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contributing to the description of this condition might be tooth posi‐ tion, aberrant frenum, or vestibular depth.
Does traumatic occlusal force accelerate the progression of periodontitis?
Gingival Recession It is proposed to adopt a classification of gingival recession with ref‐ erence to the interdental clinical attachment loss: 33 • Recession Type 1 (RT1) : Gingival recession with no loss of inter‐ proximal attachment. Interproximal CEJ is clinically not detect‐ able at both mesial and distal aspects of the tooth. • Recession Type 2 (RT2) : Gingival recession associated with loss of interproximal attachment. The amount of interproximal attach‐ ment loss (measured from the interproximal CEJ to the depth of the interproximal sulcus/pocket) is less than or equal to the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus/pocket). • Recession Type 3 (RT3) : Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss (measured from the interproximal CEJ to the apical end of the sulcus/pocket) is higher than the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus/pocket). Table 2 reports a diagnostic approach to classify gingival phe‐ notype, gingival recession, and associated cervical lesions. This is a treatment‐oriented classification supported by data included in the accompanying narrative review. 2
There is evidence from observational studies that traumatic occlusal forces may be associated with the severity of periodontitis. 34 Evidence from animal models indicate that traumatic occlusal forces may increase alveolar bone loss. 35,36 However, there is no evidence that traumatic oc‐ clusal forces can accelerate the progression of periodontitis in humans . Can traumatic occlusal forces cause non‐carious cervical lesions? There is no credible evidence that traumatic occlusal forces cause non‐carious cervical lesions. What is the evidence that abfraction exists? Abfraction, a term used to define a wedge‐shaped defect that occurs at the cemento‐enamel junction of affected teeth, has been claimed to be the result of flexure and fatigue of enamel and dentin. The ex‐ istence of abfraction is not supported by current evidence. Can traumatic occlusal forces cause gingival recession? There is evidence from observational studies that occlusal forces do not cause gingival recession. 37,38 Are orthodontic forces associated with adverse effects on the periodontium? Evidence from animal models suggests that certain orthodontic forces can adversely affect the periodontium and result in root resorption, pulpal disorders, gingival recession and alveolar bone loss. 39,40 Conversely, there is evidence from observational studies that with good plaque control, teeth with a reduced but healthy peri‐ odontium can undergo successful tooth movement without compro‐ mising the periodontal support. 41,42 Does the elimination of the signs of traumatic occlusal forces improve the response to treatment of periodontitis? There is evidence from one randomized clinical trial that reducing tooth mobility may improve periodontal treatment outcomes. 43 There is in‐ sufficient clinical evidence evaluating the impact of eliminating signs of traumatic occlusal forces on response to periodontal treatment. Should we still distinguish primary from secondary occlusal trauma in relation to treatment? Primary occlusal trauma has been defined as injury resulting in tissue changes from traumatic occlusal forces applied to a tooth or teeth
OCCLUSAL TRAUMA AND TRAUMATIC OCCLUSAL FORCES
The group defined excessive occlusal force and renamed it trau- matic occlusal force . Traumatic occlusal force is defined as any oc‐ clusal force resulting in injury of the teeth and/or the periodontal attachment apparatus. These were historically defined as exces‐ sive forces to denote that the forces exceed the adaptive capacity of the individual person or site. Occlusal trauma is a term used to describe the injury to the periodontal attachment apparatus, and is a histologic term. Nevertheless, the clinical presentation of the presence of occlusal trauma can be exhibited clinically as described in the case definition. Does traumatic occlusal force or occlusal trauma cause periodontal attachment loss in humans? There is no evidence that traumatic occlusal force or occlusal trauma causes periodontal attachment loss in humans. Can traumatic occlusal force cause periodontal inflammation? There is limited evidence from human and animal studies that traumatic occlusal forces can cause inflammation in the periodontal ligament. 3
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