PERIODONTAL

RESPONSE TO
EXTERNAL FORCES

BY:
DR KASHAF HAFEEZ
INTRODUCTION:

Sole purpose of periodontium is to support the tooth.

Tooth depends also on periodontium to keep it in the jaw.

And periodontal tissues depends on functional activity of tooth to remain

healthy.

Occlusion is the lifeline of the periodontium.

Occlusal forces stimulates the receptors in the PDL to regulate the jaw
movement.
What are occlusal forces?

Occlusal forces are nothing but

the force exerted on the opposing
teeth.

They may be physiological

occlusal forces which occurs
during swallowing and chewing
process, that are helpful for the
health of PDL and aleovolar bone.
TRAUMA FROM OCCLUSION:

It is the term that we use when

occlusal forces
become traumatic and they start
affecting the
tooth and the supporting structures.

Occlusal forces exceeds the

physiologial adaptive
capacity of tissues, they became
damage and such
damage known as trauma from
occlussion.
Trauma from occlusion also known as:

Traumatic Occlusion
PDL Traumatization
Overload
Traumatogenic Occlusion
ADAPTIVE CAPACITY OF PDL
TO OCCLUSAL FORCES
The effect of o.forces on periodontium is
influenced by:

Magnitude
Direction
Duration
Frequency
Magnitude:
When increase, it
causes widening of
PDL space, increase in
number and width of
PDL fibres and increase
density of A.bone.
Direction:

Change in direction of occlusal forces

lead to change the orientation of PDL
fibres.
Duration:

Constant pressure on
bone is more injurious
than intermittent forces,
like in clenching.
Longer duration of force
leads to damage to
A.bone.
Frequency:

More frequent application of force

more injury to PDL.
CLASSIFICATION OF TRAUMA
FROM OCCLUSION
According to duration of cause:

Acute TFO
Chronic TFO

According to nature of cause:

Primary TFO
Secondary TFO
ACUTE TFO:
Result from abrupt occlusal forces.
Like biting a hard object
Any faulty restoration
Any prosthetic appliance that interfere
with the occlusion and induce acute
trauma.
Symptoms Of Acute TFO:

Tooth pain
Tooth sensitivity
Mobility

If occlusal forces is dissipiated by shift in position of

tooth i:e; injury heals then acute TFO subsides itself,
but if it still prevales then leads to

Necrosis
Periodontal Abscess And
Lead to Chronic TFO
CHRONIC TFO:

It is more common than the accute form and of greater significace.

It occurs from gradual changes in occlusion like;

Tooth wear
Drifting movements (orthodontically)
Extrusion of teeth
Parafunctional habits (Bruxism, clenching)

If attempts to repair the injury and restore the PDL, results in angular
bone defects without periodontal pockets and mobilty occurs.
PRIMARY TFO:
Occurs by excessive o.forces on
NORMAL periodontium.
No bone loss and no periodontal pockets.
SECONDARY TFO:
Occurs when there is a marginal
periodontitis and bone loss and when
normal occlusal forces induce on this it
cannot sustain and injury occurs.
STAGES OF TISSUE RESPONSE TO
INCREASED O.FORCES

 STAGE 1 INJURY
 STAGE 2 REPAIR

 STAGE 3 ADAPTIVE

REMODELLING
STAGE 1 – INJURY:

Excessive o.forces occurs injury happens

Body attempts to repair the injury and restore the periodontium

Force is chronic> periodontium is remodelled to cushion its

impact

Ligament widened at the expanse of bone

Angular bone defects without PDL pocket

Tooth becomes mobile

Under the forces of occlusion the tooth rotates
around fulcrum or axis of rotation

For single rooted tooth > axis of rotation is b/w

the middle and apical third
For multirooted tooth > at the furcation

This creates areas of Pressure and Tension on the

opposite sides and depending upon increase of
pressue and tension different lesions may occur.
 Slight Pressure Slight Tension

PDL > widening of PDL elongation of PDL

fibres
Vasculature > increase in increase in b.vessels
b.vessels
Bone > resorption apposition of
A.bone
 Greater Pressure Greater Tension

PDL > widening of PDL stretching of PDL

destruction of CT tearing of PDL
cells, fibroblasts
hylinization

Vasculature > 30 mnts > stasis of blood flow hamorrhage

2-3 hrs > RBC fragmentation
1-7 days > distruction of blood
vessel wall with release
of content

Bone > resorption resorption

excessive bone loss
STAGE 2 – REPAIR:

When bone is resorbed by excessive occlusal forces, the

body attempts to reinforce thinned bony trabecule with
new bone, this process is called as BUTTRESSING BONE
FORMATION.

2 TYPES OF BUTTRESSING BONE:

Central > within the jaw (decrease in marrow spaces)

Peripheral > facial and lingual surfaces ( shelf like
thickening of bone called LIPPING)
STAGE 3 – ADAPTIVE REMODELLING
If repair cannot keep the pace with destruction as
injury is so excessive then PDL remodel itself.
This results in:
Thickening of PDL
Bone loss
Increased vasculature
Loosening of teeth (with no periodontal pocket)
% of bone surface undergoing bone formation and
resorption:

Bone Resorption Bone Deposition

Injury > Increased Decreased
Repair > Decreased Increased
Remodelling > Return to normal
Learning Objectives:

• Discuss previous lecture

• Discuss effects of insufficient and extensive occlusal
forces
• Clinical and radioghraphic features of trauma from
occlusion
• Management of trauma from occlusion
Effects Of Insufficient O.Force:

Hypofunction can cause by an open bite

relationship, unilateral chewing habits that
neglects 1 side of mouth, causes:

Thinning of PDL
Atrophy of fibres
Osteoporosis of A.bone
Reduction in bone height
Effects Of Excessive O.Forces:

There is possibility of pulpal damage in

excessive forces.
Mostly occurs in multi rooted teeth with
furcation involvement
CLINICAL FEATURES OF TFO:

Tooth mobility
Pain on chewing or percussion
Fremitus ( movements during function and
parafunction)
Occlusal discrepancies
Tooth migration
Chipped or fractured teeth
Thermal sensitivity
RADIOGRAPHIC FEATURES OF TFO:

Increased width of PDL space

Thickening of lamina dura
Vertical or angular bone loss
Radiolucency in furcation areas
MANAGEMENT:

Main goal is to maintain periodontium in comfort and

function.
And in order to achieve this goal we must consider:

Occlusal adjustments
Managing parafunctional habits
Splinting
Orthodontic tooth movement
Extraction of selected teeth