Radiographic signs of excessive occlusal forces are associated with marginal bone loss: a retrospective clinical study.

OBJECTIVES: Work in animal models has implicated excessive occlusal forces and occlusal trauma as co-destructive factors for periodontitis. The main aim of the present study was to make a radiographic assessment of the effects of excessive occlusal forces, ie occlusal/incisal tooth wear, widening of the periodontal space, and the presence of a mandibular torus, on interproximal marginal bone loss in a large series of patients. A secondary aim was to evaluate the statistical correlation between the parameters in two specific teeth and those of 12 teeth for marginal bone loss and six teeth for occlusal/incisal tooth wear within the same individual. METHOD AND MATERIALS: A total of 1,950 full-mouth radiographic surveys were analyzed retrospectively. Interproximal marginal bone loss was quantified relative to the root length (Schei ruler technique). In addition, occlusal/incisal tooth wear and periodontal ligament space widening of the periodontal space were assessed, as well as the presence of a mandibular torus. Odds ratio and logistic regression analysis were used to determine the association between occlusal trauma and marginal bone loss. RESULTS: The correlation of the measured parameters between the values for specific teeth and the whole dentition was evaluated from data from the first 400 radiographs. Teeth 41 and 33 showed the best correlation to the whole dentition: 0.85 for interproximal marginal bone loss, 0.83 for widening of the periodontal space, and 0.97 for occlusal/incisal tooth wear. The results of a logistic regression analysis with age as an independent variable, revealed a significant association between bone loss and both tooth wear (odds ratio = 2.767) and bone loss and widening of the periodontal space (odds ratio = 2.585). CONCLUSION: Tooth wear was positively correlated to both widening of the periodontal space and marginal bone loss. No correlation was found between the presence of a mandibular torus and marginal bone loss.

Complications of an Ageing Dentition Part 1: Occlusal Trauma and Cracked Teeth.

A growing problem in dentistry is complications associated with failing amalgam restorations that have been in place for many years. At present, there is a wide variety of treatment options available in the clinician's armamentarium when this situation arises, however, without the correct diagnosis, the prognosis for the tooth may quickly diminish, despite the clinician's best efforts. A confusing array of symptoms and failures may confound even the most experienced dentist, which will inevitably lead to invasive and time consuming approaches in a desperate attempt to rectify the initial problem. This paper, the first part of a three-part series, discusses the possible aetiological factors responsible for restoration failure, including occlusal issues and cracks within the tooth structure. The second part of the series will focus on restorative options and root-treated teeth. The third, and final, part of the series will provide an overview of the previous papers and conclude with a case report. Clinical relevance: Failure of amalgam restorations is a commonly encountered clinical problem in general practice and no one case presents in the same way. A competent diagnosis regarding the occlusion and tooth structure, followed with implementation of the most appropriate, minimally invasive treatment option, requires an adequate knowledge of current literature.

Occlusal trauma and mucositis or peri-implantitis?

BACKGROUND AND OVERVIEW: The aim of this study was to describe the effects of bruxism in peri-implant bone loss 6 years after the placement of a successful implant-supported prosthesis, to describe its treatment, and to propose a differential diagnosis of the lesion. CASE DESCRIPTION: A 62-year-old, nonsmoking, systemically healthy partially edentulous woman received 2 osseointegrated implants in the mandibular left region, which supported a 3-element fixed prosthesis. Six years later, the patient reported the development of bruxism. Clinical examination results indicated bleeding on probing, deepening of the peri-implant sulcus, and marginal soft-tissue overgrowth. Radiographic images suggested peri-implant bone loss. The authors diagnosed the lesion as trauma from occlusion and mucositis. Treatment involved anti-infective therapy and the use of a bite platform, resulting in bone recovery after 10 months. These results were maintained for 4 years. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Considering the existing contradictions in the literature, this case highlights the role of trauma from occlusion in the onset, progression, and treatment of lesions produced by occlusal overload around osseointegrated implants. In addition, it provides clinical background on the outcomes of anti-infective therapy associated with the use of a bite platform in the treatment of combined lesions of mucositis and trauma from occlusion in osseointegrated implants.

Afecciones pulpares de origen no infeccioso en órganos dentarios con oclusión traumática / Non-infectious pulpal disorders in dental organs with occlusal trauma

Introducción: la oclusión traumática se define como una alteración en las relaciones oclusales del sistema masticatorio, lo cual podría ser un factor conducente a un proceso inflamatorio en el ligamento periodontal, en la pulpa dental, y en tejidos blandos sensitivos. Objetivo: identificar las afecciones pulpares de origen no infeccioso en órganos dentarios con oclusión traumática en pacientes de un hospital del sector público de Mérida, Yucatán, México. Métodos: se realizó un estudio observacional y analítico, en un hospital del sector público de Mérida, Yucatán, México (2014). La muestra estuvo constituida con un total de 156 órganos dentarios de 82 pacientes, de 20 y más años de edad, que presentaron oclusión traumática en dientes permanentes y que mostraron alguna afección en tejido pulpar de origen no infeccioso, de acuerdo con la clasificación de la Academia Americana de Endodoncia. También se incluyó a los pacientes que presentaban caries, fracturas, fisuras, obturaciones, endodoncia, ortodoncia o trauma dentoalveolar. Se empleó un muestreo No probabilístico, por conveniencia. Se obtuvo el consentimiento informado y voluntario, historia médica y dental, y se realizó la evaluación de los signos y síntomas de dolor, pruebas pulpares (térmicas y eléctricas), palpación y percusión y abordaje diagnóstico con tinción/transiluminación, así como pruebas oclusales con papel de articular y examinación e interpretación de radiografías periapicales. Se utilizó estadística descriptiva. Resultado: hubo ausencia de dolor en 53 por ciento de los 156 órganos dentarios estudiados. Las alteraciones radiográficas se presentaron en 63 por ciento: entre ellas los nódulos pulpares tuvieron el mayor porcentaje (25 por ciento). La pulpitis fue reversible en 37 por ciento (n= 58); la oclusión traumática más frecuente fue la maloclusión (n= 49). En los 156 órganos dentarios estudiados, el signo clínico que mostró mayor frecuencia fue el desgaste en esmalte (n= 56). Conclusiones: las afecciones pulpares de origen no infeccioso se presentaron en alto porcentaje de dientes permanentes de pacientes con oclusión traumática(AU)

Introduction: Occlusal trauma is defined as an alteration in the occlusal relationships of the masticatory system, which may lead to inflammation of the periodontal ligament, the dental pulp and sensitive soft tissues. Objective: Iidentify non-infectious pulpal disorders in dental organs with occlusal trauma of patients from a public hospital in Mérida, Yucatán. Methods: An observational analytical study was conducted at a public hospital in Mérida, Yucatán, Mexico (2014). The study universe was 156 dental organs of 82 patients aged 20 years and over with occlusal trauma in permanent teeth and some degree of non-infectious pulp tissue disorder, based on the classification of the American Academy of Endodontics. Patients were also included who presented caries, fractures, fissures, fillings, endodontic treatment, orthodontic treatment or dentoalveolar trauma. Convenience non-probability sampling was applied. Voluntary informed consent was obtained. Medical and dental records were examined. An evaluation was carried out of pain signs and symptoms. Thermal and electric pulp tests were performed, as well as palpation, percussion and diagnostic staining/transillumination. Occlusal testing was conducted using articulating paper. Periapical radiographs were examined and interpreted. Descriptive statistics were used. Result: There was no pain in 53 percent of the dental organs studied. Radiographic alterations were present in 63 percent; the most common were pulp nodes (25 percent). Pulpitis was reversible in 37 percent (n= 58), and the most frequent occlusal trauma was malocclusion (n= 49). In the 156 teeth studied, the most common clinical sign was enamel wear (n= 56). Conclusions: Non-infectious pulpal disorders were present in a large number of permanent teeth of patients with occlusal trauma(AU)

Patients' Priorities and Attitudes Towards Their Temporo-Mandibular Disorders.

The diagnosis and appropriate management of temporo-mandibular disorders (TMDs) remains controversial. Current scientific evidence highlights the importance of psychosocial factors in sufferers and the reducing emphasis on occlusal or dental/prosthetic factors. This paper describes the findings of a survey of 211 patients reporting pain from their temporo-mandibular joint area and associated structures. This article offers busy primary dental care practitioners a cost effective questionnaire for obtaining relevant information from patients about the history of their condition and highlights what patients hope to achieve through the management of their disorder. It also emphasises the importance of communicating effectively with patients and offers practical tips for the management of TMDs in primary care.

Diagnóstico do trauma oclusal: extrapolações para a região óssea peri-implantar podem ser feitas / Diagnosis of occlusal trauma:extrapolations for peri-implant bone region can be done

As imagens oferecem uma linguagem que revela o dinamismo tecidual ósseo. A densidade óssea e a configuração espacial variam em suas estruturas e indicam uma menor ou maior reação e capacidade de adaptação às demandas funcionais, como cargas mastigatórias nos dentes naturais ou nos implantes osseointegrados. No planejamento de um tratamento reabilitador, é fundamental planejar a distribuição de carga e avaliar as condições dos dentes remanescentes e sua relação com o osso vizinho. Detectar a resposta óssea ao trauma oclusal preexistente pode favorecer uma avaliação mais precisa das condições mastigatórias e dos vícios parafuncionais: uma verdadeira história prévia funcional dos dentes remanescentes. Ressalta-se que as interferências e sobrecargas oclusais demoram meses, ou anos, para induzir os sinais e sintomas clássicos do trauma oclusal enquanto entidade clínica. Quando o dente apresenta-se com necrose pulpar e com sinais de trauma oclusal, o ideal será direcionar a anamnese e exames para um diagnóstico de traumatismo dentário superposto, mesmo em dentes posteriores. Não há fundamentação científica segura para afirmar-se que interferências ou sobrecargas oclusais provocam necrose pulpar. Um questionamento muito comum: até que ponto as forças ortodônticas de ancoragem podem ser aplicadas nos implantes osseointegrados? As forças ortodônticas não superam, em qualquer situação, a intensidade, amplitude e variabilidade das forças oclusais. Se um implante pode receber cargas mastigatórias, o mesmo pode se aplicar às forças ortodônticas de ancoragem.

Images provide a language to describe the dynamics of bone and tissue. Bone density and space distributionvary and indicate greater or lower reaction and adaptation to functional demands, such as masticatory loads,on natural teeth or osseointegrated implants. In rehabilitation, load distributions have to be planned, and theremaining teeth and their relation with neighboring bone should be evaluated. The detection of bone responsesto pre-existing occlusal trauma may provide a more accurate evaluation of masticatory conditions and parafunctionalhabits, that is, a true functional history of remaining teeth. Occlusal interference and overloads takemonths or years to induce classical signs and symptoms of occlusal trauma as a clinical entity. When a toothhas pulp necrosis and signs of occlusal trauma, the evaluation of history, as well as all tests, should be directedto the diagnosis of superposed dental trauma even when posterior teeth are affected. There is no scientific basisto confirm that occlusal interferences and overloads lead to pulp necrosis. A frequent question: Up to whatpoint should orthodontic forces be applied to osseointegrated implants? Orthodontic forces are not greater, inany situation, than occlusal forces in terms of intensity, amplitude and variability. If an implant can bear masticatory loads, it may also receive orthodontic forces resulting from anchorage.

Diagnóstico clínico e imaginológico do trauma oclusal / Clinical and imaginologic diagnosis of occlusal trauma

O diagnóstico mais requintado tende a ser feito baseado em sinais e sintomas sutis, o que requer muito critério e valorização do conhecimento prévio do especialista. O trauma oclusal deve ser incluído no diagnóstico diferencial de pericementite apical e do traumatismo dentário. Quando o dente apresenta-se com necrose pulpar e com sinais de trauma oclusal, o ideal será direcionar a anamnese e os exames para um diagnóstico de traumatismo dentário superposto, mesmo em dentes posteriores. Não há fundamentação científica segura para afirmar que interferências ou sobrecargas oclusais provoquem necrose pulpar. As interferências e sobrecargas oclusais demoram meses ou anos para induzir os sinais e sintomas clássicos do trauma oclusal enquanto entidade clínica. Ainda é comum comparar-se os efeitos do trauma oclusal aos do movimento ortodôntico e do traumatismo dentário. Os mecanismos das alterações teciduais induzidas pelo trauma oclusal não são nem minimamente comparáveis aos do movimento ortodôntico e aos induzidos pelo traumatismo dentário. Nesses três eventos, a causa primária tem natureza física; mas essas forças, aplicadas sobre os tecidos dentários, têm características completamente distintas na intensidade, tempo, direção, distribuição, frequência e forma de absorção pelos tecidos periodontais.

Diagnosis, equilibration, and restoration of an orthodontic failure.

This case report illustrates how an interdisciplinary team diagnosis led to occlusal correction of a significant postorthodontic malocclusion. The patient had received complete orthodontics twice previously, from different orthodontists. She could not close without pain or chew comfortably and was concerned about progressive gingival recession. A comprehensive clinical examination, occlusal analysis with diagnostic casts verified in centric relation, bite splint therapy, and full-mouth equilibration were completed prior to limited restorative dentistry. The patient has been comfortable with a stable occlusion for three years.

Predictive value of combined clinically diagnosed bruxism and occlusal features for TMJ pain.

Several works showed a decreased role for occlusion in the etiology of temporomandibular disorders (TMD). Nonetheless, it may be hypothesized that occlusion acts as a modulator through which bruxism activities may cause damage to the stomatognathic structures. To test this hypothesis, a logistic regression model was created with the inclusion of clinically diagnosed bruxism and eight occlusal features as potential predictors for temporomandibular joint (TMJ) pain in a sample of 276 consecutive TMD patients. The final logit showed that the percentage of the total log likelihood for TMJ pain explained by the significant factors was small and amounted to 13.2%, with unacceptable levels of sensitivity (16.4%). The parameters overbite > or = 4 mm combined with clinically diagnosed bruxism [OR (odds ratio) 4.62], overjet > or = 5 mm (OR 2.83), and asymmetrical molar relationship combined with clinically diagnosed bruxism (OR 2.77) were those with the highest odds for disease, even though none of those values was significant with respect to confidence intervals. Thus, the hypothesis under evaluation has to be rejected. It is possible that future studies with a higher discriminatory power for the different bruxism activities might be indicated to get deeper into the analysis of the potential mechanisms through which occlusion may play a role, even if small, in the etiology of the different TMD.

Computerized occlusal analysis technology and Cerec case finishing.

Computerized occlusal analysis is becoming the principal tool available to clinicians with which to understand functional and parafunctional forces of occlusal contact, contact timing sequences, and occlusal surface interface pressures, which arise as teeth mill against each other during mandibular movements. Because recent research on articulating paper has revealed that articulating paper mark size does not measure occlusal forces predictably, the modern clinician needs to employ an occlusal contact measuring device that can reliably determine aberrant occlusal force concentrations and time prematurities. Computerized occlusal analyses can be used to guide the operator as to which tooth contact locations require appropriate occlusal adjustments. When inserting Cerec restorations, computerized occlusal analysis can be employed to target excessive force concentrations and time premature contacts to better preserve the Cerec materials, than can be accomplished with "articulating paper-only" occlusal adjusting. This paper describes the evolution of computerized occlusal analysis, the system attributes, and illustrates its use in case-finishing Cerec bonded lingual guidance veneers.

Clasificación de la maloclusión en los planos anteroposterior, vertical y transversal / Classification of malocclusion in the anteroposterior, vertical and transversal planes

Se presenta una revisión de las clasificaciones de maloclusión más comunes. La clasificación de Angle, y de Ackerman y Proffit, sus ventajas y desventajas. Se revisan las características más importantes en el diagnóstico de las maloclusiones en los planos anteroposterior, vertical y transversal del espacio. Se propone un cuadro fácil y práctico de llenar en el diagnóstico de la maloclusión.

Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage.

Complete root coverage is not always achievable, even in gingival recession with no loss of interproximal attachment and bone. The cemento-enamel junction is the most widely used referring parameter to evaluate root coverage results. The aim of the present study was to describe the most frequent diagnostic mistakes that may lead to incomplete root coverage in Miller Class I and II gingival recessions and to suggest a method to predetermine the level/line of root coverage in non-molar teeth. The line of root coverage (i.e., the level/line to which the soft tissue margin will be positioned after the healing process of a root coverage surgical technique) was predetermined by calculating the ideal vertical dimension of the interdental papilla of the tooth with the recession defect. This method was applied to 120 recession-type defects affecting non-molar teeth of 80 young healthy subjects that were treated with root coverage surgical procedures over the last 5 years. All recessions were Miller Class I or II and were associated with at least one of the following characteristics: 1) traumatic loss of the tip of the interdental papilla(e); 2) tooth rotation; 3) tooth extrusion with or without occlusal abrasion; and 4) a cervical abrasion defect with no evidence of the cemento-enamel junction. The line of root coverage may be considered the clinical cemento-enamel junction because it may substitute the anatomic cemento-enamel junction when this is no longer clinically visible on the tooth with recession or when the ideal conditions to obtain complete root coverage are not fully represented.

Occlusal plane analysis using the Broadrick flag.

The determination of the occlusal plane can have a profound effect on the short- and long-term success of a restorative case. The fewer posterior interferences that result from the reconstruction means fewer problems for patients with their teeth, muscles, and temporomandibular joints. Proper utilization of the Broadrick flag on a semi-adjustable articulator will allow the dentist or laboratory technician to easily determine the ideal plane for each case. As mentioned earlier, the use of Monson's theory is only a starting point for the analysis. Patients come in different shapes and sizes and sometimes have mandibular incisors that are not positioned ideally. With a little experience and training, dentists can make the Broadrick flag an integral part of their practice. The Broadrick flag now has been adapted to several articulator systems, including Hanau (all models), Denar, Jensen (Artex--under development), and Kavo (Protar).

Trauma oclusal e ortodontia / Orthodontic occlusion traumatic

É necessário o conhecimento em oclusão e sobre os traumas oclusais para a compreensão e sucesso do tratamento ortodôntico. Uma revisão didática torna esse processo de aprendizagem eficaz. A oclusão traumática pode trazer injúrias ao sistema estomatognático como um todo desencadeando alterações diversas e muitas vezes complexas. O estudo da oclusão e traumas oclusais é de suma importância para os ortodontistas e toda a classe odontológica. Didaticamente, uma revisão de literatura com definições e apresentações de estudos científicos permitem a fácil compreensão do trauma oclusal e o sucesso do tratamento ortodôntico

Occlusal pressure pattern analysis of complete dentures for evaluation of occlusal adjustment.

The purpose of this study was to investigate occlusal pressure patterns of complete denture wearers to evaluate progress of occlusal adjustment of dentures. Thirty three edentulous subjects volunteered to participate in this study. A computer-based device was used to measure occlusal pressure sequence while tapping with their new dentures. The following variables obtained from each occlusal pressure pattern were assessed: Peak Time; Duration from the onset of pressure to the maximum pressure, Unloading Time; Duration from the maximum pressure to the end of pressure, Contacting Duration; Duration from the onset of pressure to the end of pressure, Tapping Cycle; Duration from the onset of pressure to the next onset, Peak Ratio; ratio of Peak Time to Unloading Time. Recordings were performed after the occlusal adjustment at each appointment and continued until denture adjustments were completed. Variables were analyzed using ANOVA and Bonferroni. A significant decrease was seen in Peak Ratio as the occlusal adjustments progressed (p<0.05). Its coefficient of variation was constantly the lowest among variables. The coefficient of variation of Peak Ratio was significantly lower than others at the completion of the adjustment (p<0.05). It was suggested that Peak Ratio was useful for evaluation of occlusal adjustment.