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Background and Objective: Despite little evidence regarding the relationship between tooth mobility and nonworking contact, the evaluation of occlusion is performed mainly by the detection of premature and/or nonworking contacts during tapping movements and lateral excursion. The hypothesis of this study is that occlusal contact during mastication is potentially traumatic to periodontal tissue. It clarifies the relationship between chewing patterns and the status of periodontal tissue., Material and Methods: Subjects included 73 adults, 20-29 years of age (39 men and 34 women), with complete sets of teeth and no history of orthodontic treatment or periodontal disease. The closing chewing patterns of each subject were classified into three groups by the Masticatory Deviation Index, which depicts the deviation from the normal chewing patterns within 5 mm from the intercuspal position. Periotest was used to diagnose teeth mobility and the values were compared among the three groups., Results: The present study indicates that the chewing movements which deviated from the normal chewing movements increased the mobility of specific types of teeth., Conclusion: The results of this study imply a relationship between chewing movements and tooth mobility and indicate that functional evaluation of occlusion is necessary for the examination of periodontal tissue. Occlusal evaluation with border and tapping movements might be insufficient, and functional occlusal evaluation during chewing movements can be clinically useful for using to evaluate periodontal tissue.

It is the author's belief, after analyzing forces and stresses on the periodontium for more than 30 years, that stabilization of severely mobile teeth can retain teeth, if in health, almost indefinitely. Because these teeth are retained using restorative materials, recurrent caries is a problem that needs to be treated. Tooth loss resulting from caries can occur. In the author's 26 years of using extracoronal adhesive resins for splinting, the technology of adhesive bonding and restorative resins have been improved. Earlier shortcomings of the physical properties of these materials never dissuaded the author from recommending splinting. When the cases were presented to the patient and the referring dentist, the types of the current materials used to splint teeth were immaterial. Realizing that improvements in adhesives and resins would be developed, the near-hopeless teeth were retained. Because the elderly population is the fastest-growing segment of the population, caries control is more of a concern than it was 50 or more years ago. Because teeth are being retained longer in this cohort, and because caries has a greater potential to exist, supportive periodontal therapy and recalls and caries examination become more important.

Tooth mobility can be a consequence of periodontal inflammation, attachment loss, and occlusal trauma. At times, this mobility may be tolerable, whereas at other times mobility may contribute to occlusal instability and/or patient discomfort. This article describes the clinical rationale for and the effects of splinting mobile teeth.

With the dearth of well-controlled human clinical studies, it is still impossible to answer the question of whether occlusal trauma modifies the progression of attachment loss resulting from inflammatory periodontal disease and the companion questions related to the treatment of occlusal trauma and mobility. Teeth with stable mobility are apparently at no greater risk of attachment loss than nonmobile teeth. Increasing mobility is a concern that must be addressed by inflammatory control, occlusal adjustment, and perhaps some type of stabilization or splinting of the tooth in question. In addition, greater attachment gains have been noted when occlusal adjustment was included as part of surgical therapy. There is no question that aspects of occlusal therapy have an empiric base. It is incumbent on the clinician to examine for, diagnose, and treat trauma from occlusion to stabilize the dentition. Proper occlusal management assists in maintaining the patient's natural dentition in a state of health and comfortable function.

The necessity for splinting and the advantages of some types of permanent, semipermanent, and temporary splinting are given. Specific step-by-step instructions are given for a special purpose splint that can be used for stabilizing mobile maxillary teeth when the patient has thin teeth faciolingually and a steep vertical overlap. This can be the treatment of choice for such patients.

Anterior crossbite, a permanent upper central or lateral incisor occluding lingually to an opposing tooth, can have serious dental health implications if left untreated. It usually becomes evident in the early mixed dentition, and all general dental practitioners should be aware of the condition and know how to manage it in order to prevent the possibly serious consequences.

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.

Tooth mobility measurements were carried out on 107 teeth with gingival recession in 20 subjects. Alveolar bone dehiscence around 43 of these teeth was measured during flap surgery in 13 subjects. No significant correlation was found between gingival recession and tooth mobility, and between tooth mobility and alveolar bone dehiscence. A positive, significant correlation was present between gingival recession and bone dehiscence. In 17 of the subjects, tooth mobility of 29 homologous contralateral teeth with and without gingival recession was compared. The difference was not significant. The role of trauma from occlusion in the etiology of gingival recession is questioned.

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.