Tooth mobility measurements following two methods of eliminating nonworking side occlusal interferences

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.

Upper anterior tooth mobility. Selected associations in untreated periodontitis

The relationship between buccolingual tooth mobility (TM) and other clinical parameters was studied in 124 upper anterior teeth in 21 patients with untreated periodontitis. Periapical long-cone radiographs were available for 74 teeth in the same population. TM was measured with Mühlemann's macroperiodontometer. Probing depths, attachment levels and bleeding were measured with a constant force probe. Bone levels were estimated from radiographs. Presence of occlusal contact was noted in the intercuspal position and excursive movements of the mandible. Attachment levels showed the highest correlation with TM, and radiographically estimated bone support was the next highest. Results varied according to tooth type: the attachment level of the lateral incisors showed the highest correlation with TM, while probing depths and proximal bone support showed lower associations with TM in all cases. In this population, no association was detected between the presence of occlusal contact and TM, or between inflammation and TM. Multiple and partial correlation analysis indicated that probing attachment level was the most important correlate of tooth mobility.

Occlusal interferences analysed in patients treated with fixed prosthesis four years earlier

This study consists of 147 subjects treated with fixed prostheses 4 years previously. Occlusal analyses were made, and the fillings, crowns, and pontics on the occlusal surfaces were recorded. Occlusal interferences were found in 42.6% of the fillings, in 34.9% of the crowns, in 27.0% of the pontics, and in 24.6% of the intact surfaces. The most common interference types were intercuspidation, retrusion and mediotrusion in the fillings, as well as intercuspidation, retrusion, and laterotrusion interferences in the crowns. In pontics interferences appeared mostly in intercuspidation and retrusion. When adjustment was made for preprosthetic occlusion, the number of interferences on all types of occlusal surfaces considerably decreased.

Influence of occlusal interferences on the periodontium in patients treated with fixed prosthesis

Gingival bleeding, pocket depth, and tooth mobility were recorded, and occlusal analyses were made on 147 subjects treated with fixed prostheses placed 4 years earlier. The percent of gingival bleeding was greater in teeth with interferences than in those without interferences. A slight increase in pocket depth was found in connection with interferences. However, the difference was statistically significant only in the group with no preprosthetic treatment. No differences in tooth mobility were found between teeth with and those without interferences, possibly partly because of the splinting influence of the fixed partial dentures on the mobile teeth.