This document provides an overview of trauma from occlusion including: - Definitions from various dental organizations - Etiology and types of occlusal forces that can cause trauma - Historical perspectives on the study of occlusion and trauma - Terminologies used to describe occlusal trauma - Stages of tissue response to excessive occlusal forces - Signs and symptoms of trauma from occlusion - Classification systems for trauma from occlusion - Examination and diagnosis techniques - Radiographic signs of trauma - Debate around reversibility of traumatic occlusion - Considerations for trauma around dental implants - Treatment approaches including occlusal adjustments and splinting

1. DR. BEENA VIJAYAN PARVATHY
II nd YEAR PG

2. CONTENTS
• DEFINITION
• ETIOLOGY
• HISTORICAL PRESPECTIVE
• TERMINOLOGIES WHICH HAVE BEEN USED TO
DESCRIBE OCCLSAL TRAUMA
• REVIEW OF LITERATURE
• OCCLUSAL FORCES DURING JAW MOVEMENTS
• CLASSIFICATION
• STAGES OF TISSUE RESPONSE TO EXCESSIVE
OCCLUSAL FORCES
• EXAMINATION AND DIAGNOSIS

3. • RADIOGRAPHIC SIGNS
• IS TRAUMATIC OCCLUSION REVERSIBLE?
• TRAUMA FROM OCCLUSION ARROUND
IMPLANTS
• OUR PRESENT UNDERSTANDING
• TREATMENT

4. DEFINITION
• WHO, 1978
• GPT, 2001
• Jan De Boever, 2004
• Carranza, 2006

5. ETIOLOGY
• Precipitating factors (Primary etiology)
Destructive occlusal forces
Magnitude of force Direction of force
Frequency of force Duration of force
• Predisposing factors
Development of TFO indirectly
Intrinsic factors Extrinsic factors

6. Types of Occlusal Forces
• Normal physiological forces
• Impact forces
• Continuous forces
• Jiggling forces

7. HISTORICAL PRESPECTIVE
• Karolyi, 1901
• Box’s Study, 1935
• Stone’s Study, 1938
• Bhaskar & Orban, 1955

8. TERMINOLOGIES WHICH HAVE BEEN USED TO
DESCRIBE OCCLUSAL TRAUMA
• Stillman 1917
• Box 1930
• Ramfjord & Ash 1972
• Muhlemann 1956 Traumatogenic occlusal situation
• Orban 1958 & Pichard 1965 Periodontal traumatism
• Glickman 1974 Trauma from Occlusion
Traumatic occlusion

9. REVIEWOF LITERATURE
• Stillmann 1917
AUTOPSY STUDIES:
• Weinman et al
• Glickman’s Concept:-
– Glickman & Smulow (1962,1969)
– Glickman (1963,1965) “Theory of Co-destruction”

11. • Waerhaug’s Concept
ANIMAL STUDY:
• Rochester Group (Polson & Co-workers)
• Gothenburg Group (Lindhe & Co-workers)
HUMAN TRIALS:
• Burgett et al 1992
• Shefter GJ & Philstrom BL
• McGuire MK & Nunn ME

12. OCCLUSAL FORCES DURING JAW
MOVEMENTS
• Svanberg GK, King GJ & Gibbs CH

13. CLASSIFICATION
• Acute Trauma From Occlusion
• Chronic Trauma From Occlusion
• Primary Trauma From Occlusion
– GPT, AAP 1992
– Polson AM, 1976
• Secondary Trauma From Occlusion
– GPT, AAP 1992

14. STAGES OF TISSUE RESPONSE TO EXCESSIVE
OCCLUSAL FORCES
• Carranza (1967, 1970)
I. Stage I, Injury
– Slightly excessive forces Zaki AE,1963
– Greater than slightly excessive force Rygh P,1972-
1974)
– Severly high forces Stallard,1964 & Stahl SS,1975)
II. Stage II, Repair
 Buttressing Bone Formation – Glickman & Smulov,
1965
 Lipping - Glickman & Smulov, 1962

15. III. Stage III, Adaptive Remodelling of the Periodontium
– Lindhe & Ericsson, 1984
– Carranza & Dotto, 1966

17. EXAMINATION AND DIAGNOSIS
Signs of Trauma From Occlusion
• Tooth Mobility
• Tooth Migration
• Wear Patterns
• Abfraction, especially in premolars
• V-Shaped or Angled Gingival Recession
• Fremitus Test  Ingervall B, 1972

18. Symptoms of Trauma From Occlusion
• Persistent Discomfort on Eating
• Thermal Sensitivity
• Muscle Hypertonicity

19. RADIOGRAPHIC SIGNS

20. IS TRAUMATIC OCCLUSION
REVERSIBLE?

21. TRAUMA FROM OCCLUSION
ARROUND IMPLANTS

22. TREATMENT
• Occlusal adjustments
• Management of parafunctional habits
• Splinting of teeth
• Orthodontic tooth movement
• Occlusal reconstruction
• Extraction of selected teeth
Perio 2000, 2017

23. OUR PRESENT UNDERSTANDING

24. REFERENCE
• Role Of Occlusion In The Etiology And Treatment, Of Periodontal Disease,
IRVING GLICKMAN, Tufts University School Of Dental Medicine, Boston,
Massachusetts 02111, USA.
• Radiographs In Periodontics, Niklaus P. Langi And Roger W. HILLS, Journal Of
Clinical Periodontology: 1977: 4: 16-28.
• The Infrabony Pocket And Its Relationship To Trauma From Occlusion And
Subgingival Plaque By Jens Waerhaug.
• Role Of Occlusion In Periodontal Disease, Euloir Passanezi, Adriana Campos
Passanezi Sant'ana.
• Association Of Trauma From Occlusion With Localized Gingival Recession In
Mandibular Anterior Teeth Pratibha Panduranga Kundapur, Khandige Mahalinga
Bhat, And Giliyar Subraya Bhat, Dent Res J (Isfahan). 2009 Autumn; 6(2): 71–74.
• Occlusal Trauma And Excessive Occlusal Forces: Narrative Review, Case
Definitions, And Diagnostic Considerations Jingyuan Fan Jack G. Caton.
• Clinical Diagnosis Of Trauma From Occlusion And Its Relation With Severity Of
Periodontitis L. J. Jtn And C. F. Cao.