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Review Article

Trauma from Occlusion: The Overstrain of the Supporting

Structures of the Teeth
Dhirendra Kumar Singh, Md. Jalaluddin, Rajeev Ranjan
Department of Periodontics and Oral Implantology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India

Abstract
Any occlusal force which goes beyond the adaptive capacity of our periodontium causes injury to periodontal structures, and the resultant
trauma is called as trauma from occlusion (TFO), several schools of thoughts are there that whether TFO is an etiological factor or cofactor for
the occurrence of periodontal diseases. Present review paper is an effort to clear the actual concept of TFO along with its historical background,
etiological factors, relevant terminologies, signs and symptoms, and advanced diagnostic methods.

Keywords: Occlusal forces, periodontium, traumatic occlusion

Introduction This review is based on analysis of 150 papers published

For many years, the role of occlusion and its dynamic interactive
impact on the periodontium has been an issue of controversy and
extensive debate. Although a variety of occlusal conditions have
purportedly been related to this interaction, the central focus
has been on occlusal trauma resulting from excessive forces
applied to the periodontium.[1‑4] In an attempt to clarify and
better understand this condition, early investigators used human
necropsy specimens and a variety of animal models as a basis
for clinical and histological studies. Findings were often diverse
and somewhat contradictory. In the animal studies, factors of
concern included differences among animals, forces applied,
and lack of controls. Retrospective descriptive observations of
the effect of excessive forces on the periodontium were derived
from human necropsy materials. The selection of study sites
was based on occlusal wear, patterns of pocket formation, and
presence of attachment loss leaving some questions as to the
presence of ongoing occlusal trauma.
Despite the foregoing concerns, the majority of these early
studies agreed that occlusal trauma in and of itself failed
to result in pocket formation or loss of connective tissue
attachment. It is apparent that the effects of excessive occlusal
force and the destructive, adaptive, and reparative response
of the periodontium have been complicated by a relative lack
of evidence based on well‑controlled prospective studies in
human beings.[5‑7]
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in English language till November 2016 in peer‑reviewed
journals. The search for papers was performed using Medline,
Google Scholar, and PubMed by searching keywords such
as trauma from occlusion, primary trauma from occlusion,
secondary trauma from occlusion, trauma from occlusion,
and periodontal diseases. Any discussion related to the
trauma from occlusion  (TFO) use of in periodontics and
implantology was taken into consideration if appropriate
for this review.
The present literature review is an attempt to address the
histological and clinical effects of abnormal occlusal forces
on other teeth and periodontium and to provide diagnosis and
clinical aspects for the same.
Historical Aspects
Karolyi was the first one to start the most controversial issue
by introducing in 1901 the concept of bruxism as a significant
factor in the pathogenesis of periodontitis. It is known as the
“Karolyi effect.”
Address for correspondence: Dr. Dhirendra Kumar Singh,
Department of Periodontics and Oral Implantology, Kalinga Institute of Dental
Sciences, KIIT University, Bhubaneswar ‑ 751 024, Odisha, India.
E‑mail: dr.dhirendra27@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and
build upon the work non‑commercially, as long as the author is credited and the new creations
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DOI: How to cite this article: Singh DK, Jalaluddin M, Rajeev R. Trauma from
10.4103/IJDS.IJDS_21_16 occlusion: The overstrain of the supporting structures of the teeth. Indian
J Dent Sci 2017;9:126-32.

126 © 2017 Indian Journal of Dental Sciences | Published by Wolters Kluwer - Medknow
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Singh, et al.: Trauma from occlusion
Talbot did the first comprehensive study of the role of occlusal
stress on teeth in relation to periodontal disease was made by
Talbot, who pointed out that man is predisposed to disease of
the supporting tissues of the teeth because jaw function has
been greatly decreased by modern methods of food preparation.
Box et  al. did study on sheeps’ tooth suggesting that TFO
produces vertical bone defect. Stillman[8] was the first to
emphasize traumatic occlusion as a cause of periodontal
disease. Repeated abnormal pressures of one tooth on another
produce traumatic injury. He pointed out that there are
noninfectious changes that are directly produced by traumatic
occlusion.
Glickman and Smulow[9‑11] proposed the theory in the early
1960s that a traumatogenic occlusion could act as a cofactor in
the progression of periodontitis. This theory is known as the “co
destructive theory.” Goldman[12] proved that occlusal trauma
was not the cause of soft tissue lesions such as Stillman’s clefts
and McCall’s festoons. Waerhaug[13,14] proved the involvement
of TFO in the pathogenesis of Infrabony pockets. Polson[15,16]
used squirrel monkeys as their animal model. Houston et al.[17]
concluded that there is no correlation between periodontal
disease and bruxism; they seldom occurred in the same
individual, and bruxism and occlusal status are not closely
associated.
Burgett et al.[18] found no significant difference in the reduction
in tooth mobility between the adjusted and the nonadjusted
groups. Wolffe et al.[19] stated that “a periodontium remained
healthy despite the persistent forces that caused the drifting of
the teeth and significant changes in occlusion.”
Ericsson et  al. [20] showed that splinting failed to retard
attachment loss or to inhibit plaque down growth. He showed
that despite healthy gingival tissues, jiggled teeth lost marginal
bone and had more probing depth when compared to the
nonjiggled.
Terminologies Used With Trauma from Occlusion
1. Occlusal traumatism:[21] The term traumatic occlusion,
introduced by Stillman, denoted abnormal stress capable
of producing injury to dental or periodontal tissues
2. Trauma from occlusion: It is a term used to describe
pathologic alterations or adaptive changes which develop
in the periodontium as a result of undue force produced
by the masticatory muscles
TFO was defined by Stillman[8] as “a condition where
injury results to the supporting structures of the teeth
by the act of bringing the jaws into a closed position.”
The WHO in 1997 defined TFO as “damage in the
periodontium caused by stress on the teeth produced
directly or indirectly by teeth of the opposing jaw.” In
“Glossary of Periodontics terms”  (American Academy
of Periodontology 1986), occlusal trauma was defined
as “An injury to the attachment apparatus as a result of
excessive occlusal force”[22]
Indian Journal of Dental Sciences  ¦  Volume 9  ¦  Issue 2  ¦  April-June 2017
3. Fremitus: A palpable or visible movement of a tooth when
subjected to occlusal forces  (also known as functional
mobility)
4. Occlusal adjustment: Reshaping of the occlusal surfaces
of teeth by grinding to create harmonious contact
relationships between the upper and lower teeth, or
orthodontic movement of the teeth to create more
harmonious contact relationship
5. Occlusal interference: Any contact that inhibits the
remaining occluding surfaces from achieving stable and
harmonious contacts
6. Occlusal traumatism: The overall process by which
a traumatogenic occlusion produces injury in the
periodontal attachment apparatus
7. Parafunction: Abnormal or perverted function
8. Premature occlusal contact: A condition of tooth contact
that diverts the mandible from a normal path of closure
9. Traumatogenic occlusion: [23] Any occlusion that
produces forces those cause an injury to the attachment
apparatus
10. Occlusal trauma: [24,25] An injury to the attachment
apparatus as a result of excessive occlusal forces.
Classification of Trauma from Occlusion
Glickman’s classification (1953)
According to duration of cause:
i. Acute TFO
ii. Chronic TFO.
According to nature of cause:
i. Primary TFO
ii. Secondary TFO.
Box’s classification
Physiologic occlusion
Box defined it as a condition, in which the systems of forces
acting upon the tooth during the occlusion are in a state of
equilibrium, and they do not and cannot change the normal
relationship existing between the tooth and its supporting
structures.[26]
Traumatic occlusion
The damage produced in the periodontium is due to the
overstress produced by the occlusion.
Hamp, Nyman, and Lindhe’s classification (1975)
This classification is based on a horizontal component of
tissue destruction that has occurred in the interradicular area,
i.e., degree of horizontal root exposure or attachment loss.
• Degree I: Horizontal loss of periodontal tissue support not
exceeding one‑third of the width of the tooth
• Degree II: Horizontal loss of periodontal support
exceeding one‑third of the width of the tooth
• Degree III: Horizontal through‑and‑through destruction
of the periodontal tissue in the furcation area.
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Singh, et al.: Trauma from occlusion
Primary trauma from occlusion
It is generally referred to as a condition resulting from
abnormal occlusal forces on relatively sound periodontal
structure. In effect, the traumatic forces acting on teeth with
normal support are greater than the forces that can be withstood
without injury to the periodontium.
Secondary trauma from occlusion
Applied to a condition resulting from physiologic or abnormal
occlusal forces, which act on a dentition that is seriously
weakened by the loss of supporting alveolar bone. This lack
of periodontal support may result not only from effects of
periodontal disease but also from injudicious bone resection
during periodontal therapy or oral surgery, from accidental
trauma or from excessive apical resorption associated with
orthodontic or endodontic therapy.
Acute trauma from occlusion
Acute TFO results from an abrupt occlusal impact such as that
produced by biting on a hard object (e.g., an olive pit). In addition,
restorations or prosthetic appliances that interfere with or alter the
direction of occlusal forces on the teeth may induce acute trauma.
Chronic trauma from occlusion
Chronic TFO is more common than the acute form and
is of greater clinical significance. It most often develops
from gradual changes in occlusion produced by tooth wear,
drifting movement, and extrusion of teeth, combined with
parafunctional habits such as bruxism and clenching, rather
than as a sequel of acute periodontal trauma.
Etiological Factors
Ross has divided the factors causing chronic destructive
periodontal disease into two groups:
a. Precipitating factors: Precipitating factors are the irritants
and the destructive occlusal forces that further destroy the
tissues weakened by predisposing factors
b. Predisposing factors: Factors which take the place of
those contributing to the histopathologic lesion are listed
as developmental factors, functional mechanisms, and the
systemic component.
They can be divided into intrinsic and extrinsic factors:
Intrinsic factors
1. Morphologic characteristics of the roots. Such factors as
their size, shape, and number are of prime importance.
Teeth with short, conical, slender, or fused roots rather
than divergent roots are more predisposed to occlusal
traumatism when subjected to prolonged excessive force
than are those with normal structure
2. The manner in which occlusal surfaces and the roots
are oriented in relation to the forces to which they are
exposed. Axially inclined forces are more tolerable than
are nonaxially inclined forces, which may be functional
or parafunctional. When teeth are badly aligned, the effect
of excessive force can be deleterious
128 Indian Journal of Dental Sciences  ¦  Volume 9  ¦  Issue 2  ¦  April-June 2017
3. Morphologic characteristics of the alveolar processes.
If the quantity or quality of alveolar bone is inherently
lacking, the effects of prolonged parafunctional forces
may result in rapid loss of the remaining support.
Extrinsic factors
Among the extrinsic factors that may seriously increase the
rapidity of loss of supporting alveolar bone are the following:
1. Irritants: Microbial plaque is implicated as the most
serious irritant. Other irritants that may have similar
effects are food impaction that results in positive pressure
on the tissues, overhanging restorations, poorly contoured
crowns and bands, and ill‑fitting partial denture clasps
2. Neuroses that result in parafunctional activities, for
example, bruxism. These factors are the most prevalent
and serious causes of abnormal occlusal stresses
3. Loss of supporting bone: Periodontitis, injudicious bone
resection, inadvertent trauma, and systemically related
diseases are the chief causative factors
4. Loss of teeth resulting in overloading of the remaining
teeth, for example, posterior bite collapse
5. Iatrogenically created functional malocclusion.
The terms precipitating and predisposing are equally applicable
to the factor causing occlusal traumatism.
Normal Function Versus Parafunction
Two major categories of activity are performed by the
stomatognathic system: normal function and parafunction.
Mastication, occlusional light contact during speech,
swallowing, coughing, and yawning are regarded as normal
functions; all other forms of pressure contact of the teeth are
parafunctional.[27]
Significance of Parafunction
Parafunctional forces have been stressed as the major etiologic
factors in occlusal traumatism. The significance of parafunction
becomes increasingly greater in mouths that already show signs
of alveolar bone loss. Dentitions with moderate‑to‑severe loss
of periodontal support cannot adequately resist parafunctional
forces. Alveolar support rapidly deteriorates unless proper
therapeutic measures are undertaken. The periodontium must
receive additional resistance to normal and parafunctional
forces.
Other Predisposing Factors
Loss of teeth
The early loss of teeth from caries or accident is common
and predisposes to occlusal traumatism. A classic example is
posterior bite collapse resulting from premature loss of the
first permanent molar. The effects of tooth loss are not always
restricted to the immediate vicinity of the loss. Changes often
take place some distance from missing teeth. As a result of
loss of first permanent molars, there are occlusal discrepancies.
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Singh, et al.: Trauma from occlusion
The discrepancies often cause an increased slide from centric
relation occlusion to centric occlusion; the anterior teeth hit
each other with increased force during mastication. This
functional disharmony causes the anterior teeth to drift labially,
thereby resulting in an open contact relationship of the anterior
segment. The next phase usually is further bite collapse and
loss of alveolar bone.
Faulty restorative dentistry
It is commonly a predisposing factor to acute occlusal
traumatism. The traumatism may be transient if the tooth or
teeth can drift or rotate into a harmonious occlusal relationship
if not, the traumatic situation may become chronic. Therefore,
the principles of good functional occlusion must be followed
during restorative procedures.
Injudicious periodontal surgery
Loss of alveolar support caused by either periodontal disease
or corrective procedures may seriously aggravate occlusal
traumatism. In many severe cases, the value of pocket
elimination by bone resection must be weighed carefully
against this decrease in support. In such circumstances,
functional forces previously within a physiologic range may
become excessive and irreversible breakdown may occur.
Whether bone resection will predispose to occlusal traumatism
depends on several factors. The most significant are the amount
and location of bone loss around the tooth before surgical
intervention. One must relate the degree of loss to the mobility.
Significant intrinsic factors to consider are the size, shape,
number, and position of roots relative to the alveolar process.
Faulty occlusal adjustment
Therapeutic measure to correct faulty functional occlusion
can result in further aggravation if used indiscriminately.
Occlusal adjustment procedures resulting in occlusal contact
relationships with forces not directed axially cause further
trauma.
Temporomandibular joint dysfunction
Some forms of temporomandibular joint  (TMJ) affliction
can result from minor functional occlusal discrepancies
coupled with psychoneurotic habits as well as from major
dysfunctional occlusal relationships alone. Often patients
demonstrate mandibular deviations that result in bizarre
occlusal relationships. Before any occlusal adjustment, one
must determine how much of the faulty occlusal relationship
is caused by mandibular deviation resulting from myospasm
or edema related to posterior encapsulitis. Occlusal correction
should not be done during the acute stages of TMJ dysfunction.
Posselt and Maunsbach (1957)[28] basing his observations
on the result of three separate studies noted that bruxism
and clenching activities are associated with biting forces of
over 20 kg/s, and in some instances, intermaxillary contacts
for up to 2.5 s.
Tooth malposition or occlusal discrepancies are almost
universally present unless the occlusion has to be treated.
Indian Journal of Dental Sciences  ¦  Volume 9  ¦  Issue 2  ¦  April-June 2017
However, they do not necessarily produce signs or symptoms
of occlusal trauma since adaptation is the rule. Adaptation
to interferences is dependent on the level of psychic tension
or stress to which the individual is subjected. Consequently,
the functional impact of an occlusal discrepancy cannot be
predicted and could change over time. An overloaded tooth
may adapt to the excessive forces by having increased, but not
increasing, mobility or by moving away from the excessive
force (migration). Under stress, however, the effect of occlusal
discrepancy may become significant enough to overcome
adaptation and thus become a traumatic interference. The
interplay between stress and occlusal interference may trigger
the production of bruxism. It is the first manifestation of lack
of adaptation to occlusal relationships. It’s true detrimental role
depends on the degree of adaptation of the particular individual.
If well‑adapted teeth may depict wear facets, minimal
increased mobility, and radiographically a well‑defined
periodontal support. This represents hyperfunction. If
adaptation is overridden, this parafunctional habit may trigger
symptomatology and an occlusion dysfunction develops.
Etiologic factors of periodontal occlusal trauma can be divided
into four categories:
1. Situation that increases the magnitude or frequency of
occlusal forces
2. Situations that change the direction of occlusal forces
3. Circumstances that decrease the resistance of the
periodontium to occlusal forces
4. Combination of all three factors.
Situation that increases the magnitude or frequency of
occlusal forces
a. Long sustained occlusal contacts from parafunctional habits
such as clenching, bruxism, and chewing on pipe stems
b. Parafunctional habits stimulated by occlusal interferences
such as centric prematurities and balancing side contacts
c. Parafunctional habits and/or the direction of an entire
occlusal load onto one or a few teeth triggered by
restorative and prosthetic dentistry that does not
harmonize with the entire occlusion
d. Fixed and removable prosthetic appliances.[29]
Situations that change the direction of occlusal forces
a. Tipping forces from occlusal interferences such as centric
prematurities and balancing side contacts, which usually
occur on inclined planes
b. Parafunctional habits in extreme eccentric positions
c. Restorative and prosthetic treatment that generate tipping
occlusal forces
d. Tilting and drifting of teeth.
Circumstances that decrease the resistance of the
periodontium to occlusal forces
a. Loss of alveolar bone and periodontal ligament  (PDL)
support
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Singh, et al.: Trauma from occlusion
b. Loss of a number of teeth, thereby requiring fewer teeth
to absorb the entire occlusal load.
Combination of all three factors
All the three, i.e.,  combination may be found in case of
moderate‑to‑severe periodontitis combined with missing and
drifted teeth, occlusal disharmonies, and parafunctional habits.
Tissue Response to Trauma from Occlusion
Stages of tissue response
The tissue injury occurs in three stages. The first is injury,
the second is repair, and third is adaptive remodeling of the
periodontium. Tissue injury is produced by excessive occlusal
forces. Nature attempts to repair the injury and restore the
periodontium. This can occur if the forces are diminished or
if the total drifts away from them. However, if the offending
force is chronic, the periodontium is remodeled to cushion its
impact. The ligament is widened at the expense of the bone;
angular bone defects occur without periodontal pockets; and
the tooth becomes loose.[30-33]
Stage I injury
Under the forces of occlusion, a tooth rotates around a fulcrum
or axis of rotation that is located in single‑rooted teeth, in the
junction between the middle third and the apical third of the
clinical root. This creates areas of pressure and tension on
opposite sides of the fulcrum. Different lesions are produced
by pressure and tension although if jiggling forces are exerted
they may coexist in the same area.
Slightly excessive pressure stimulates resorption of the
alveolar bone, with a resultant widening of the PDL space.
Slightly excessive tension causes elongation of PDL fibers and
opposition of alveolar bone. In areas of increased pressure, the
blood vessels are numerous and reduced in size, in areas of
increased tension they are enlarged. Greater pressure produces
a gradation of changes in the PDL, staring with compression of
the fibers, which produces areas of hyalinization. Subsequent
injury to the fibroblasts and other connective tissue cells leads
to necrosis of areas of the ligament.[2,24,32,33]
Stage II repair
Repair is constantly occurring in the normal periodontium.
During TFO, the injured tissues stimulate increased reparative
activity. The damaged tissues are removed, and new connective
tissue cells and fibers, bone, and cementum are formed in an
attempt to restore the injured periodontium. Forces remain
traumatic only so long as the damage produced exceeds the
reparative capacity of the tissues. Cartilage‑like material
sometimes develops in the PDL space as an aftermath of the
trauma. Formation of crystals from erythrocytes has also been
shown. When bone is resorbed by excessive occlusal forces,
nature attempts to reinforce the thinned bony trabeculae with
new bone. This attempt to compensate for lost bone is called
buttressing bone formation and is an important feature of the
reparative process associated from TFO. It also occurs when
bone is destroyed by inflammation or osteolytic tumors.
130 Indian Journal of Dental Sciences  ¦  Volume 9  ¦  Issue 2  ¦  April-June 2017
Stage III adaptive remodeling of the periodontium
If the repair process cannot keep pace with the destruction
caused by the occlusion, the periodontium is remodeled in an
effort to create a structural relationship, in which the forces
are no longer injurious to the tissues. This result in a thickened
PDL, which is funnel shaped at the crest and angular defects
in the junctional epithelium with no pocket formation. The
involved teeth become loose. An increase in vascularization
had also been reported.
The three stages in the evolution of traumatic lesions have
been differentiated histometrically by means of the relative
amounts of periodontal bone surface undergoing resorption
or formation. The injury phase shows an increase in areas
of resorption and decrease in bone formation, whereas the
repair phase demonstrates increased formation and decreased
resorption. After adaptive remodeling of the periodontium,
resorption and formation return to normal.[24,32,33]
Signs and Symptoms
The most important clinical sign of trauma is increased
tooth mobility. Tooth mobility produced by TFO occurs in
two phases. The initial phase is the result of alveolar bone
resorption increasing the width of the PDL and reducing
the number of periodontal fibers. The second phase occurs
after repair of the traumatic lesion and adaptation to the
increased forces, which results in permanent widening of
the PDL space.
Presence of occlusal wear which can note attributed to any
abnormality of patient diet and is not commensurate with
patient’s age.
Tilting and migration of individual teeth or of complete
segments.
Radiographic signs
1. Widening of the PDL space, often with thickening of the
lamina dura along the lateral aspect of the root in the apical
region and in bifurcation areas
2. Vertical rather than horizontal destruction of the interdental
septum, with the formation of infrabony defects
3. Radiolucency and condensation of the alveolar bone
4. Root resorption.[34‑36]
Clinical signs
Box and Stillman considered TFO to be the causative factor
for the following signs of incipient periodontal disease:
1. Traumatic crescent – a crescent‑shaped bluish red zone of
gingiva confined to about one‑sixth of the circumference
of the root
2. Recession of the gingiva, which may be asymmetrical,
associated with resorption of the alveolar crest
3. Stillman’s clefts  –  indentations in the gingival margin,
generally on one side of the tooth
4. McCall’s festoons ‑ discrete semilunar enlargement of the
marginal gingiva
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Singh, et al.: Trauma from occlusion
5. Absence of stippling – interpreted as evidence of edema
secondary to trauma.
None of these changes have been shown conclusively to be
associated with trauma to the periodontium.
Clinical Features of Occlusal Trauma
1. No periodontitis
2. Tooth wear (mild faceting or marked attrition)
3. Fractures of the enamel or restorations
4. Occlusal interferences (either from the retruded contact
position to intercuspal position  (ICP) or in lateral
excursions/protrusive movements)
5. Ridging of buccal mucosa
6. Indentations in lateral border of the tongue
7. Reddening of the tip of the tongue.
Radiographical Features
1. Hypercementosis
2. Secondary dentin laid down in the pulp chamber.
Diagnosis
Because TFO is defined and diagnosed on the basis of
histologic changes in the periodontal supporting structure,
diagnosis is impossible without block section biopsy. Often
Angle’s classification is a part of occlusal analysis. However,
the Angle’s classification was designed to classify the skeletal
relationship between the mandible and maxilla and the little
bearing on the occlusal relationship that exists between
various cusp surfaces. Therefore, it is the relationship between
opposing cusps that is the most important aspect of occlusion.
The tooth mobility and wear patterns are extremely difficult to
correlate with occlusal contacts. In the case of mobility, many
other factors such as loss of attachment can affect the presence
and severity of the mobility.
1. Cardinal manifestation of primary TFO is increased tooth
mobility. The mobility can be assessed by mechanical and
electronic instrument. Subjective assessments of mobility
are done as in Miller classification assigned from 0 to 3
score
2. Tilting and migration of individual teeth or of complete
segments. The percussion of teeth on tapping with a blunt
instrument changes from a resonant note with a healthy
supporting structure to a dull note if there is primary TFO
in attachment apparatus
3. Careful palpation of the muscles of mastication to ascertain
whether there is hypertrophy or sign of hypertonicity with
possible spasm of one group of muscle
4. Palpation of TMJ and observation of any deviation of the
mandible in various paths of closure
5. Fremitus test:[36,37] Fremitus is a measurement of the
vibratory patterns of the teeth when the teeth are placed in
contacting positions and movements. A dampened index
Indian Journal of Dental Sciences  ¦  Volume 9  ¦  Issue 2  ¦  April-June 2017
finger is placed along the buccal and labial surfaces of
the maxillary teeth, and patient is asked to tap the teeth
together in the maximum ICP and grind systemically in
the lateral, protrusive, and lateral protrusive contacting
movements and positions. The teeth that are displaced
by the patient in these jaw positions are then identified.
In general, this is limited to the maxillary teeth; however,
in cases of edge‑to‑edge occlusion or when there is little
overlap of the teeth, mandibular teeth can also be assessed.
The following classification system is used:
• Class 1: Mild vibration or movement detected
• Class II: Easily palpable vibration but no visible movement
• Class III: Movement visible with the naked eye.
Conclusion
Despite decades of debate and multiple publications that
discuss the theory of occlusion, occlusal design, and
equilibration techniques, there have been few well‑designed
human studies that can help answer the question “does occlusal
trauma modify the progression of attachment loss due to
inflammatory periodontal disease?” The articles reviewed
clearly demonstrate that occlusal forces are transmitted to the
periodontal attachment apparatus, and those forces can cause
changes in the bone and connective tissue. These changes can
affect tooth mobility and clinical probing depth. While occlusal
forces do not initiate periodontitis, results are inconclusive
on the interactions between occlusion and the progression
of attachment loss due to inflammatory periodontal disease.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Indian Journal of Dental Sciences  ¦  Volume 9  ¦  Issue 2  ¦  April-June 2017