Abstract
This chapter addresses the ongoing controversy regarding occlusion's role in the progression of periodontal disease. Occlusal force has been considered a non-factor in the initiation of periodontal attachment loss. However, the absence of a validated measuring device or quantifying method for analyzing the occlusion has contributed to the confusion that still exists in the scientific community today about the relationship between periodontal disease and occlusion. The development of the T-Scan occlusal measurement technology, which is independent of a clinician's occlusal contact force level subjective assessment, may change the scientific opinion about occlusion's role in periodontal disease. This chapter illustrates how the T-Scan 8 system aids in treating patients who have tissue loss and occlusal issues. Notably, after the major etiologic risk factors of periodontal disease have been controlled, adjusting the occlusion with the T-Scan improves healing outcomes resulting in less inflammation, decreased probing depths, and bone level stability.
TopIntroduction
The Periodontium is characterized by several tissues:
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Soft tissues such as the keratinized gingiva,
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The free gingiva,
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The periodontal ligament (PDL),
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The hard tissues around the teeth such as bone and cementum.
Periodontal diseases are multifactorial and considered to be of host deficiency origin, which are characterized by the presence of gingival pockets and progressive loss of attachment, with bone resorption occurring around teeth. It is possible to ensure the periodontal health of the patient by keeping these pockets shallow. Clinicians are therefore perpetually faced with the need for probing pocket depths of any detected periodontal pockets.
Clinicians also check for two groups of potential Periodontal disease risk factors, which include:
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Innate human factors (age, sex, ethnicity, genetic predisposition).
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Acquired factors (microbiological factors, smoking, and other systemic disease states).
The link between occlusion and impaired periodontal health has always been a matter of great debate (Green & Levine, 1996). However, occlusion is not generally considered to be a risk factor for periodontal disease, but is rather viewed as an aggravating factor, in the same was as is tobacco use. Despite that in everyday practice, clinicians observe obvious links between occlusion and periodontal parameters, the absence of an “evidence based” occlusal force analysis makes difficult the demonstration of these interrelationships. The T-Scan 8 system (Tekscan, Inc., S. Boston, MA, USA), could help to address unanswered questions. The aim of this chapter is to review how computerized occlusal analysis can be integrated into periodontal practice, and how it can greatly aid the clinician in the treatment of Periodontal Disease.
TopBackground
Interrelations between periodontal disease and occlusal forces have been usually defined by the term Occlusal Trauma. Stillman was the first to define occlusal trauma, as a traumatic state of the tissues supporting the teeth resulting from the movement of the jaws towards the closed position (Stillman, 1917). In 1978, the World Health Organization (WHO) defined occlusal trauma as a periodontal traumatism caused by stress on the teeth induced directly or indirectly by contacting the teeth present in the other arch (Lindhe, Karring, & Lang, 2008). The American Academy of Periodontology (AAP) defined occlusal trauma as damage to the dental support tissues caused by an excessive occlusal load (Gher, 1996).
There are 2 classifications of periodontal damage resultant from occlusal trauma:
Figure 1. Primary occlusal trauma results from excessive occlusal force with normal support. The center of rotation is near the middle of the tooth.
Figure 2. Secondary occlusal trauma results when excessive occlusal force is applied to a tooth with reduced support. The center of rotation moves down into the apical third of the root.
Key Terms in this Chapter
Secondary Occlusal Trauma: Occlusal trauma observed on teeth with reduced periodontal bone height.
Occlusal Trauma: Occlusal trauma describes changes in the periodontal state due to the applied force of the masticatory muscles.
Periodontal Maintenance Therapy: Following active periodontal therapy, maintenance is necessary to preserve the results obtained during the active therapy, and to prevent further periodontal disease breakdown. Maintenance is an extension of active periodontal therapy, requiring the combined efforts of both the Periodontist and the patient.
Full Mouth Disinfection: An intense course of treatment for periodontitis, typically involving scaling and root planning in combination with adjunctive use of local antimicrobials, such as chlorhexidine, applied to the diseased tissues by various intraoral methods. The aim iof this therapy is complete debridement of all periodontal pocket areas within a very short time frame (in 24 hours), to minimize the chance of re-infection from pathogens that reside in other oral niches like the tongue, tonsils, and non-treated periodontal pockets.
Periodontal Attachment Loss: A reduction in the connective tissue attachment to both the root of the tooth and to the alveolar bone. It is usually caused by persistent inflammation of the gingival and periodontal tissues, and can be worsened by occlusal trauma.
Primary Occlusal Trauma: Occlusal trauma observed on teeth without reduced periodontal bone height.
Periodontal Disease: An inflammatory disease process affecting the soft and hard structures that support the teeth, often caused by local pathogens combined with other contributory risk factors.
Jiggling: When an applied constraint to a tooth alternates in two opposite directions (i.e. only buccal-lingual or only mesial-distal), where the tooth no longer is able to move in any given direction. Jiggling is different from the movement resultant from the continuous unidirectional force applied by an orthodontic device. Functional (non-constrained) mobility is therefore stronger, and more uncontrolled compared to the mobility induced by orthodontic treatment, which is somewhat controlled.