Periodontal traumatism produced by sustained increase in occlusal vertical dimension: a histopathological study

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.

Trauma from occlusion in monkeys

Traumatic occlusion was induced in monkeys by insertion of bridges raising the bite. Both incisors and molars were used as abutments. Observation periods ranged from 7 to 24 months. No appreciable effect of the trauma on the apical proliferation of the crevicular epithelium was found. The results were the same in monkeys with or without marginal gingival inflammation before the trauma was induced.

Stresses created by occlusal prematurities in a new photoelastic model system

A new photoelastic model system incorporating a simulated periodontal ligament sleeve around an experimental first molar has been developed. The system was used to visualize internal compressive stresses created by various premature occlusal incline relationships in both buccolingual and mesiodistal dimensions. When prematurities were applied singly and observed buccolingually, both class 1 and and class 2 prematurities produced stresses along the lingual aspect of the root, whereas the class 3 prematurity produced stresses along the buccal aspect of the root. When viewed buccolingually, combinations of class 1 and class 2 prematurities resulted in stresses along the lingual aspect of the root. The stress pattern was similar to those created by the single class 1 or class 2 prematurities. A combination of class 2 and class 3 prematurities did not produce a well-defined indication of stress distribution. There was slightly more stress along the buccal aspect of the root. Comparison of this combination with individual class 2 and class 3 prematurities indicates that such a combination tended to diminish tipping of the tooth in any one direction. A combination of class 1 and class 3 prematurities showed slightly greater stress along the buccal aspect of the root surface. Again, the combination produced less tipping of the tooth in any one direction when compared with tipping caused by the individual prematurities. When all three prematurities were tested at the same time, the stress pattern was almost coincident with that achieved in the absence of prematurities. When prematurities were observed mesiodistally, the location of stresses was dependent on the mesial or distal placement of the prematurity, irrespective of its position buccolingually.