![]() 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. 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. 9.5) illustrates that occlusal trauma can manifest itself in different ways within the same mouth.A growing problem in dentistry is complications associated with failing amalgam restorations that have been in place for many years. Pulpal necrosis and development of periapical radiolucencies in absence of caries, failed restorations, and tooth fractures. Root fractures can be related to occlusal trauma or other predisposing factors. Since a widened periodontal ligament can also be caused by rare medical conditions such as scleroderma and osteosarcomas, 5 thorough medical history taking and oral cancer screening must rule out these conditions when widened periodontal ligament is observed. 4 A widened periodontal ligament due to occlusal trauma should correspond to clinically observable tooth mobility. Widened periodontal ligament near the alveolar crest. Usually, these defects will appear as narrow, funnel-shaped bone defects on teeth with significant occlusal wear. Vertical bone defects not attributable to other factors such as furcation entrances and calculus. Radiographic signs of occlusal trauma include the following: 3ĭevelopment of exostoses, although other factors such as genetics can also favor the development of exostoses.Ī history of bruxism (tooth grinding) or clenching may suggest the presence of occlusal trauma if there are signs of damage to teeth such as fractures and significant attrition. Tooth and restoration fracture may suggest occlusal trauma, although these can also be related to predisposing restorative factors such as root canal treatment or the presence of large direct restorations. Similarly, abfraction should not be confused with abrasion, where a mechanical agent such as a gritty dentifrice or smokeless tobacco wears away exposed dentin. 2 When evaluating abfractions, it is important to check how the patient uses a toothbrush on this tooth as brushing can cause abfraction-type lesions as well. Abfractions are wedge-shaped noncarious cervical lesions that may be caused by high occlusal loads. Erosion can be distinguished from attrition if the erosion process leaves restorative margins higher than the surrounding tooth structure.Ībfractions may suggest occlusal trauma. Wear and attrition should not be confused with erosion caused by acidic foods and medical conditions. Some loss of enamel is typical with increasing age, but occlusal dentin should not appear in nongeriatric patients eating mostly soft, cooked, and processed foods. Wear facets and attrition, which is excessive for a patient’s age and diet pattern, may suggest the presence of occlusal trauma. Percussion sensitivity usually indicates inflamed periapical tissue, which may be caused by pulpal disease, and also by irritation triggered by excessive occlusal force. Percussion sensitivity in the absence of pulpal disease. Tooth mobility not explainable by inflammatory processes or loss of bone support. Presence of fremitus is diagnostic for occlusal trauma, and fremitus needs to be eliminated as part of initial, nonsurgical periodontal treatment. What are the signs of occlusal trauma? Clinical signs of occlusal trauma include the following:įremitus means tooth movement that can either be observed or felt as a patient occludes. Abbreviations: BOP, bleeding on probing (1), suppuration (2) CAL, clinical attachment level Furc, furcation involvement (Glickman class) GR, gingival recession MGJ, position of mucogingival junction from margin Mobil, tooth mobility (Miller grade) PD, probing depths PLQ, plaque level (0 = none, 5 = heavy).
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