The importance of occlusal trauma in the primary etiology of periodontal disease.

The presence of periodontal disease can be ascertained by clinical examination (redness, edema and probe depth, bleeding-on-probing). Occlusal adjustment can lead to a marked, stable improvement in periodontal health in terms of bacterial profile and clinical appearance, presumably by obviating tissue distress caused by occlusal dysfunction, thereby providing unfavorable conditions for bacterial growth. Therefore, occlusal trauma can be an essential indicator of the periodontal disease and, if not corrected, could lead to a relapse.

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.

Un nuevo recurso para generar expansión transversal en los maxilares / A new resource to generate transversalexpansion in the jaws

La filosofía de la bioadaptación transversal de los maxilares preconiza una nueva forma de generar crecimiento a nivel de los tejidos dento alveolares, a través de una mecánica ortodoncia biológicamente más segura a la hora de realizar expansión transversal. El principio básico de esta filosofía no es soloel uso de brackets autoligantes, ni marcas comerciales específicas, ya que puede utilizarse cualquiera de ellas; se trata de no generar daños colaterales denominados “costos biológicos”, frecuentemente ligados a fuerzas excesivas. Se pretende proporcionar una menor fricción entre bracket y arco, reduciendo así el uso de aparatos auxiliares y el tiempo de tratamiento, aprovechando los beneficios de cada componente. Para generar el crecimiento transversal del maxilar es fundamental el uso de gomas intermaxilares, teniendo como tutores a los segundos molares superiores que son los menos afectados por las disfunciones. Podemos decir que después del correcto estímulo de una fuerza que inicie el proceso de desequilibrio y consecuente respuesta tisular, las fuerzas naturales de la musculatura oral, más las existentes en el sistema de brackets, serán suficientes para definir la necesaria bioadaptación dentoalveolar individual del paciente.

The transverse bioadaptation philosophy of the jaws advocates a new way of generating growth at thelevel of dentoalveolar tissues, through a biologically safer orthodontic mechanics when carrying outtransversal expansion. The basic principle of this philosophy is not only the use of self-ligating bracketsor specific trademarks, since any of them can be used, but also not to generate collateral damagescalled "biological costs" frequently due to excessive forces. Aiming at providing less friction betweenbracket and bow, thus reducing the use of auxiliary appliances and treatment time, taking advantageof the benefits of each component. In order to generate maxilla transversal growth the use ofintermaxillary gums is fundamental, having as tutor the upper second molars that are the least affectedby the dysfunctions. It can be stated that after the correct stimulus of a force that initiates the process of imbalance and consequent tissue response, the natural forces of the oral musculature plus thoseexisting in the bracket system will be sufficient to define the necessary individual dento alveolar bioadaptation of the patient.

Regeneración tisular guiada en defecto óseo de 3 paredes: enfermedad periodontal y oclusión / Guided tissue regeneration and in a three-walled osseous defect: periodontal disease and occlusion

Relacionar la importancia del éxito en regeneración tisular guiada y el correcto diagnóstico del problema, en este caso enfermedad periodontaly un contacto prematuro en ORC producto de una obturación de amalgama incorrecta. Caso clínico: tratamiento de un defecto infraóseo de3 paredes mediante la utilización de hueso de origen bovino particulado junto con proteínas derivadas de la matriz del esmalte. Tanto los parámetros clínicoscomo los radiográficos fueron evaluados al inicio, en el postquirúrgico inmediato y a los 12 meses. Conclusión: se observó un alto grado de regeneración pasados los 12 meses del tratamiento. Parecería no ser siempre necesaria la utilización de membrana colágena. Las proteínas derivadas de la matrizdel esmalte serían un sustituto de la membrana en algunos casos. Resulta fundamental el chequeo de la situación oclusal en piezas periodontalmente comprometidas...

Non-Orthodontic, Non-Restorative Closure of Acquired Diastemata.

AIM: To illustrate the reversibility of "pathologic tooth migration" in several patients that were managed by periodontal therapy alone, along with a review of the relevant literature. BACKGROUND: Pathologic tooth migration (PTM) is a common phenomenon among patients seeking dental care. Different etiologic factors have been implicated in PTM: loss of periodontal support, occlusal interferences, posterior bite collapse, and various oral habits such as: lip biting, tongue thrusting, and playing wind instruments. Identification of all the causative factors involved in PTM is crucial for a successful treatment outcome. Managing severe cases of acquired diastemata may necessitate a complex and a sequential intervention involving periodontic, orthodontic and prosthodontic measures. However, "spontaneous regression" of teeth to their original position may occur in certain cases after elimination of the offending factors. CONCLUSION: "Spontaneous" closure of acquired diastemata could occur following surgical and/or non-surgical periodontal therapy or removal of occlusal interferences. Correction of pathologically migrated teeth without orthodontic or restorative treatment is feasible, but unpredictable.

Periodontal therapy for severe chronic periodontitis with periodontal regeneration and different types of prosthesis.

We report a patient with severe chronic periodontitis requiring regenerative periodontal surgery and different types of prosthesis in the maxillary and mandibular regions. The patient was a 57-year-old woman who presented with the chief complaint of occlusal pain. An initial clinical examination revealed that 73% of sites had a probing depth of ≥4 mm, and 60% of sites exhibiting bleeding on probing. Radiographic examination revealed vertical bone defects in the molar region and widening of the periodontal ligament space around teeth #17 and 24. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. Periodontal regenerative therapy using enamel matrix derivative was performed on #14, 15, and 35-37. Tunnel preparation was performed on #46 as it had a 2-wall vertical bony defect and Degree 3 furcation involvement. Other sites with residual periodontal pockets were treated by modified Widman flap surgery. After a re-evaluation, functional rehabilitation was implemented with a removable maxillary partial denture and a fixed mandibular bridge. No further deterioration was observed in the periodontal condition of most of the teeth during a 2-year period of supportive periodontal therapy (SPT). The patient is currently still undergoing SPT and some minor problems remain. However, the results suggest that treatment and subsequent maintenance for severe periodontitis with traumatic occlusion can be successful as long as the appropriate periodontal and prosthodontic treatment is planned and careful SPT carried out.

Orthodontic treatment in a periodontal patient with pathologic migration of anterior teeth.

A 22-year-old man with severe periodontitis and pathologic tooth migration sought orthodontic treatment. He was treated successfully with effective control of the strength and the direction of the orthodontic forces, and a combination of periodontic and orthodontic treatment. After 22 months of orthodontic treatment, his occlusal trauma resulting from pathologic tooth migration was relieved, a stable occlusion was achieved, and mutual aggravation of occlusal trauma and periodontitis was prevented. Furthermore, the patient's facial esthetics and self-confidence were improved. Newly formed trabecular bone could be seen in the periapical x-rays in some regions where resorption had been severe. This case report shows that resorption of alveolar bone can be prevented and that multidisciplinary orthodontic treatment of a periodontal patient with pathologic tooth migration is effective and helpful.

[Effect of periodontal initial therapy on teeth with chronic periodontitis and secondary occlusal trauma].

OBJECTIVE: To evaluate the effect of subgingival scaling/root planning (SRP) and occlusal adjustment on clinical and occlusal parameters in teeth with chronic periodontitis and secondary occlusal trauma. METHODS: Eighteen patients with chronic periodontitis and occlusal trauma were included and randomly divided into group A and group B. On day 0, group A was treated by full-mouth subgingival scaling and root planning, and group B was treated by occlusal adjustment in occlusal trauma site. On day 28, group A was treated by occlusal adjustment in occlusal trauma site, and group B was treated by full-mouth subgingival scaling and root planning. Probing depth (PD), attachment loss (AL), bleeding index (BI) were evaluated on 0, 28 and 56 d, and the occlusal time (OT) and the percentage of occlusal force were evaluated on 0, 28 and 56 d in occlusal trauma site. The data was statistically analyzed. RESULTS: In baseline, the PD[(4.42 ± 1.41) mm vs (4.36 ± 1.38) mm], AL [(2.75 ± 1.32) mm vs (2.63 ± 1.37) mm] and BI [(2.20 ± 0.81) vs (2.24 ± 0.89)] of the full-mouth showed no significant difference between the two groups (P > 0.05). There was no significant difference in PD [(5.21 ± 1.21) mm vs (5.08 ± 1.12) mm], AL [(4.94 ± 1.47) mm vs (4.89 ± 1.32) mm], BI [(2.61 ± 0.92) vs 2.50 ± 0.79)], OT [(1.29 ± 0.39) s vs (1.34 ± 0.35) s] and the percentage of occlusal force [(6.8 ± 2.1)% vs (7.4 ± 1.7)%] in occlusal trauma site between the two groups(P > 0.05). After SRP therapy, the PD,AL,BI and OT were significantly decreased (P < 0.05).The clinical parameters exhibited no significant difference after only occlusal adjustment(P > 0.05).On 56 d, the reduction in clinical parameters was not significantly different between the two groups(P > 0.05),however the reduction of OT and the change of the percentage of occlusal force in group A [(0.85 ± 0.41) s, (2.2 ± 2.2)%] were more significant than those in group B [(0.70 ± 0.38) s; (1.5 ± 1.6)%] (P < 0.05). After occlusal adjustment, the increase of OT in group A [(0.21 ± 0.11) s] was lower than that in group B [(0.67 ± 0.37) s]through the 28-day observation period (P < 0.05). CONCLUSIONS: Occlusal adjustment alone is inadequate for control and management of periodontitis.SRP therapy can eliminate the inflammation and decrease the OT of tooth with occlusal trauma.The combination of SRP and occlusal adjustment may achieve more stable results.

Accelerated esthetic dental results using an interdisciplinary approach.

Traditionally, achieving case acceptance in situations that involve orthodontics has been challenging for clinicians, especially among adult male patients. In recent years, surgically accelerated orthodontics has emerged as an alternative approach for patients who might otherwise avoid treatment or choose a compromised form of treatment due to esthetic concerns about wearing traditional braces. In this case report, use of an interdisciplinary approach that combined Kois diagnostic principles with Accelerated Osteogenic Orthodontics (AOO) and lingual braces resulted in a successful restoration while maintaining satisfactory esthetics during treatment.

An esthetic concern leads the way to improved oral health.

In order to make appropriate treatment decisions, clinicians must consider a patient's needs in total. As such, a systematic risk assessment is essential for developing a treatment plan that will both satisfy the patient's esthetic concerns and lower his or her risk for future problems. In this case, the patient's immediate concern was his smile, but he was unaware of the need for additional treatment, which included addressing occlusal dysfunction, extracting hopeless teeth and replacing them with an implant-retained prosthesis, and placement of indirect porcelain restorations. A comprehensive interdisciplinary approach between the clinician, implant surgeon, and laboratory was crucial for a successful outcome.

Multidisciplinary approach to an asymmetric traumatic occlusion: a case report.

The case of a 47-year-old female patient with an asymmetric traumatic occlusion, great alveolar destruction in the mandibular left central incisor, gingival recession with attachment loss and lack o fkeratinized tissue more accentuated in the crossbite teeth is described. This situation was caused by the traumatic position of the teeth, aggravated by a forced asymmetric anterior position of the mandible and aggravated by mandibular movements. After the extraction of the left central mandibular incisor, keratinized tissue reconstruction and alveolar bone regeneration were performed to obtain enough bone to move the adjacent teeth in this direction and allow the correct placement of an implant at the end of orthodontic treatment. The orthodontic treatment achieved general stable occlusal contacts and esthetic results that were finalized with a definitive prosthetic treatment. This interdisciplinary management was important to solve in the present case the seriously compromised function and esthetics that would never be achieved without this combination.

A systematic approach to recreate a patient's former smile.

In this case involving a 29-year-old woman with a history of stomach-acid-related reflux and extensive loss of tooth structure, the patient desired to regain the smile she "used to have." The treatment goals throughout the process were to manage risk, use minimally invasive procedures, and improve the prognosis in each of the four dental categories-periodontal, biomechanical, functional, and dentofacial. The treatment plan utilized a systematic approach to sequentially restore and protect the young woman's dentition. It included esthetic crown lengthening, establishing the ideal esthetic position of maxillary anterior and posterior teeth, addressing the mandibular plane of occlusion, and achieving optimal function.

Occlusal adjustment associated with periodontal therapy--a systematic review.

OBJECTIVES: Occlusal adjustment as part of periodontal therapy has been controversial for years, mostly because the literature does not provide enough evidence regarding the influence of trauma from occlusion (TfO) on periodontitis. The need for occlusal adjustment in periodontal therapy is considered uncertain and requires investigation. The aim of this systematic review was to identify and analyse those studies that investigated the effects of occlusal adjustment, associated with periodontal therapy, on periodontal parameters. DATA: A protocol was developed that included all aspects of a systematic review: search strategy, selection criteria, selection methods, data collection and data extraction. SOURCES: A literature search was conducted using MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE. STUDY SELECTION: Three reviewers screened the titles and abstracts of articles according to the established criteria. Every article that indicated a possible match, or could not be excluded based on the information given in the title or abstract, was considered and evaluated. On final selection, four articles were included. CONCLUSIONS: Although the selected studies suggest an association between occlusal adjustment and an improvement in periodontal parameters, their methodological issues (explored in this review) suggest the need for new trials of a higher quality. There is insufficient evidence at present to presume that occlusal adjustment is necessary to reduce the progression of periodontal disease. CLINICAL SIGNIFICANCE: Although it is still not possible to determine the role of occlusal adjustment in periodontal treatment, adverse effects have not been related to occlusal adjustment. This means that the decision made by clinicians whether or not to use occlusal adjustment in conjunction with periodontal therapy hinges upon clinical evaluation, patient comfort, and tooth function.

Tooth surface loss: tools and tips for management.

UNLABELLED: Tooth surface loss is becoming increasingly prevalent. Many cases can be managed with preventive measures, although there remain a number of patients for whom restorative intervention is indicated. Traditional treatment modalities have entailed extensive 'full-mouth' indirect restoration, although this approach has a number of disadvantages. Contemporary restorative techniques allow for a broader range of treatment options: this paper presents an overview of common issues and clinical techniques to overcome these. CLINICAL RELEVANCE: Treatment options and guidance for managing patients who present with tooth surface loss.

A combined prosthodontic and orthodontic treatment approach in a case of growth inhibition induced by dental implants: a case report.

Functional and esthetic results can improve significantly when a combined prosthodontic-orthodontic treatment approach is employed in cases requiring extensive oral rehabilitation. The patient presented in this case report was treated in his late teens with dental implants as a replacement for his maxillary incisors. Ten years later, the entire maxillary anterior segment was in infraocclusion compared to the rest of the dentition and lip line. Since prosthodontic follow-up treatment alone could not achieve an optimal functional and esthetic outcome, the patient was treated orthodontically prior to renewing the restoration. A fixed appliance was used to intrude the mandibular anterior teeth as well as vertically align the infrapositioned maxillary lateral incisors.

Treatment planning and sequence for implant therapy in a young adult with generalized aggressive periodontitis.

Treatment planning for full-mouth rehabilitation in patients with generalized aggressive periodontitis often requires a staged approach. Few articles have addressed treatment planning and sequencing issues in this patient population. This report describes the multidisciplinary management of a young adult by a combination of periodontal and implant therapy and rehabilitation with fixed prostheses. At a 2-year follow-up, the patient's periodontal health and peri-implant conditions were stable. Prosthodontic rationale and treatment planning concepts in a patient with multiple challenges are discussed.