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Background: Excessive occlusal forces and occlusal trauma have been implicated as co-destructive factors for periodontitis in animal models. The objective of this study was to assess the association between occlusal trauma and periodontitis., Methods: A total of 167 cases and 205 controls were included for analysis. Occlusal trauma was the exposures of interest and was registered for cases and controls. Additional clinical co-variables were registered as well for further analysis. The association of the exposure and periodontitis was determined by the odds ratio and logistic regression analysis adjusted for confounders., Results: Amalgam restorations, pathogenic occlusion and occlusal trauma were more frequent in cases as compared to controls (P ≤ 0.05). The distribution of pathogenic occlusion and occlusal trauma was similar according to the stage and class of periodontitis. Logistic regression analysis showed a significant association for cigarette smoking, systemic conditions, amalgam restorations, pathogenic occlusion, and occlusal trauma with periodontitis (P ≤ 0.05). After adjusting for confounding variables in the model, amalgam restorations and occlusal trauma remained strongly associated with periodontitis (P ≤ 0.05)., Conclusions: Occlusal trauma is strongly associated with periodontitis. Additional long-term prospective studies are necessary to further understand the impact of the occlusal condition and periodontitis., (© 2021 American Academy of Periodontology.)

Background: Occlusal trauma can aggravate periodontitis, but the mechanism remains unclear. Yes-associated protein (YAP), a mechanical stressor protein, may play an important role in this process., Methods: Western blot and quantitative real-time polymerase chain reaction (qRT-PCR) were applied to detect the expression of YAP and inflammatory factors in patients with periodontitis accompanied with or without occlusal trauma. Through local administration of Porphyromonas gingivalis and composite resin bonding on maxillary molars in mice, we established periodontitis and occlusal trauma models. Treatment with or without XAV939, to inhibit YAP activation, was performed in these models. Micro-computed tomography, immunofluorescence (IF), and qRT-PCR were used to explore the YAP pathway in periodontitis with occlusal trauma. Cyclic stress and lipopolysaccharide (LPS) stimuli were applied to the L929 mouse fibroblast cell line with or without XAV939. Western blot, IF, and qRT-PCR were used to verify the in vivo results., Results: Activated dephosphorylated YAP and increased expression of inflammatory factors were observed in patients with periodontitis accompanied with occlusal trauma. In the mouse model of periodontitis with occlusal trauma, YAP transferred into the nucleus, resulting in Jun N-terminal kinases (JNK) related pro-inflammatory pathway up-regulation. L929 cell cyclic stress and LPS stimulation results confirmed the in vivo results. Application of XAV939 inhibited YAP protein dephosphorylation and reduced JNK pro-inflammatory pathway factor expression in vivo and in vitro., Conclusions: Occlusal trauma can activate YAP nuclear transfer, resulting in the up-regulation of the JNK pro-inflammatory pathway. This can be inhibited by the XAV939 YAP inhibitor., (© 2020 American Academy of Periodontology.)

Background: Diabetes mellitus (DM) involves metabolic changes that can negatively influence periodontal tissues, resulting in more prevalent and severe periodontitis and impaired bone formation. Occlusal trauma (OT) is an injury of the supportive periodontium that results in bone loss. It can be hypothesized that DM would increase bone loss after OT, mainly when associated with periodontitis. Thus, the aim of the present study is to evaluate the influence of DM on bone response in the furcation area of teeth subjected to OT in the presence, or absence, of experimental periodontitis (EP) in the rat model., Methods: Thirty-two male Wistar rats were assigned to four groups: 1) group 1 (G1): DM+OT+EP (n = 8); 2) group 2 (G2): DM+OT (n = 8); 3) group 3 (G3): OT+EP (n = 8); and 4) group 4 (G4): OT (n = 8). G1 and G2 received a single intraperitoneal injection of streptozotocin (STZ). After 10 days, G1 and G3 were subjected to EP by ligature placement. Fifteen days after the start of EP, OT was induced by the creation of a premature contact. The animals were euthanized 35 days after DM induction., Results: DM enhanced bone loss in the presence of OT combined with EP, but did not increase bone loss in teeth subjected to OT alone. EP caused greater bone loss when associated with OT., Conclusion: Within the limits of this animal study, it can be concluded that DM enhances bone loss in the presence of occlusal trauma associated with EP.

Background: This study systematically evaluates the effect of occlusal overload (OV) on peri-implant tissue health in animal studies., Methods: MEDLINE, EMBASE, and LILACS databases were searched for articles published up to and including January 2010. Studies that reported outcomes of non-splinted titanium dental implants submitted to OV were eligible for inclusion. Probing depth (PD), clinical attachment level (CAL), radiographic and histologic distances from the implant base to the most coronal point of bone-to-implant contact (RDIB and DIB, respectively), and bone density (BD) were the main outcomes of interest., Results: Two controlled trials were included in this review and both were considered at a high risk of bias. The marked heterogeneity between studies did not allow data to be combined for meta-analyses. Two studies reported no association between OV and peri-implant tissue breakdown in the absence of dental plaque, with PD and CAL varying from 2 to 3 mm at the end of the experiments. In the presence of plaque accumulation, OV played a key role in peri-implant tissue breakdown (PD change: 5.3 mm; DIB: 6.0 mm). Trends suggested that OV may increase BD., Conclusions: Data on OV on stable implants are limited and conflicting. OV may lead to bone loss in the presence of dental plaque and to an increase in BD in areas where plaque control is performed.

Background: It has been suggested that eccentric occlusal forces may be an etiologic factor for abfraction lesions. It has also been suggested that traumatic occlusal forces may have a damaging effect on the periodontal tissues. The purpose of this study was to determine whether associations were present between premature contacts in centric relation (PCCR), clinical attachment loss, and abfraction lesions., Methods: Forty-six subjects were examined. Within subjects, the mean attachment loss was determined for teeth with and without PCCR and for teeth with and without abfractions. In addition, teeth with PCCR (experimental group) were matched with contralateral teeth without PCCR (control group). Comparisons between groups were made with the Wilcoxon signed rank test, Wilcoxon rank sums test, and the Spearman rho correlation coefficient., Results: The results demonstrated that attachment loss increased with age. Within subjects, teeth with abfraction lesions had significantly more buccal attachment loss than teeth without abfraction lesions (P <0.01). The majority of abfractions and PCCR occurred in premolars. The presence of PCCR had no influence on the appearance of an abfraction lesion or increased attachment loss. Similarly, subjects who exhibited abfractions had similar attachment loss as those subjects without abfraction lesions., Conclusions: Within the same patient, teeth with abfractions presented more attachment loss than those without abfractions. However, associations were not demonstrated between PCCR and the presence of abfractions or increased attachment loss. Future studies are needed to improve the knowledge regarding interactions among occlusal factors, attachment loss, and abfractions.

Background: The purpose of this study was to investigate potential associations between dynamic occlusal interferences and signs of periodontal disease in posterior teeth based on dental and medical measurements obtained from a population-based sample in the cross-sectional epidemiological study entitled, "Study of Health in Pomerania" (SHIP)., Methods: Medical history and dental and sociodemographic parameters of 2,980 representatively selected dentate subjects, 20 to 79 years of age, were collected. The analysis was performed on posterior teeth only using a mixed linear model that considers the clustered structure of the data. The model also was adjusted with respect to known risk factors for periodontal disease., Results: The presence of non-working side contacts only was significantly related to probing depth (P<0.0001) and attachment loss (P=0.001). The presence of non-working side contacts and working side contacts on the same tooth was significantly related to increased probing depth (P=0.004) but not attachment level. The effect magnitude was a mean increase of 0.13 mm for probing depth and 0.14 mm in attachment loss. Known risk factors for periodontal disease that also showed significant associations with probing depth and attachment loss included male gender, age, smoking, education, and plaque score. Other factors significantly related to probing depth and/or attachment loss were tilted teeth, restored occlusal surfaces versus sound surfaces, elongated teeth, and tooth type (molar versus premolar)., Conclusion: The effect of non-working contacts on periodontal disease status was discernible, but weak in terms of magnitude and specificity.

Background: The aim of the present study was to verify nicotine effects on alveolar bone changes induced by occlusal trauma during a periodontitis experimental model in rats., Methods: Thirty adult male rats were used. The animals were randomly assigned to one of three groups receiving daily intraperitoneal injections: A, nicotine solution (0.44 mg/ml) and occlusal overload; B, saline solution and occlusal overload; or C, saline solution. Rats from groups A and B underwent bilateral amputation of the second and third molar cusps to simulate an occlusal overload. The first molars were then randomly assigned to receive a cotton ligature in the sulcular area, while the contralateral tooth was left unligated. The animals were sacrificed 30 days later. The resected mandibles were processed, and histomorphometric measurements were performed in the alveolar bone adjacent to the furcation area of the first molars., Results: Nicotine enhanced the bone loss induced by occlusal trauma (P<0.001) on the ligated teeth of group A (12.27 +/- 4.4 mm2), when compared to groups B (8.43 +/- 3.51 mm2) and C (4.43 +/- 2.17 mm2). Alveolar bone loss (P<0.01) was also observed in the contralateral teeth of groups A (nicotine + trauma) and B (saline + trauma), when compared to group C (saline only)., Conclusion: Within the limits of the study, it is concluded that nicotine may influence the alveolar bone changes induced by occlusal trauma by enhancing bone loss.

Background: The study of occlusal therapy in humans with periodontitis is problematic due to potential irreversible bone loss in control subjects. The hypothesis of this pilot investigation was that increased interocclusal contact initiated by short-term occlusal splint disuse would increase tooth mobility and the bone-resorptive cytokine interleukin (IL)-1beta in gingival crevicular fluid (GCF), comparable to IL-1-positive genotype and increased periodontitis severity., Methods: Nineteen non-smoking chronic periodontitis patients using nocturnal occlusal splints and undergoing periodontal maintenance in a private practice were evaluated at five time points: 24 hours after continuous splint use; 1, 2, and 3 days after no occlusal splint use; and 14 days after resumption of customary nighttime splint use. Subjects were evaluated to confirm that the plaque index and gingival index were < or = 1.0, and to categorize past periodontitis (moderate or severe) and IL-1 genotype (1A +4845 plus IL-1B +3954). Test sites on two anterior teeth vulnerable to occlusal trauma were sampled for mobility, GCF IL-1beta, and IL-1 receptor antagonist (ra)., Results: Tooth mobility remained low during the 3-day period when patients were not wearing their occlusal appliance. GCF IL-1beta decreased after not wearing the appliances (P = 0.016), especially at 48 hours. At this time, genotype-positive subjects had higher levels of GCF IL-1beta/IL-1ra than genotype-negative subjects (P = 0.045), and patients who had experienced severe periodontitis had higher IL-1beta levels than moderate periodontitis subjects (P = 0.004)., Conclusions: These findings suggest that short-term discontinuation of occlusal splint therapy in non-smoking periodontitis patients undergoing periodontal maintenance does not result in potential signs of early occlusal trauma (increasing mobility or GCF IL-1beta). Longer-term studies may be needed to determine appropriate therapy applications for periodontitis-susceptible patients with definable occlusal discrepancies and/or parafunction.

Background: A patient presented with moderate probing depth, pain on occlusal contact, and a fistula on a mandibular bicuspid. The probing depth increased 2 mm over a 3-month period despite relief of the occlusal trauma and resolution of the fistula. A radiograph showed an apparent separation of the cementum in the area of the pocket., Methods: The lesion was treated using a minimally invasive surgical approach to place a bone graft., Results: The probing depth was reduced to 2 mm with less than 1 mm of increased recession. A histologic examination of the damaged calcified tissue confirmed that it was cementum., Conclusions: The increasing probing depth associated with a cemental tear seems to indicate that this phenomenon contributed to loss of attachment and bone. Removal of the detached cementum in combination with bone grafting using a minimally invasive surgical approach appears to have successfully corrected the periodontal destruction.

The American Academy of Periodontology has developed the following parameter on occlusal traumatism in patients with chronic periodontitis. Occlusal therapy is an integral part of periodontal therapy. Patients should be informed about the occlusal problem, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. Failure to treat occlusal traumatism appropriately in patients with chronic periodontitis may result in progressive loss of bone and an adverse change in prognosis, and could result in tooth loss. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy.

The mechanism of accelerated periodontal destruction around teeth with occlusal trauma and increased mobility remains unclear. One possibility is that tooth mobility creates a subgingival environment conducive to overgrowth by periodontal pathogens. This study compared the subgingival microflora in mobile and non-mobile teeth of 35 adults on supportive maintenance therapy and 15 with untreated adult periodontitis. In each subject, subgingival paper-point samples were obtained from a mobile tooth with a probing depth of 4 mm or greater and from a non-mobile tooth with similar probing depth and gingival index. Samples were transported in VMGA III medium. Pockets around mobile teeth harbored significantly higher proportions of Campylobacter rectus (P = 0.001) and Peptostreptococcus micros (P = 0.05) than pockets with non-mobile teeth. Mobile teeth also tended to show elevated levels of Porphyromonas gingivalis, but this did not reach statistical significance. This study suggests that tooth mobility may constitute a risk for periodontal breakdown due to an increased subgingival occurrence of specific periodontopathogens. This hypothesis needs to be verified in longitudinal clinical and microbiological studies.

Conflicting results have been reported regarding the effect of periodontal trauma upon progression of periodontitis. In these studies, different initial pocket morphologies were present. This study investigated the effect of trauma superimposed upon existing intrabony pockets. Localized intrabony pockets were produced adjacent to the mesial and distal surfaces of the mandibular third bicuspids in 10 squirrel monkeys. Two animals were killed after 10 weeks of periodontitis. In four (experimental) of the remaining eight animals, mesio-distal jiggling of the third bicuspid was begun 10 weeks after induction of periodontitis, and continued for another 10 weeks. The other four animals (control) were killed 20 weeks after initiation of periodontitis. Step-serial histologic sections were selected from experimental and control specimens and analyzed for loss of connective tissue attachment, loss of crestal alveolar bone and percentage of bone in the coronal interproximal periodontium. When corresponding dimensions from experimental and control surfaces were compared statistically, there were no differences in loss of connective tissue attachment but a greater loss of bone had occurred in specimens with the combination of periodontitis and trauma. In addition, there was a marked difference in osseous morphology between the experimental and control specimens. It was concluded that trauma superimposed upon existing intrabony pockets increased loss of alveolar bone and altered osseous morphology, but did not affect the loss of connective tissue attachment.

A large group of patients (236) was examined for Myofascial Pain Dysfunction Syndrome. The symptoms of the patients were recorded, using as a guide the classic parameters of pain and tenderness to the head and neck muscles and temporomandibular joint, joint sounds, and limited function. Our basic data were similar to those of other studies. The significant difference of this study is the detail with which the symptoms were studied. The relationships of suspected etiology and symptoms were compared and discussed. This paper is the second of a three part series. The first part dealt with the demographic profile of our patient population. The third part will present the data dealing with treatment modalities and relief.

Both the inflammatory and noninflammatory types of periodontal diseases begin with an aseptic, traumatic destruction of alveolar bone, caused by traumatizing parafunctions and followed by changes in the gingiva. The latter may or may not have a superimposed infectious inflammatory process. A new concept to fit these facts is proposed: periodontal diseases are autodestructive processes in the masticatory system, with or without superimposed septic inflammation. To confirm the theory of autodestruction, direct evidence as well as indirect but conclusive evidence is given for the existence of traumatizing forces in the masticatory system, for traumatic destruction of alveolar bone, for changes in the gingiva following destruction of alveolar bone, and for the parafunctions by all persons afflicted by periodontal disease. It is concluded that traumatizing parafunctions are the main factor in the etiology of periodontal diseases and that in therapy recurrences are inevitable unless parafunctions have been eliminated.

The aim of the present investigation in dogs was to analyze the effect on periodontal disease induced by a combination of ligatures and jiggling trauma, when the jiggling forces are eliminated. The experiment was performed in six dogs. On Day 0 a phase of periodontal tissue breakdown was initiated around the mandibular fourth premolars (4P; P4) by placing plaque retention ligatures around the necks of the teeth. The ligatures were changed once a month during a 90-day period. On Day 90 the ligatures were removed. On Day 0 trauma from occlusion (jiggling) was also produced in the 4P and P4 region. On Day 90 the jiggling trauma was removed from the 4P-region (test) while it was maintained in the P4-region (control). Tooth mobility measurements and radiographic examinations were carried out on experimental Days 0, 30, 60, 90, 180, and 360. One dog was sacrificed on Day 90 and the remaining five on day 360. Following sacrifice, tissue sections comprising 1M, 4P, 3P, P3, P4, M1 were obtained and subjected to microscopic analysis. Removal of the jiggling trauma from the test teeth resulted in a markedly decreased tooth mobility, but the loss of connective tissue attachment on Day 360 was similar in the test and control sites. This means that although the control teeth had an increased mobility and a widened periodontal ligament space, the height of the remaining periodontal tissue support was similar in the test and control tooth regions.

This experiment was carried out in order to study the rate of progression of experimentally produced periodontal tissue breakdown in teeth which prior to the placement of cotton floss ligatures either had a normal or a permanently increased tooth mobility. Six beagle dogs were used. Trauma from occlusion of the jiggling type was produced on test teeth using a model previously described. Four months later experimental periodontal tissue breakdown was induced around both control and test teeth by placing cotton floss ligatures around the necks of the teeth. The ligatures which were exchanged once every 4 weeks during a 4-month period were replaced at the level of the gingival margin. Tooth mobility measurements and radiographic examinations were performed on Days 0, 30, 60, 90, 120, 160, 240 and 300. One dog was killed on Day 120 and the remaining 5 dogs on Day 300. Biopsies of the test and control teeth were fixed in formalin, decalcified, embedded in paraffin and mesiodistal sections cut with the microtome set at 4 micron. The results demonstrated that the degree of periodontal breakdown, initiated and maintained by ligature placement and plaque accumulation, was similar around teeth with a wide periodontal ligament space and in teeth with a normal width of the periodontium. In other words, progression of the plaque-associated lesions appeared to be unrelated to the width of the periodontal ligament space, i.e., to the degree of horizontal tooth mobility.

This report reviews bite plate therapy and describes several variations of bite plates. Bite plates may be useful as an adjunct to periodontic and orthodontic therapy. They may be used as a diagnostic appliance, to take mobile teeth out of trauma by disarticulating them, to allow teeth to extrude and shallow out associated osseous deformities, and to eliminate the superimposed occlusal trauma that may be caused by the parafunctional habits that can develop during orthodontic tooth movement. The change in vertical position of the dentition and the decrease in overbite are primarily due to eruption of the posterior teeth and not intrusion of the lower anterior teeth. The decrease in overbite may be accompanied by an increase in overjet and an alteration of the mesio-distal and bucco-lingual occlusal landmarks. In some cases the use of a bite plate may cause the development of an anterior open bite. Any such occlussal alterations produced by the bite plate should be corrected by occlusal adjustment or orthodontic therapy and occlusal adjustment.

1. The subjective separation of the normal and the diseased periodontium for splinting purposes is artificial. With the exception of cases of secondary trauma from occlusion, the diseased periodontium should be treated in the same manner as the normal periodontium with regards to splinting. 2. Retionales for stabilization found to be valid are: I. Prevention of mobility A. Post acute trauma. B. In occlusal therapy. II. Prevention of drifting A. Replacement of missing teeth. B. Postorthodontics. III. In treatment of secondary trauma for occlusion. A. For functional stability. B. With unknown effects on the progression of periodontitis. 3. The relationship of trauma from occlusion and periodontitis is unclear at this time. 4. A need exists for a clinical test correlating histologic signs of trauma from occlusion and clinical findings. 5. Temporary splinting generally is not indicated during the initial or surgical phase of treatment of the periodontal patient, because mobility short of secondary trauma from occlusion does not impair healing.

When treating patients, the objectives of restorative therapy must be clear. The first and most basic objective is preservation of the teeth. The attainment of this objective would be far less complex if it could be considered independent of restoration of function, comfort and esthetics, but such is not the case. The latter objectives usually require sophisticated restorative dentistry and often include restorations with intracrevicular margins. Although it is widely accepted that the best restorative margin is one that is placed coronal to marginal tissue, most restorations have margins in the gingival crevice, and permanent tissue damage is common. In attempting to reach his objective, the restorative dentist must remember the fundamental precept of the health professions, which is: Do no harm. Daily observation of the three physiologic dimensions permits the therapist to restore teeth with minimal injury to the periodontium.

Elimination of lesions diagnostic of trauma from occlusion is an essential part of complete periodontal therapy and restoration of health in the masticatory system for such patients. This can be achieved by orthodontic treatment, temporary splinting, bite-planes, occlusal adjustment and permanent splinting of teeth. Occlusal therapy may be required during periodontal treatment for trauma from occlusion and to enhance occlusal stability at any stage of periodontitis, but is most often needed in advanced periodontitis. Splinting of hypermobility of self-limiting trauma from occlusion is not indicated. Splinting may be required in addition to occlusal adjustment in moderate to severe periodontitis when trauma from occlusion is progressive.

The role of trauma from occlusion and subgingival plaque in the pathogenesis of the infrabony pocket as observed in the radiograph was studied in 48 teeth which had to be extracted because of advanced periodontal disease. Prior to extraction the teeth were examined with regard to the degree of mobility and the direction of the horizontal components of the masticatory forces. Following extraction, the teeth were stained and examined under the stereomicroscope. When the tooth is adequately stained, the subgingival plaque and the remaining attachment fibers can be distinguished easily from the area of the junctional epithelium. The observations which were made on the extracted teeth were then correlated with what could be seen in the radiograph. The following major observations were made: In the depth of the infrabony pocket there was a close congruence between the front of the subgingival plaque and the borderline of the remaining attachment fibers, the distance varying between 0.2 and 2.0 mm. There was also a close relationship between the front of the subgingival plaque and the alveolar crest adjacent to the tooth as well as between the surface of the subgingival plaque and the opposite vertical wall of the infrabony pocket, the distances ranging between 1 and 3 mm. The horizontal forces were mainly or exclusively oriented bucco-lingually, whereas the infrabony pockets were located mesially or distally, i.e. parallel to the direction of the force and not at a right angle to it as observed in experimental studies. The mobility of the teeth adjacent to which infrabony pockets developed was normal in 42% of the cases, slightly increased in 31%, and only in 11% of the cases was it excessively increased. In 19 cases the infrabony pocket was located on one of the roots of lower molars which were removed by hemisection. In eight of the 12 cases, which were observed for periods from 1 to 10 years, the remaining root functioned well without further development of angular bone defects or infrabony pockets. All of them became markedly firmer as a consequence of successful periodontal treatment. Three of the four remaining roots were extracted because of periapical problems. There was no evidence to indicate that trauma from occlusion had been involved in the pathogenesis of the infrabony pockets.

The purpose of this study was to evaluate the association between signs of trauma from occlusion, severity of periodontitis and radiographic record of bone support. The maxillary first molars of 300 individuals were independently evaluated by two examiners for signs of trauma from occlusion, pattern or occlusal contacts and severity of periodontitis. Each site was also evaluated radiographically by an independent third examiner. The results indicated that: teeth with either bidigital mobility, functional mobility, a widened periodontal ligament space or the presence of radiographically visible calculus had a deeper probing depth, more loss of clinical attachment and less radiographic osseous support than teeth without these findings, teeth with occlusal contacts in centric relation, working, nonworking or protrusive positions did not exhibit any greater severity of periodontitis than teeth without these contacts, teeth with both functional mobility and radiographically widened periodontal ligament space had deeper probing depth, more clinical attachment loss and less radiographic osseous support than teeth without these findings and given equal clinical attachment levels, teeth with evidence of functional mobility and a widened periodontal ligament space had less radiographic osseous support than teeth without these findings.