THE ROLE OF OCCLUSAL TRAUMA IN THE PRODUCTION OF CHRONIC MARGINAL

PERIODONTitis

 Occlusal trauma is defined as an injury to the periodontium or the tooth, as a result of

excessive occlusal force.

 This can be caused by premature contact caused by high fillings or incorrectly

performed prosthetic work, or by various vicious habits or accidents

According to Horia Traian Dumitriu, oclusal trauma can be

 -acute, with clinical sympthoms : - immediate

- delayed

 -chronic.

In acute trauma from occlusion, the immediate clinical signs are:

• mild pain

• transient violent pain (a few seconds),

• prolonged pain, accompanied by an increase in dental mobility, which lasts from a few hours
to a few days, depending on the effect of occlusal trauma: concussion, subluxation or even
dental sprain.

In lateral areas, in premolars and molars, the symptoms are delayed, without obvious
clinical symptoms of inflammation or other long-term local traumatic circumstances,
that could explain this abnormal mobility.

Through a well-conducted anamnesis, in most cases it is found that months or

even years ago, the patient used to exert excessive pressure by breaking bones between
the teeth or by removing lids or stoppers from bottles.

In these cases, there can be found microruptures of the ligaments,

microhemorrhages, microhematomas with the release of lysosomal enzymes, which
participate in the phenomena of tissue histolysis and by superinfection, pathological
dental mobility is installed.

Radiologically, in such cases, intense and diffuse demineralization predominates, and

less bone resorption

Chronic trauma from occlusion is caused by high fillings or crowns, overload of teeth
that border edentulous spaces and bruxism. It is accompanied by::

• increased tooth mobility beyond normal limits (but this is not pathological because it
results from overload of the periodontal ligament)

• an elastic deformation, more accentuated than usual of the alveolar bone; rarely by its
lateral resorption
 • gingival recession

Radiologically:

 widening of the dento-alveolar space

 angular defects of the septum tip, without accentuated bone resorption

 sometimes rizalysis phenomena.

Chronic trauma from occlusion is followed in many cases, when not excessive, by
adaptive phenomena:

 thickening of the periodontal ligament

 thickening, in some places, of the dura mater (in the apical area and at the level of the
furcations)

 condensation of the trabecular bone structure,

 thickening of the edge of the alveolar bone, which can be clinically highlighted by the
appearance of bulbous, punctiform prominences scattered on the vestibular slope and
sometimes oral, above which the free gingival margin, and especially the attached
gingiva, are stretched, whitish, punctate.

According to the American school, trauma from occlusion can be of 2 types:

 primary

 secundary.

Primary occlusal trauma occurs when occlusal forces greater than

normal act on the teeth, as in the case of vicious habits, such as bruxism or habits
related to biting or chewing (pens, seeds, other objects, removing corks, bottle caps).

These forces applied in excess are also divided into 3 categories:

 by duration,

 frequency,

 amplitude

Primary occlusal trauma occurs in the case of periodontally healthy teeth, with the tooth
support device, intact

Secondary occlusal trauma occurs when normal occlusal forces are applied to the teeth with a
compromised periodontal support system, worsening the clinical situation

Etiology and treatment:

In primary trauma from occlusion, the etiology or cause of mobility was the application of
excessive force to a tooth with a normal, healthy support device.
 The approach should be to eliminate the etiology of pain and mobility by determining the
causes and eliminating them. The mobile tooth or teeth will soon decrease in mobility.

This could involve removing a high point of contact on a recently restored tooth or a
recently unrestored tooth that has migrated into hyperocclusion.

It could also mean eliminating vicious habits such as biting a pen, nails, seeds, etc.

In people with bruxism, the treatment of primary trauma from occlusion may involve selective
grinding of the occlusal contacts and wearing a splint to protect the teeth from the increased
occlusal forces generated by the vicious, parafunctional habit.

 In the case of edentulous teeth, the teeth that remain on the arch support an occlusal
force increased by mm². The treatment in this case involves the restoration of the
dental arches by mobile prostheses or fixed prostheses on implants.

 In secondary occlusal trauma, simply removing premature contact or selective grinding

is not enough because the teeth are already periodically affected.

 Next, bone loss and ligament support must be managed. This is done through surgical
procedures such as bone or soft tissue grafts.

As in the case of primary occlusal trauma, treatment may include mobile prostheses or
fixed prostheses on implants.

Conclusions

Numerous studies have questioned the role of occlusion in the evolution of

periodontal disease. Although the results were inconclusive, most studies have concluded
that occlusal trauma alone cannot cause an increased loss of periodontal support in the
absence of inflammation.

Teeth that are not mobile or subject to occlusal trauma, respond better to
regenerative therapy.