Association between clinical manifestations of occlusal trauma and magnetic resonance imaging findings of periodontal ligament space.

OBJECTIVES: The purpose of this study was to evaluate the association between clinical manifestations of occlusal trauma of the teeth and maximum signal intensity of periodontal ligament space on MRI. METHODS: 20 subjects (males: 9, females: 11, mean age: 35.9 ± 14.0 years, range: 22-65 years) participated in this study. Subjective symptoms of bruxism, tooth mobility, fremitus, occlusal contact area, occlusal force, widening of the periodontal ligament space, and thickening of the lamina dura were defined as clinical manifestations of occlusal trauma. The total number of clinical manifestations was used to evaluate the degree of clinical occlusal trauma, with a score of 7 indicating the highest degree of occlusal trauma. The maximum signal intensity in the periodontal ligament space was evaluated by a specific T2 weighted MRI sequence: IDEAL image. RESULTS: Spearman's rank correlation between the total clinical occlusal trauma score and maximum signal intensity in the periodontal ligament space was 0.529 for all teeth, 0.517 for anterior teeth, and 0.396 for molar teeth (p < 0.001 for all). CONCLUSIONS: A significant correlation between the degree of occlusal trauma and the signal intensity of the periodontal ligament space suggests a new potential MRI-based method for objectively determining occlusal trauma.

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.

Intrusion of supra-erupted molars using miniscrews: clinical success and root resorption.

INTRODUCTION: Conventional orthodontic techniques do not intrude posterior teeth effectively, and almost all methods result in anterior extrusion rather than posterior intrusion. New absolute anchorages (miniscrews and miniplates) are said to make posterior tooth intrusion possible. The aim of this study was to evaluate the clinical success of a new method for molar intrusion with miniscrews and its probable accompanying side effects. MATERIAL AND METHODS: Ten women with overerupted upper first molars participated in this study. Upper molar bands with brackets were cemented. Two miniscrews were placed, 1 in the mesiopalatal and another in the mesiobuccal aspect of the upper first molars; a spring made of 0.017 × 0.25-in titanium-molybdenum alloy (TMA) wire was used to apply 100 g of force through the attachments (50 g each side). Molar intrusion and external apical root resorption were evaluated by comparing parallel periapical radiographs with bite blocks at 3 intervals: beginning of treatment (T0), at the end of active treatment (T1), and 6 months after treatment completion (T2). RESULTS: The mean value of intrusion was 2.1 mm after completion of active treatment. On average, 0.4 ± 0.2 mm relapse had occurred during 6 months of retention, and the mean residual intrusion was 1.7 mm, which was statistically significant. Mean root resorption of 0.3 ± 0.2 mm for palatal root and 0.4 mm for mesiobuccal and distobuccal root was measured. CONCLUSIONS: Statistically significant intrusion (2.1 ± 0.9 mm) was obtained during active treatment. The mean value of relapse was 0.4 ± 0.2 mm, and the mean value for residual intrusion was 1.7 ± 0.6 mm. Minor apical root resorption occurred during treatment.

Effects of occlusal overload on peri-implant tissue health: a systematic review of animal-model studies.

BACKGROUND: This study systematically evaluates the effect of occlusal overload (OV) on peri-implant tissue health in animal studies. METHODS: MEDLINE, EMBASE, and LILACS databases were searched for articles published up to and including January 2010. Studies that reported outcomes of non-splinted titanium dental implants submitted to OV were eligible for inclusion. Probing depth (PD), clinical attachment level (CAL), radiographic and histologic distances from the implant base to the most coronal point of bone-to-implant contact (RDIB and DIB, respectively), and bone density (BD) were the main outcomes of interest. RESULTS: Two controlled trials were included in this review and both were considered at a high risk of bias. The marked heterogeneity between studies did not allow data to be combined for meta-analyses. Two studies reported no association between OV and peri-implant tissue breakdown in the absence of dental plaque, with PD and CAL varying from 2 to 3 mm at the end of the experiments. In the presence of plaque accumulation, OV played a key role in peri-implant tissue breakdown (PD change: 5.3 mm; DIB: 6.0 mm). Trends suggested that OV may increase BD. CONCLUSIONS: Data on OV on stable implants are limited and conflicting. OV may lead to bone loss in the presence of dental plaque and to an increase in BD in areas where plaque control is performed.

Orthognathic surgery for occlusal reconstruction of old malunited jaw fracture.

Old malunited jaw fractures of nine patients who underwent orthognathic surgery for occlusal reconstruction were clinically evaluated. Early surgery on fractures of the jaw is the optimal treatment when due attention must be paid to occlusion. Since occlusal revision surgery subsequent to inaccurate diagnosis and inappropriate surgery is certainly very difficult and often unsuccessful, surgeons need to pay special attention to this situation.

Occlusal and temporomandibular joint disorders in patients with unilateral condylar fracture. A prospective one-year study.

Adult dentate patients with unilateral condylar fractures were followed up for one year after injury. Patients were interviewed about subjective complaints, and mandibular excursions and function of occlusion and temporomandibular joints (TMJs) were recorded. Radiological characteristics were assessed from panoramic and Towne's views and compared between patients with occlusal disorders and patients without. During follow up, mandibular deviation on opening towards the fractured side was more pronounced in cases with marked reduction of ramus height and condylar dislocation. This restriction of translation movement of the fractured joint was also seen radiologically in one-third of cases while in two-thirds of the fractured condyles, malpositioning was observed when compared with the healthy side. In patients (39%) having subjective symptoms such as TMJ pain, altered occlusion or ability to bite only unilaterally, and objectively verified occlusal interferences, a marked reduction of the ramus height on the fractured side was observed. In such cases nonoperative treatment of condylar fractures may be compromised.

[The effect of artificial traumatic occlusion on the pulp and periodontium in rat molars].

In order to study relationship between the period of occlusal trauma and pulpal and periodontal tissues, 44 rats were used in experimental occlusal trauma. The pulpal and periodontal tissues of rat molars were observed by histological examination and micrographic examination. The results showed that the damage of pulp became more serious as time went on, but periodontium appeared adaptive changes. The same changing area in periodontal tissues were observed between histological section and micrographic film. The results provide experimental evidences for the pathology and pathogeny of pulpitis and perioapical periodontitis caused by occlusal trauma.

[The relationship of the mechanical properties of the dentoalveolar complex to the status of the bone tissue in traumatic occlusion]. / Zavisimost' mekhanicheskikh svoistv dentoal'veoliarnogo kompleksa ot sostoianiia kostnoi tkani pri travmaticheskoi okkliuzii.

The authors have developed a model of traumatic occlusion, simulating a swinging functioning overload of the periodontium in dogs; this model is adequate to the clinical conditions of occlusion disorders of dentitions. Experiments with 18 dogs have demonstrated a relationship between change in the biomechanical and physical properties of dentoalveolar tissues and the length of traumatic occlusion. Experiments have shown a progressive reduction of the ability of dental abutment tissues to resist the load and slowed down reparative processes in the periodontal tissues in swinging type traumatic occlusion.

[Linear tomography and the Zonarc TMJ program. Reproducibility of condylar position of TMJ after surgical correction of dysgnathia]. / Lineare Tomographie und Zonarc-TMJ-Programm. Die Reproduzierbarkeit der Kondylusposition des TMJ nach kieferchirurgischer Korrektur von Dysgnathien.

In this clinical study the position of the mandibular condyles of 40 patients treated for malocclusion by surgical splitting of the mandibular ramus alone or combined with Le Fort I osteotomies was studied on lateral linear TMJ tomograms. Linear tomograms of the right and left TMJ with the mandible closed were taken from each patient prior to surgery and 6 months postoperatively. The postoperative changes in condylar position wee assessed in terms of direction and amount. Condylar displacements were found in 89% of the examined joints, most of them were less than 2mm. All types and combinations of displacement occurred, however, general trends in direction depending on the type of treatment could not be established with statistical significance. The type of surgical correction, its direction and amount did not seem to have an effect on the direction and amount of condylar displacement resulting. A comparison of the measured values with data in the literature showed that the amount of condylar displacement was markedly less--this seemed to be attributable to our precise evaluation method and a more sophisticated surgical technique.

Occlusal interferences related to dental panoramic radiographic changes in subjects treated with fixed prosthesis.

Because of contradictory reports between clinical and radiographic findings, occlusal analysis correlated to dental panoramic findings was completed in 147 patients treated with fixed prosthesis. Both occlusal interferences and radiographic changes in the TMJ area and/or in dentition were frequently discovered. Dysfunction and occlusal indices gave statistically significant correlations to radiographic changes (P less than 0.01 and P less than 0.05, respectively) in the TMJ area. Periodontal changes with vertical bone pocket formation and sclerotic lamina dura seem to be early radiographic findings and occlusal interferences were the only means to give a clear-cut correlation to the radiographic changes (P less than 0.001). However, if periodontal tissues with supporting bone structure fail to respond to occlusal trauma, changes in the TMJ area will probably appear. From the clinical changes the deviation on mouth opening, tenderness to palpation of TMJ, and slide from retrusion to intercuspidation (RP-IP) explained most of the radiological TMJ changes when tested by the discriminant analysis. The value of radiographic follow-up of subjects following prosthetic treatment is emphasized.

Radiographic interpretation of chronic periodontitis.

There has recently been a substantial change in our concept of periodontal disease and particular attention is now focused on that small proportion of the population who appear susceptible to its more aggressive forms rather than the majority in whom bone loss progresses very slowly. It is also apparent that the presently available clinical parameters are of little value in predicting future destructive activity. Under these circumstances, the aim of this paper is to review the contribution of radiography to the diagnosis of chronic periodontitis as traditionally perceived and then reassess its status in the light of these newer concepts. Panoramic radiography, followed by the appropriate periapical radiographs (taken with the paralleling technique), is proposed as an alternative to complete mouth intra-oral surveys on grounds of both diagnostic yield and radiation thrift. The five areas to which radiography, despite its limitations, can make a significant contribution are in the assessment of bone loss, mobility, occlusal trauma, calculus and marginal overhangs and crown-root ratio. The validity of the three criteria that have been proposed for the radiographic assessment of early periodontitis, loss of crestal bone height, marginal widening of the periodontal ligament and crestal irregularity, is evaluated in detail and it is concluded that only the first is of any diagnostic worth, providing at least two sequential radiographs are available. While there is an urgent need to develop techniques of greater sensitivity for the early identification of periodontal bone loss, there must be some doubt as to the value of any bone imaging technique in predicting the susceptible patient. Follow-up radiography should be limited to these sites showing clinical evidence of further disease activity.

Association between signs of trauma from occlusion and periodontitis.

The purpose of this study was to evaluate the association between signs of trauma from occlusion, severity of periodontitis and radiographic record of bone support. The maxillary first molars of 300 individuals were independently evaluated by two examiners for signs of trauma from occlusion, pattern or occlusal contacts and severity of periodontitis. Each site was also evaluated radiographically by an independent third examiner. The results indicated that: teeth with either bidigital mobility, functional mobility, a widened periodontal ligament space or the presence of radiographically visible calculus had a deeper probing depth, more loss of clinical attachment and less radiographic osseous support than teeth without these findings, teeth with occlusal contacts in centric relation, working, nonworking or protrusive positions did not exhibit any greater severity of periodontitis than teeth without these contacts, teeth with both functional mobility and radiographically widened periodontal ligament space had deeper probing depth, more clinical attachment loss and less radiographic osseous support than teeth without these findings and given equal clinical attachment levels, teeth with evidence of functional mobility and a widened periodontal ligament space had less radiographic osseous support than teeth without these findings.

Radiographs in periodontics.

Intraoral radiographs are widely used in periodontal diagnosis and research. However, accurate radiographic interpretation is only possible with high quality images. Some of the technical and geometric variables to consider have been presented. Early periodontal lesions are not detected in radiographs. The amount of periodontal destruction in more advanced disease is generally underestimated. The accurate topography of periodontal pockets and the buccal and lingual aspects of the teeth cannot be visualized. Clinical probing is therefore a prerequisite for a complete periodontal diagnosis. However, radiographs are a valuable adjunct for the periodontal diagnosis and the diagnosis of trauma from occlusion. With standardized systems, radiographs may furnish additional quantitative data in clinical research.