REVIEW ARTICLE
Trauma from Occlusion
The Overstrain of the Supporting Structures of the Teeth
Singh, Dhirendra Kumar; Md., Jalaluddin; Ranjan, RajeevAuthor Information
Indian Journal of Dental Sciences 9(2):p 126-132, Apr–Jun 2017. | DOI:
10.4103/IJDS.IJDS_21_16
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Abstract
Any occlusal force which goes beyond the adaptive capacity of our periodontium
causes injury to periodontal structures, and the resultant trauma is called as trauma
from occlusion (TFO), several schools of thoughts are there that whether TFO is an
etiological factor or cofactor for the occurrence of periodontal diseases. Present
review paper is an effort to clear the actual concept of TFO along with its historical
background, etiological factors, relevant terminologies, signs and symptoms, and
advanced diagnostic methods.
INTRODUCTION
For many years, the role of occlusion and its dynamic interactive impact on the
periodontium has been an issue of controversy and extensive debate. Although a
variety of occlusal conditions have purportedly been related to this interaction, the
central focus has been on occlusal trauma resulting from excessive forces applied to
the periodontium.[1234] In an attempt to clarify and better understand this condition,
early investigators used human necropsy specimens and a variety of animal models
as a basis for clinical and histological studies. Findings were often diverse and
somewhat contradictory. In the animal studies, factors of concern included
differences among animals, forces applied, and lack of controls. Retrospective
descriptive observations of the effect of excessive forces on the periodontium were
derived from human necropsy materials. The selection of study sites was based on
occlusal wear, patterns of pocket formation, and presence of attachment loss leaving
some questions as to the presence of ongoing occlusal trauma.
Despite the foregoing concerns, the majority of these early studies agreed that
occlusal trauma in and of itself failed to result in pocket formation or loss of
connective tissue attachment. It is apparent that the effects of excessive occlusal
force and the destructive, adaptive, and reparative response of the periodontium
have been complicated by a relative lack of evidence based on well-controlled
prospective studies in human beings.[567]
This review is based on analysis of 150 papers published in English language till
November 2016 in peer-reviewed journals. The search for papers was performed
using Medline, Google Scholar, and PubMed by searching keywords such as trauma
from occlusion, primary trauma from occlusion, secondary trauma from occlusion,
trauma from occlusion, and periodontal diseases. Any discussion related to the
trauma from occlusion (TFO) use of in periodontics and implantology was taken into
consideration if appropriate for this review.
The present literature review is an attempt to address the histological and clinical
effects of abnormal occlusal forces on other teeth and periodontium and to provide
diagnosis and clinical aspects for the same.
HISTORICAL ASPECTS
Karolyi was the first one to start the most controversial issue by introducing in 1901
the concept of bruxism as a significant factor in the pathogenesis of periodontitis. It is
known as the “Karolyi effect.”
Talbot did the first comprehensive study of the role of occlusal stress on teeth in
relation to periodontal disease was made by Talbot, who pointed out that man is
predisposed to disease of the supporting tissues of the teeth because jaw function
has been greatly decreased by modern methods of food preparation.
Box et al. did study on sheeps' tooth suggesting that TFO produces vertical bone
defect. Stillman[8] was the first to emphasize traumatic occlusion as a cause of
periodontal disease. Repeated abnormal pressures of one tooth on another produce
traumatic injury. He pointed out that there are noninfectious changes that are directly
produced by traumatic occlusion.
Glickman and Smulow[91011] proposed the theory in the early 1960s that a
traumatogenic occlusion could act as a cofactor in the progression of periodontitis.
This theory is known as the “co destructive theory.” Goldman[12] proved that occlusal
trauma was not the cause of soft tissue lesions such as Stillman's clefts and McCall's
festoons. Waerhaug[1314] proved the involvement of TFO in the pathogenesis of
Infrabony pockets. Polson[1516] used squirrel monkeys as their animal model.
Houston et al.[17] concluded that there is no correlation between periodontal disease
and bruxism; they seldom occurred in the same individual, and bruxism and occlusal
status are not closely associated.
Burgett et al.[18] found no significant difference in the reduction in tooth mobility
between the adjusted and the nonadjusted groups. Wolffe et al.[19] stated that “a
periodontium remained healthy despite the persistent forces that caused the drifting
of the teeth and significant changes in occlusion.”
Ericsson et al.[20] showed that splinting failed to retard attachment loss or to inhibit
plaque down growth. He showed that despite healthy gingival tissues, jiggled teeth
lost marginal bone and had more probing depth when compared to the nonjiggled.
TERMINOLOGIES USED WITH TRAUMA FROM
OCCLUSION
