
vorhandenen ZJihne wurden hinsichlJich ver-
schiedenartiger abnormer okklusaler Kon-
takte. der Anzeichen von okklusalem Trauma
und der Schwere der Parodontitis evaluiert,
Standardisierte periapikale Rontgenbilder
wurden auch von jedem Zahn erstellt. Die
Ergebnisse zeigten: (I) Es besteht kein signifl-de Tespace desmodontal (PDLS), la profon-
kanter Unterschied in der klinischen Sondic-
rungstiefe (PD). dem kiinischen Attachment-
Verlust (AL), oder dem Prozenlsatz an Alve-
olarknocheiihohe |BH) zwischen Ziihnen niit
und ohne verschiedenartige abnorme okklu-
sa!e Kontakte. Da7U gehoren vorzeitige Kon-
takte in zeotrischer Relation, Kontakte bei
seitlicher Exktirsion aufder Nicht-Arbeitssei- ies autres; (3) on a propose la combinaison de
te. vorzeitige KonLakte von Frontzahnen
oder posteriore protrusive Zahnkontakte: (2}
Zahne mit entweder signifikanter Beweglich-
keit, funktioneller Beweglichkeit. oder ronge- tisme du a l'ocelusion et de la reaction du
noJogisch verbreitertem Parociontalspalt parodonte i'l des forces occlusales excessives
(PDLS) hatten groBere PD. mehr AL und
niedngere BH als Zahne ohnt' diese Befunde.
wahrend Zahne mit ausgepriigter Abrasion
oder rongenologisch dickerer Lamina dura
geringeren AL als Zahne ohne diese Befunde
hatten; (3) Es wurden zwei kombinierte Indi-
zes, z.B.. der Trauma durch Okklusions Index
(TOI) und entspreehend der Anpassungs-In-
dex (AI), vorgeschiagen. um die Identifika-
tion des okklusaien Traumas und der Reak-
tion des Parodoritiums auf exzessive Kau-
krafie bei sehwerer Kauarbeit erreichen zu
konnen; TOI-positive Zahne zeigten tiefere
PD, mehr AL und geringere knocherne Un-
terstijtzung, ais TOI-negative Zahne, Jedoch
hatlen Al-positive Zahne geringeren AL und
mehr knocheme Unterstiitzung als Al-nega-
live Zahne; (4) mit identischem Attachment-
niveau, TOI-positive Zahne geringere kno-
cherne Unterstiitzung hatten, ais TOI-negati-
ve Ziihne, wahrend die Differenz mit
zunehmendem AttachmentverlusI groBer
wurde.
Resume
Diagnostic ctiniquc des traumati.smes dus a
I'occtiision ct relation avec la severite des paro-
don t ites
La presente etude avait pour but de determi-
ner la fiabilite de plusieurs signes choisis coin-
me indiquant I'cxistence de traumatismes dus
a Focciusion et leur relation avec la severite
des parodontites. Uetude porlail sur 32 pa-
tients atteints de parodontite chronique mo-
deree a avancee, Les contacts occlusaux anor-
maux de differentes sortes. les signes indi-
quant un traumatisme du a rocciusion. et la
severite des parodontites ont ete evaiues sur
toutes les dents presentes, Des radiographies
ont aussi ete prises, Les resultats ont montre
que (!) aucune diflerence significative concer-
nant ia profondeur des poehes au sondage
|PD). la perte d'attache a I'examen clinique
|AL) et la hauteur relative (%) de Fos alveo-
laire (BH) n'existait entre les dents avec et
sans contacts occlusaux anormaux de diffe-
rente nature: contacts premaiures en occlu-
sion eentree. contacts du cote non travaillant
dans les mouvements de lateralite. contacts
prematures sur les dents anterieures et
contacts sur les dents posterieures dans les
mouvements de propulsion: (2) sur les dents
presentant soit une motiilite notable, soit une
mobilite fonctionneiie, soil un elargissement
deur des poehes et la perte d'attache etaient
plus importantes et la hauteur relative de I'os
alveolaire plus basse que sur les dents ne
presentanl pas ces signes, tandis que les dents
presentant un attrition marquee ou un epais-
sissement de la lamina dura sur ies radiogra-
phies avaient moins de perle d'attache que
2 indices, un indice de traumatisme occlusal
(TOI) et un indice d'adaptibilite (AI) pour
i'identifieation respectivement d'un trauma-
pendant une forte charge fontionnelie: les
dents dont le TOI etait positif avaient des
PD plus profondes, uoe perte d'attache plus
marquee et moms de soutien osseux que les
dents dont le TOI etait negatif; cependant,
les dents dont 1',^! etait positif avaient moms
de perte d'attache et plus de soutien os.seux
que les dents dont I'Al etail negatif; (4) avec
des niveaus d'attache identiques, les dents a
TO! positif avaient moins de soutien osseux
que les dents a TOI negalif, mais la grandeur
de la difference augmentait avec Taugmeota-
tion de la perte d'attache.
References
Abrams, L, & Potashnick, S, R, (1990) Role
of occlusion in periodonta] disease. In:
Contemporary periodontics, eds. Genco. R,
J,, Goldman, H, M. & Cohen, D. W, pp.
194 202. St, Louis: C, V, Mosby Co.
Bureh, J, G, (1980) The selection of occlusal
patterns in periodontal therapy. Dental
Clinics ofA'orfh America 24, 343-356,
Carranza, F, A, Jr. (1984) Giickman 's clinical
periodontology. 6th edition, p, 267, Phila-
delphia: W, B, Satinders Co,
Chasens. A. 1, (1990) Controversies in oc-
clusion. Dental Clinks of North America
M. Ill 123,
Comar. iVI, D . Kollar. J, A, & Gargiuio,
A. W, (1969) Local irritation and occlusal
trauma as co-factors in the periodontai dis-
ease process. Journal of Periodontotogy 41),
193-200.
Cripps, S, (ed,) (1984) Periodontal disease:
recognition, interception and prevention. A
guide for the general practitioner, pp,
195-203, Chicago: Quintessence Pub-
lishing Co, Inc,
Ericsson. 1, & Lindhe. J. (1982) The effect
of long-standing jiggling on experimental
marginal periodontitis in the beagle dog.
Journal of Clinical Periodonioiogy 9.
497 503.
Giickman. I, (i963) inQammation and
trauma from occiusion: co-destructive fac-
tors in chronic periodontal di.sease, .louma!
of Periodontoiogy 34. 5-10,
Giickman. I, & Smuiow. J, B, i 1967) Further
observations on the effects of trauma from
occlusion in humans. Journal of Perio-
dontology 38, 280 284,
Giickman. I, & Smuiow, J, B, (1968) Adap-
tive alternations in the periodontium of
the rhesus monkey in chronic trauma from
occiusion. Journal of Periodantotogy 39,
iOi-iO.5,
Hanamura. H,. Houston. F,. Ryiander, K,,
Carlsson, G, t".. Haraidson, T, & Nyman,
S, (i9K7) Periodontal status and bruxism
- a comparative study of patients with
periodontai disease and occiusai parafunc-
tions, Journat of Periodoniologv 58,
173-176.
Ingle. J, I, (1957) Determination of occiusai
discrepancies, Journat of American Dciuat
As.sociatiiin 54, 6-24.
Kenney, E, B, (1971) A histopathologic study
of ineisal dysfunction and gingivai inflam-
mation in the rhesus monkey. Journal of
Periodontology 42. 3 7,
Lindhe, J, & Svanberg, G, (i974) Innuence
of trauma from occiusion on progression
of experimental periodontitis in the beagle
dog, Journat of Clinicat Periodontotogy 1,
3-14,
Loe, H. & Siiness, J, (i963) Periodontal dis-
ease in pregnancy (1). Prevalence and se-
verity, Acta Odontotogica Scandinavica 21,
533-551.
Mazza, J, E,. Newman, M. G, & Sims, T, N,
(1981) Clinical and anlimicrobiai effects of
stannous fiuoride on periodontitis. Journat
of Clinical Periodontology 8, 203-2 i 2,
Meitner, S, (1975) Co-destructive factors of
marginal periodontitis and repetitive
mechanical injury. Journal of Dented Re-
search 54 (Speciai Issue C). C78- C85.
Nyman, S., Lindhe. J, & Ericsson, I. (i978)
The effect of progressive tooth mobiiity on

destructive periodontitis in the dog. Joui-
nat of Clinical Periodontology 5. 213-225,
Pihlstrom, B. L., Anderson, K. A.. Aeppli.
D. & Schaffer, E. M. (1986) Association
between signs of trauma from occlusion
and periodontitis. Journal of Periodoniolo-
gy 57, 1-6.
Poison, A. M., Meilner, S, W & Zander. H.
A. (1976) Trauma and the progression of
marginal periodontitis in squirrel mon-
keys. III. Adaptation of interproximal
bone Io repetitive injury, .lournal of Perio-
dontal Research 11. 279-289.
Poison. A. M. (1980) Efficacy of occlusal
adjustment in periodontal treatment. In:
Efficacy of treatment procedure.^ in perio-
dontics. ed. D. B. Shanley, p, 245. Chicago:
Quintessence Publishing Co. Inc.
Poison. A. M. (1986) The relative importance
of plaque and occlusion in periodontai dis-
ease. Journal of Clinical PerioiJonlologv 13.
923 927.
Quigley, G. A, & Hein. J. W. (1962) Com-
parative cleansing efficiency of manual and
Diagnosis of trauma from occlusion
power brushing. Journal of American Den-
tat A.ssociation 65, 26-29.
Ramfjord, S. P. & Ash. M. M. Jr, (1981)
Significance of occlusion in the etiology
and treatment of early, moderate and ad-
vanced periodontitis. Journal of Perio-
doniology 52, 511-517.
Rygh, P. (1973) Uhrastructural changes in
pressure zones of human periodontium in-
cident to orthodontic tooth movement.
Acta Odonlohgica Scandinavica 31.
109 122,
Schei, O.. Waerhaug. J., Lovdai. A. & Arno.
A. {1959) Alveolar bone loss as related to
oral hygiene and age. Journal of Perio-
donlotogy 30, 7-16,
Shefter, G. J. & McFall, W 1. Jr. (1984)
Occlusal relations and periodontai status
in human adults. Journal of Pertodunlology
55, 368-374,
Smith, B, G, N, & Knight. .1, K. (1984) An
index for measuring the wear of teeth.
British Dentat Journal 156. 435^38,
Waerhaug. J. (1955) Pathogenesis of pocket
97
formation in traumatic occiusion. Journal
of Periodontology 26, 707-718.
Wentz, F. M., Jarabak, J. & Orban, B, (15J58)
Experimental occlusal trauma imitating
cuspai interferences. Journal of Perio-
dontology 19, 117-127.
Yuoddis. R. & Mann, W. Y Jr, (1965) The
prevalence and possible roJe of non-
working contacts in periodontal disease.
Periodontics i, 219-223.
Zachrisson, B, U, & AInaes, L, (1974) Perio-
dontal condition in orthodontically treated
and untreated individuals. Angle Ortho-
dontist 44. 48-55,
Address:
L. J. Jin
Department of Periodontology
School of Dentistry
Karolin.ika Institute
Box 4064
S-I41 04 Huddinge
Sweden