Periodontal Response to External Forces in Periodontics

Adaptive capacity of the periodontium in response to occlusal forces is variable, influenced by factors like magnitude, direction, duration, and frequency. Trauma from occlusion occurs when occlusal forces exceed tissue's adaptive capacity, leading to tissue injury. It is classified into acute and chronic types, with manifestations like tooth pain, mobility, and discomfort. Acute trauma may cause tooth sensitivity and pain, while chronic trauma involves gradual changes due to factors like tooth wear, drifting, and parafunctional habits.

• Periodontal Response
• External Forces
• Trauma from Occlusion
• Periodontics
• Dental Sciences

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1. PERIODONTAL RESPONSE TO EXTERNAL FORCES DR. A. CHAITANYA, READER SIBAR INSTITUTE OF DENTAL SCIENCES DEPARTMENT OF PERIODONTICS

2. INTRODUCTION Adaptivecapacityof periodontium toforces exertedisvariable Occlusalforces Magnitude Direction Duration Frequency Magnitude -wideningof the PDLspace -increasein the no.&width of PDLfibers -increasein the densityofalveolarbone

3. Direction -Reorientation of stress &strain -Principal fibers of PDL Occlusal forces along the long axis of thetooth -Lateral/Horizontal &Torque/Rotational: Injure the periodontium Duration -Constant pressure >intermittent Frequency -Frequent application of intermittentforce: injurious

4. TRAUMA FROM OCCLUSION DEFINITION Whenocclusalforcesexceedthe adaptive capacityof the tissues,tissue injury results. Theresultantinjury istermedastraumafrom occlusion An occlusion that produces forces that cause an injury to the attachment apparatus -Carranza

5. CLASSIFICA TION I. Acute &Chronic II. Primary &Secondary

6. ACUTE TFO Causes: An abrupt occlusalimpact Restorations/prosthetic appliances Manifestations: Toothpain Sensitivity topercussion Increased toothmobility

7. Forcedissipated i. ii. Shift in toothposition Wearing heals & subsides iii. Correction ofrestoration Orelse Periodontalinjury Necrosis+ periodontalabscess or Cementumtears

8. CHRONIC TFO More common&significant Gradualchangesby: - toothwears - drifting movement&extrusion - parafunctionalhabits

9. PRIMARY TFO Definition: Injuryresultingintissuechangesfromexcessive occlusalforcesappliedtoatoothor teethwith normalsupport

10. Causes Highfilling Prostheticreplacement Drifting/ extrusion Orthodontic movement into functionally unacceptable positions Primary TFO - no changes in connective tissue attachment level & no pocket formation

11. SECONDARY TFO Definition Injuryresultingintissuechangesfromnormalor excessiveocclusalforcesappliedto a tooth withreducedsupport

13. GLICKMAN CONCEPT

14. THREE STAGES OF TFO 1. INJURY 2. REPAIR 3. ADAPTIVE REMODELING OF THE PERIODONTIUM

15. I NJU R Y Excessive Occlusal forces: Tissue Injury Repair of injury & Restoration of periodontium if- i. Forces are diminished ii. Tooth drifts away from them

16. Occlusalforces:Toothrotation arounda Fulcrum/AxisofRotation Junctionofmiddle& apicalthirdofclinical root Areasof pressure& tensioncreatedon oppositesidesof thefulcrum

17. SLIGHTLY EXCESSIVE PRESSURE Resorptionof the alveolarbone Numerous blood vessels-reduced insize SLIGHTLY EXCESSIVE TENSION Elongation of the PDLfibers Apposition of alveolarbone Enlarged bloodvessels

18. GREATER PRESSURE GradationofChanges Compressionof fibers Areasofhyalinization Injury to fibroblasts&other cells:Necrosisof PDL Vascular changes occurs within 30minutes

19. Impairment&stasisofbloodflow in2-3hours bloodvesselspackedwith RBC sfragment in 1-7days disintegrationof bloodvesselwalls-contents dischargedinto the surrounding tissues Increasedresorptionof alveolarbone& toothsurface

20. SEVERE TENSION WideningofPDL Thrombosis Haemorrhage Tearingof thePDL Resorptionof the alveolarbone

21. SEVERE PRESSURE Forcethe root againstbone Necrosisof the PDL&bone Undermining Boneresorptionfrom viablePDL& marrow spaces Resorption Mostsusceptibleareasof Injury-Furcations

22. REPAIR Normalperiodontium: Constantrepair TFO-increasedreparativeactivity Damagedtissuesremoved& formationofnew Cells Fibers Bone Cementum

23. Forces are traumatic as long as injury exceeds the repair Boneresorbedbyexcessiveocclusalforces Thinnedbonytrabeculaereinforcedwithnew bone Buttressing bone formation: Important featureof RepairafterTFO Central buttressing: Occurs within thejaw Newbonedeposition

24. Peripheral buttressing: Facial& lingualsurfacesof thealveolarplate LIPPING: Severe shelflike thickeningofthe alveolarmargin Pronouncedbulgeinthecontourofthefacial & lingualbone

25. ADAPTIVE REMODELING OF THE PERIODONTIUM Repair= Destruction:remodeled PDL Thickened &funnelshapedatthecrest Angulardefectsinthebone Nopockets Teethbecomeloose

26. HISTOMETRIC DIFFERENTIA TION Injuryphase: resorption formation Repairphase: resorption formation Adaptive remodeling: both return tonormal

27. EFFECT OF INSUFFICIENT OCCLUSAL FORCES Injurioustoperiodontium Thinningof thePDL Atrophyoffibers Osteoporosisof the alveolarbone Reductionin boneheight

28. Canresultfrom: Open-biterelationship Absenceof functionalantagonists Unilateralchewinghabits

29. FREMITUS TEST Measurement of the vibratory patterns of the teeth when the teeth are placedincontacting positions&movements Finger buccal& labialsurfaces-maxillary teeth T apthe teeth togetherin themaximum intercuspalposition Grind symmetrically in lateral, protrusive & lateral-protrusive contacting movements

31. CLASS I: Mild vibrationdetected CLASS II: Easilypalpablevibrationbut novisible movement CLASS III: Movementvisiblewith thenakedeye

32. RADIOGRAPHIC ASSESSMENT Degreeof bonelossfrom the CEJ to the apex. Width of the PDLspacearoundeachtooth Examinefor angularbonydefects Butthesefindingsnot necessarilywith TFO

33. PATHOLOGIC TOOTH MIGRATION DEFINITION Tooth displacement that results when the balance among the factors that maintain physiologictoothpositionisdisturbedby periodontaldisease

34. Common& earlysign Anteriorsfrequent Anydirection Mobility &Rotation Extrusion:Pathologicmigrationin theincisal/ occlusalaspect

36. WEAKENED PERIODONTAL SUPPORT Unableto maintainnormalposition Movesawayfrom opposingforceunless restrainedbyproximalcontact Forcesacceptedbynormalperiodontium becomeinjurious

37. CHANGES IN FORCES EXERTED ON THE TEETH A. Unreplaced missingteeth Driftinginto edentulousspaces Not dueto periodontaldestruction Conducivefor periodontaldiseases

38. B.FailuretoreplaceFirstMolars Second& third molarstiltreducingthe vertical dimension Premolars-distally& mandibularincisors-drift lingually Anterior overbite increased & mandibular incisors traumatize the gingiva Maxillary incisors pushed labially & laterally Anterior teeth extrude because incisal apposition has largely disappeared Diastema created- anterior teeth

40. OTHER CAUSES Pressure from the tongue Pressure from granulation tissue of periodontal pocket