S226 |
JEPSEN et al .
TABLE 2 Classification of mucogingival conditions (gingival phenotype) and gingival recessions
widened periodontal ligament space, tooth migration, discomfort/ pain on chewing, and root resorption.
As some of the signs and symptoms of traumatic occlusal forces and occlusal trauma may also be associated with other conditions, an appropriate differential analysis must be performed to rule out other etiologic factors. The group agreed to a classification related to traumatic occlusal forces and occlusal trauma (Table 3).
with normal periodontal support. This manifests itself clinically with adaptive mobility and is not progressive. Secondary occlusal trauma has been defined as injury resulting in tissue changes from normal or traumatic occlusal forces applied to a tooth or teeth with reduced support. Teeth with progressive mobility may also exhibit migration and pain on function. Current periodontal therapies are directed primarily to address etiology; in this context, traumatic occlusal forces. Teeth with progressive mobility may require splinting for patient comfort. The group considered the term reduced periodontium related to secondary occlusal trauma and agreed there were problems with defining “ reduced periodontium ”. A reduced periodontium is only meaningful when mobility is progressive indicating the forces acting on the tooth exceed the adaptive capacity of the person or site. RT = recession type 33 REC Depth = depth of the gingival recession GT = gingival thickness KTW = keratinized tissue width CEJ = cemento‐enamel junction (Class A = detectable CEJ, Class B = un‐ detectable CEJ) Step = root surface concavity (Class + = presence of a cervical step > 0.5 mm. Class – = absence of a cervical step > 0.5 mm) 44
DENTAL PROSTHESES AND TOOTH‐ RELATED FACTORS
Several conditions, associated with prostheses and teeth, may predispose to diseases of the periodontium and were extensively reviewed in a background paper. 4 The extent to which these condi‐ tions contribute to the disease process may be dependent upon the susceptibility of the individual patient. What is the biologic width? Biologic width is a commonly used clinical term to describe the apico‐coronal variable dimensions of the supracrestal attached tis‐ sues. The supracrestal attached tissues are histologically composed of the junctional epithelium and supracrestal connective tissue at‐ tachment. The term biologic width should be replaced by supracrestal tissue attachment . Is infringement of restorative margins within the supracrestal connective tissue attachment associated with inflammation and/or loss of periodontal supporting tissues? Available evidence from human studies supports that infringement within the supracrestal connective tissue attachment is associated with inflammation and loss of periodontal supporting tissue. Animal studies corroborate this statement and provide histologic evidence that infringement within the supracrestal connective tissue attach‐ ment is associated with inflammation and subsequent loss of peri‐ odontal supporting tissues, accompanied with an apical shift of the junctional epithelium and supracrestal connective tissue attachment. supracrestal connective tissue attachment due to dental plaque biofilm, trauma, or some other factors? Given the available evidence, it is not possible to determine if the negative effects on the periodontium associated with restoration margins located within the supracrestal connective tissue attach‐ ment is caused by dental plaque biofilm, trauma, toxicity of dental materials, or a combination of these factors. Are changes in the periodontium caused by infringement of restorative margins within
Case definitions and diagnostic considerations
1. Traumatic occlusal force is defined as any occlusal force resulting in injury of the teeth and/or the periodontal attachment ap‐ paratus. These were historically defined as excessive forces to denote that the forces exceed the adaptive capacity of the individual person or site. The presence of traumatic occlusal forces may be indicated by one or more of the following: fre‐ mitus, tooth mobility, thermal sensitivity, excessive occlusal wear, tooth migration, discomfort/pain on chewing, fractured teeth, radiographically widened periodontal ligament space, root resorption, and hypercementosis. Clinical management of trau‐ matic occlusal forces is indicated to prevent and treat these signs and symptoms. 2. Occlusal trauma is a lesion in the periodontal ligament, cementum and adjacent bone caused by traumatic occlusal forces. It is a histo‐ logic term; however, a clinical diagnosis of occlusal trauma may be made in the presence of one or more of the following: progressive tooth mobility, adaptive tooth mobility (fremitus), radiographically
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