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Periodontitis is a widespread oral disease accompanied by uncontrolled inflammation-related tissue destruction. Periodontitis is related to various factors. Among them, occlusal trauma can aggravate the severity of periodontitis and has been attracting a great deal of attention. We systematically searched PubMed and Web of Science databases for related articles. Keywords for the search were "mechanical force", "mechanical stress", "occlusal trauma" and "periodontitis". This review focuses on the effect of mechanical forces on periodontitis and discusses the possible pivotal targets participating in this process. We elucidated and summarized 21 articles that reported on our topic. Several biological processes and pathways that participate in enhancing the inflammatory response to mechanical stress have been studied, including the regulation of osteogenesis and osteoclastic resorption balance, Yes-associated protein signaling, induction of collagen destruction, and regulation of programmed cell death. Mechanical force enhances the process of periodontitis in multiple ways. However, currently, no studies have further examined its underlying mechanism. Understanding the specific roles of mechanical forces may assist in the treatment of periodontitis with traumatic occlusal trauma., (© 2023 Wiley Periodicals LLC.)

Background: High occlusal forces in patients with untreated periodontitis may reflect occlusal trauma-associated periodontal conditions. Occlusal analysis using T-scan might provide the distribution of occlusal loading forces in periodontitis patients. The study aimed to evaluate the effect of occlusal trauma in periodontitis patients and occlusal calibration using a T-scan., Materials and Methods: A total of 30 periodontitis patients were recruited for the study. Patients were categorized into two groups: Group I: scaling and root planing followed by T-scan recording and no occlusal calibration; Group II: scaling and root planing followed by occlusal calibration using T-scan. Clinical parameters, orthopantomogram (OPG) and T-scan evaluation were evaluated at baseline, 3-month and 6-month intervals., Results: Significant improvements in clinical parameters were noted at different time intervals after occlusal calibration using T-scan. At 3-month intervals, mean pocket depth showed statistically significant difference among the test group in the right (upper and lower) and left lower quadrant at P = 0.01, 0.002 and 0.005, respectively. Mean clinical attachment level (CAL) showed statistically significant difference among the test group in the right upper, right lower and left lower quadrants at P = 0.02, 0.001 and 0.009, respectively, at 3 months. The comparison of the mean gingival index (GI) at 6 months showed statistically significant difference among test and control groups at 6 months in different study quadrants (P = 1 in right upper, 0.009 in right lower, <0.001 in left upper and <0.001 in left lower). Mean pocket depth at the 6-month follow-up showed statistically significant difference among the test group in all the study quadrants (P = <0.001 in right upper, <0.001 in right lower, 0.003 in left upper and 0.005 in left lower). Mean CAL showed statistically significant difference among the test group in all the study quadrants at 6-month intervals (P = 0.02 in right upper, <0.001 in right lower, 0.01 in left upper and 0.04 in left lower). The bone defect height showed a statistically significant difference only in the right upper quadrant among both the test groups at the 6-month follow-up (P = 0.02). Comparing the mean percentage of force on both sides of the jaw showed a statistically significant difference among the test group at 6 months (P = 0.001 on the left side and 0.001 on the right side)., Conclusion: The occlusal correction using T-scan showed a positive association between probing pocket depth (PPD) and CAL at different time intervals from baseline to 6 months when these parameters were compared after occlusal adjustments., (Copyright © 2024 Copyright: © 2024 Indian Journal of Dental Research.)

Objectives: The purpose of this study was to evaluate the association between clinical manifestations of occlusal trauma of the teeth and maximum signal intensity of periodontal ligament space on MRI., Methods: 20 subjects (males: 9, females: 11, mean age: 35.9 ± 14.0 years, range: 22-65 years) participated in this study. Subjective symptoms of bruxism, tooth mobility, fremitus, occlusal contact area, occlusal force, widening of the periodontal ligament space, and thickening of the lamina dura were defined as clinical manifestations of occlusal trauma. The total number of clinical manifestations was used to evaluate the degree of clinical occlusal trauma, with a score of 7 indicating the highest degree of occlusal trauma. The maximum signal intensity in the periodontal ligament space was evaluated by a specific T 2 weighted MRI sequence: IDEAL image., Results: Spearman's rank correlation between the total clinical occlusal trauma score and maximum signal intensity in the periodontal ligament space was 0.529 for all teeth, 0.517 for anterior teeth, and 0.396 for molar teeth ( p < 0.001 for all)., Conclusions: A significant correlation between the degree of occlusal trauma and the signal intensity of the periodontal ligament space suggests a new potential MRI-based method for objectively determining occlusal trauma.

Objectives: Work in animal models has implicated excessive occlusal forces and occlusal trauma as co-destructive factors for periodontitis. The main aim of the present study was to make a radiographic assessment of the effects of excessive occlusal forces, ie occlusal/incisal tooth wear, widening of the periodontal space, and the presence of a mandibular torus, on interproximal marginal bone loss in a large series of patients. A secondary aim was to evaluate the statistical correlation between the parameters in two specific teeth and those of 12 teeth for marginal bone loss and six teeth for occlusal/incisal tooth wear within the same individual., Method and Materials: A total of 1,950 full-mouth radiographic surveys were analyzed retrospectively. Interproximal marginal bone loss was quantified relative to the root length (Schei ruler technique). In addition, occlusal/incisal tooth wear and periodontal ligament space widening of the periodontal space were assessed, as well as the presence of a mandibular torus. Odds ratio and logistic regression analysis were used to determine the association between occlusal trauma and marginal bone loss., Results: The correlation of the measured parameters between the values for specific teeth and the whole dentition was evaluated from data from the first 400 radiographs. Teeth 41 and 33 showed the best correlation to the whole dentition: 0.85 for interproximal marginal bone loss, 0.83 for widening of the periodontal space, and 0.97 for occlusal/incisal tooth wear. The results of a logistic regression analysis with age as an independent variable, revealed a significant association between bone loss and both tooth wear (odds ratio = 2.767) and bone loss and widening of the periodontal space (odds ratio = 2.585)., Conclusion: Tooth wear was positively correlated to both widening of the periodontal space and marginal bone loss. No correlation was found between the presence of a mandibular torus and marginal bone loss.

Background: Literature is scarce on malocclusion prevalence and orthodontic treatment need (OTN) in subjects with stage III-IV periodontitis. Study aims were to assess prevalence of primary and secondary malocclusions in subjects with stage III-IV periodontitis and OTN based on pathologic tooth migration (PTM) and occlusal trauma of anterior teeth (AT)., Subjects and Methods: One hundred and twenty-one subjects with stage III-IV periodontitis were examined. A comprehensive periodontal-orthodontic examination was performed. Exclusion criteria: age <30 years, removable prosthetics, uncontrolled diabetes, pregnancy/lactation, and oncologic disease., Results: Class II malocclusion was found in 49.6% (Class II div 1-20.7%, Class II div 2-9.9%, subdivision Class II-19.0%), Class I-31.4%, Class III-10.7%, no malocclusion-8.3% of subjects. PTM was observed in 74.4% of maxillary and 60.3% of mandibular AT. Spacing and extrusion were the main types of PTM of AT. Odds ratio for PTM of maxillary AT was 9.3 in cases with >30% of sites with clinical attachment loss ≥5 mm (P = 0.001). Spacing of maxillary AT was influenced by periodontitis, Class III malocclusion, and lost teeth. Tongue habit had impact on spacing of mandibular AT. Dental Health Component of Index of Orthodontic Treatment Need yielded that OTN was found in >50% and OTN due PTM, occlusal trauma and impaired function in 66.1% of subjects., Conclusions: The most prevalent malocclusion was Class II. Spacing and extrusion were prevalent types of PTM of AT. OTN was found in more than half of the subjects. The study highlights the need for preventive measures for PTM in subjects with stage III-IV periodontitis., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society.)

Background and Objective: Occlusal trauma is considered to be a contributing factor to bone loss associated with inflammatory periodontal disease. We hypothesized that pyroptosis, a recently discovered inflammation-induced programmed cell death pathway, plays a role in occlusal trauma., Materials and Methods: The occlusal trauma model was established using a cemented 1-mm elevated computer-aided design and manufacturing (CAD/CAM) metal crown. The periodontitis model was established by periodontal wire ligation with lipopolysaccharide (LPS) injection. The rats were sacrificed at 1, 2, 3, and 4 weeks. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to analyze the expression of pyroptosis-, inflammation-, and osteoclast-related markers. Micro-computed tomography (micro-CT) was used to determine bone morphology parameters. Tissue morphology was evaluated using hematoxylin and eosin staining (H&E). Osteoclasts were identified using tartrate-resistant acid phosphatase (TRAP) staining. The expression and distribution of factors related to pyroptosis and inflammation were evaluated by immunohistochemistry (IHC). The colocalization of dead cells and cysteinyl aspartate-specific proteinase-1 (caspase-1)-positive cells was analyzed by immunofluorescence., Results: Quantitative real-time polymerase chain reaction and IHC results showed that occlusal trauma induced the expression of pyroptotic factors during the early stages, while occlusal trauma with periodontitis upregulated the expression of pyroptotic factors at the later stages. The results of qRT-PCR, TRAP staining, and micro-CT showed that occlusal trauma with periodontitis increased the production of proinflammatory cytokines, leading to severe bone loss. Glyburide, an NOD-like receptor pyrin domain containing protein 3 (NLRP3)inhibitor, reduced the expression of pyroptosis markers induced by occlusal trauma with periodontitis and reversed bone resorption., Conclusions: Pyroptosis was involved in bone loss induced by occlusal trauma with or without periodontitis, while glyburide reversed inflammation and bone resorption., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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.)

Observational studies have indicated that crestal bone level changes at implants are typically associated with clinical signs of inflammation, but still mechanical overload has been described as possible factor leading to hard-tissue deficiencies at implant sites without mucosal inflammation. The aim of this paper was systematically review the literature regarding the possible effect of traumatic occlusal forces on the peri-implant bone levels. Literature search was conducted using PubMed, Scielo and Lilacs, including the following terms: oral OR dental AND implant$ AND (load OR overload OR excessive load OR force$ OR bruxism) AND (bone loss OR bone resorption OR implant failure$). Databases were searched for the past 10 years of publications, including: clinical human studies, either randomized or not, cohort studies, case control studies, case series and animal research. Exclusion criteria were review articles, guidelines and in vitro and in silico (finite element analysis) research, as well as retrospective studies. The PICO questions formulated was: "does traumatic occlusal forces lead to peri-implant bone loss?" The database searches as well as additional hand searching, resulted in 807 potentially relevant titles. After inclusion/exclusion criteria assessment 2 clinical and 4 animal studies were considered relevant to the topic. The included animal studies did not reveal an association between overload and peri-implant bone loss when lower overloads were applied, whereas in the presence of excessive overload it seemed to generate peri-implant bone loss, even in the absence of inflammation. The effect of traumatic occlusal forces in peri-implant bone loss is poorly reported and provides little evidence to support a cause-and-effect relationship in humans, considering the strength of a clinically relevant traumatic occlusal force.

Purpose: Occlusal trauma, resulting in the destruction of alveolar bone, is a form of periodontal disease caused by excessive mechanical stress (MS) during hyperocclusion. Previously, we showed that CC chemokine ligand (CCL) 2/CCR2 receptor axis plays a crucial role in MS-dependent osteoclastogenesis. However, in the previous work, we were unable to precisely measure changes in alveolar bone profiles. In the present study, we sought to establish a precise method for evaluating alveolar bone resorption induced by hyperocclusion using micro-computed tomography., Methods: Under anesthesia, a stainless steel wire was attached to the molars of 5-week-old C57/BL6 wild-type (WT) mice, CCL2 -/- mice, and CCR2 -/- mice to induce occlusal force overload. At days 0 and 7, hard tissue samples were harvested and analyzed by micro-computed tomography., Results: In the WT mice, bone mineral density of the alveolar bone was significantly decreased at day 7 as compared with day 0, with marked alveolar bone resorption observed. Similarly, significant alveolar bone resorption was observed in the CCL2 -/- and CCR2 -/- mice at day 7 as compared with day 0., Conclusions: Micro-computed tomographic images can be used to measure changes in bone mineral density in a mouse model of hyperocclusion. This method may be useful for further investigating bone changes in other periodontal disease research fields., (Copyright © 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Objective: Besides inflammatory bone loss, trauma from occlusion (TO)-induced alveolar bone loss increases the risk of future tooth loss. We have shown that resveratrol, a polyphenol, possesses anti-inflammatory characteristics and a suppressive effect on osteoclastogenesis. Therefore, we investigated the effects of resveratrol on TO-induced bone loss in mice., Material and Methods: Trauma from occlusion was induced by overlaying composite resin onto the maxillary first molar of C57BL/6 mice. TO-induced mice were administered either resveratrol or vehicle for 15 days from 5 days before TO induction. The mice administered vehicle only served as controls. The effect of resveratrol on bone resorption was assessed histologically. Gene expression in gingival and periodontal ligament tissues was analyzed. In vitro effect of resveratrol on the differentiation of RAW 264.7 cells and bone marrow-derived macrophages into osteoclastic cells was analyzed., Results: Resveratrol administration significantly decreased the bone loss and suppressed the elevated expression of osteoclastogenesis-related gene in periodontal ligament tissue by TO. Resveratrol treatment also suppressed the differentiation of both RAW 264.7 cells and bone marrow-derived macrophages into osteoclastic cells., Conclusion: Resveratrol administration suppressed the TO-induced alveolar bone loss by suppressing osteoclast differentiation, suggesting that resveratrol is effective in preventing both inflammation and mechanical stress-induced alveolar bone resorption., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Context: A better understanding of the relation between traumatic dental occlusion and periodontal changes is needed., Aims: This study aimed to evaluate the pattern of osteoclastic activity in the periodontal bone in front of the traumatic dental occlusion in rat molars., Patients and Methods: Traumatic dental occlusion (TO) was induced in twenty rats, which were sacrificed after periods of 2, 5, 7, and 14 days. Transversal histological sections of both jaws were stained with tartrate-resistant acid phosphatase and hematoxylin and eosin. Mann-Whitney U-test was used for group comparison, and Pearson's correlation test was applied for the number of osteoclasts and bone area (BA)., Results: Traumatic dental occlusion caused an increase in the number of osteoclasts in the bone of the upper and lower right first molar from days 2-5 to 2-14, respectively. In the TO groups, the number of osteoclasts on the lamina dura and in the center of the alveolar bone septum, respectively, increased almost 4-fold and 9-fold in the lower jaw; and 3-fold and 5-fold in the upper jaw, during all periods. In the TO groups, the BA of the alveolar bone septum was substantially reduced. There was a negative correlation between the number of osteoclasts and BA in both jaws during all experimental periods., Conclusions: Traumatic dental occlusion increases osteoclast activity in the alveolar lamina dura and in the center of alveolar bone and stimulates a higher degradation in the center of the alveolar bone septum.

Goldenhar syndrome (GS) is a development syndrome, characterized by incomplete development of the craniofacial region. The involvement is mainly unilateral; it varies from being mild to severe; and it can range from malocclusion and facial asymmetry to a more complex phenotype with complete absence of the mandibular ramus and temporomandibular joint. However, orthopedic symptoms of orofacial pain and dysfunction have not generally been considered as part of the symptom complex in GS cases. The case presented here is of a 15-year-old Caucasian patient, who was referred for evaluation because of bilateral pain in the masticatory muscles and temporomandibular joints.

Objective: The use of chewing-gum and piercing has become common among adolescents and might result in increased oral muscle activity and overloading. Aim To investigate the frequency of oral piercing and parafunctions in relation to symptoms of temporomandibular disorders (TMD) among adolescents., Materials and Methods: One hundred and twenty-four third level high school students, living either in a city or in a small town, enrolled in either science or media programmes, were included. The students completed a questionnaire regarding different parafunctions and symptoms of TMD. A clinical examination of the temporomandibular system and estimation of the tooth wear was performed in 116 students., Results: Chewing-gum was used by 86% of the students (25% with a daily use) and 14% had an oral piercing. The science students used more chewing gum than the media students (p = 0.008), while the media students had more piercings (p < 0.001). Symptoms once a week or more were reported with 39% for headache, 18% for clicking, 7% for facial pain and 6% for difficulty to open wide. Girls reported more headaches (p = 0.007) and more severe symptoms (p = 0.003), had more medical consultations and used more analgesics (both p < 0.05) and had more clinical signs (p = 0.01) than boys. Girls had more oral piercings and used more chewing gum than boys (both p < 0.05). The media students had more sick leave (p < 0.01) than the science students. Chewing-gum use was associated with headache (p < 0.01), with difficulty to open wide (p < 0.05) and with tenderness of the temporomandibular joints and muscles (both p < 0.05). Oral piercing was associated with headache and muscle tenderness (both p < 0.05) and daily nail biting with headache (p < 0.05) and tooth wear (p = 0.004)., Conclusions: There is an association between use of chewing gum, nail biting, oral piercing, and symptoms of TMD.

Aim: To illustrate the reversibility of "pathologic tooth migration" in several patients that were managed by periodontal therapy alone, along with a review of the relevant literature., Background: Pathologic tooth migration (PTM) is a common phenomenon among patients seeking dental care. Different etiologic factors have been implicated in PTM: loss of periodontal support, occlusal interferences, posterior bite collapse, and various oral habits such as: lip biting, tongue thrusting, and playing wind instruments. Identification of all the causative factors involved in PTM is crucial for a successful treatment outcome. Managing severe cases of acquired diastemata may necessitate a complex and a sequential intervention involving periodontic, orthodontic and prosthodontic measures. However, "spontaneous regression" of teeth to their original position may occur in certain cases after elimination of the offending factors., Conclusion: "Spontaneous" closure of acquired diastemata could occur following surgical and/or non-surgical periodontal therapy or removal of occlusal interferences. Correction of pathologically migrated teeth without orthodontic or restorative treatment is feasible, but unpredictable.

Objective: To determine whether a unilateral increase or decrease in the bite affects the curvatures of the vertebral spine in rats., Methods: 25 male Sprague Dawley rats were included. Five animals received no alteration on their bite. Bite was increased on 10 animals and molar teeth were extracted on 10 other animals. Frontal and lateral radiographs were taken on days 0, 7, 14 and 21. Distances from landmarks to a true vertical line were measured on both radiographs., Results: Repeated measures analysis showed statistically significant differences between the amount of the curvature at the cervical and thoracic spines on frontal and lateral radiographs over time (P<0.05 and P<0.0001). One-way ANOVA computed significant differences (P<0.05) at D14 at the cervical and thoracic spines on both, increased and decreased vertical dimension., Conclusion: Alterations in the dental occlusion affects the normal curvatures of the vertebral spine in rats.

Purpose: The aim of this long-term cohort study was to evaluate the efficacy and complications of fixed partial dentures in a convenience sample of 100 patients with periodontal disease who were treated and maintained periodontal patients after 20 years., Materials and Methods: After active treatment, including periodontal surgery and endodontic and prosthetic treatment, patients were enrolled in a supportive periodontal care (SPC) program with 3- to 6-month recalls. All patients showed clinical data recorded at (1) the original consultation (T0), (2) the first SPC visit following the completion of prosthetic treatment (T1), and (3) at the latest SPC clinical session 20 years after T1 (T2). Multivariate analyses were performed to investigate the influence of clinical variables on the risk of prosthetic abutment (PA) loss after 20 years' visits., Results: The final sample comprised 100 patients. At T1, a total of 948 PAs represented the original sample of experimental teeth. At the 20-year follow-up, a total of 854 PAs (90.1%) were still in function, while 94 (9.9%) PAs in 41 patients (41%) were lost during SPC; 98% of lost PA were endodontically treated. Vertical root fracture (48%) was the major cause of PA loss, while progression of periodontitis caused 31% of PA loss. Age (P = .002), Full-Mouth Plaque Score (P < .0001), Full-Mouth Bleeding Score (P = .0002), and oral parafunctions (P = .0083) were associated with increased probability of PA failure. Among clinical-related factors, endodontic treatment (P = .0082), root resection/ amputation (P < .0001), multi-rooted teeth (P = .0005), and abutment associated with parafunction (P < .0001) were associated with increased risk of abutment loss after 20 years., Conclusions: Perioprosthetic treatment in compliant patients is highly successful after 20 years of SPC.

The main aim of this retrospective study was to describe clinical and histopathological findings in cats with mucogingival lesions developed at the contact point of the premolar and molar teeth of the opposite quadrant. Cases were retrieved following manual review of the medical records, dental records and photographic documentation of all feline dental patients visited in the period between February 2001 and August 2011. Cats showing different lesions at different times were calculated as multiple cases. A total of 27 cats (31 cases) with 44 lesions (26 proliferations [59%], 11 clefts [25%] and seven foveae [16%]) were included. Mean age at the time of the first visit was 6.6 years. The lesion object of the study was the main reason for presentation in only five cases (16%). Proliferations showed two different histopathological patterns and had characteristics in common with human oral pyogenic granuloma. Successful treatment was achieved in all cases by removing the occlusal contact by dental extraction or coronal reduction, possibly associated with lesion excision. This study underlines the need for a thorough oral examination and evaluation of dental occlusion in all patients. Causes for the development of traumatic occlusion may include an acquired overbite (possibly secondary to selective dental extraction), congenital or post-traumatic malocclusion, abnormal latero-lateral mobility of the mandible, occlusal drift of the premolar and molar teeth, and/or alveolar bone expansion., (© ISFM and AAFP 2014.)

Aetiology is the cause of a diagnosis. The essential key for the determination ofaetiology is a thorough examination: the history of the problems, the crucial elements in function, and habits. Our case report involves progression of a malocclusion and aggravation of the gum recessions which resolved following root planing and fixed orthodontic correction for the underlying cause, malocclusion, without any gum graft procedures.

Background and Objective: Occlusal trauma is an important factor that influences the progression of periodontitis, but it is unclear whether occlusal trauma influences periodontal destruction at the onset of periodontitis. We established an experimental periodontitis model with both site-specific loss of attachment and alveolar bone resorption. The purpose of the present study was to investigate the effects of occlusal trauma on periodontal destruction, particularly loss of attachment, at the onset of experimental periodontitis., Material and Methods: Sixty rats were used in the present study. Forty-eight rats immunized with lipopolysaccharide (LPS) intraperitoneally were divided into four groups. In the trauma (T) group, occlusal trauma was induced by placing an excessively high metal wire in the occlusal surface of the mandibular right first molar. In the inflammation (I) group, periodontal inflammation was induced by topical application of LPS into the palatal gingival sulcus of maxillary right first molars. In the trauma + inflammation (T+I) group, both trauma and periodontal inflammation were simultaneously induced. The PBS group was administered phosphate-buffered saline only. Another 12 nonimmunized rats (the n-(T+I) group) were treated as described for the T+I group. All rats were killed after 5 or 10 d, and their maxillary first molars with surrounding tissues were observed histopathologically. Loss of attachment and osteoclasts on the alveolar bone crest were investigated histopathologically. To detect immune complexes, immunohistological staining for C1qB was performed. Collagen fibers were also observed using the picrosirius red-polarization method., Results: There were significant increases in loss of attachment and in the number of osteoclasts in the T+I group compared with the other groups. Moreover, widespread distribution of immune complexes was observed in the T + I group, and collagen fibers oriented from the root surface to the alveolar bone crest had partially disappeared in the T, T+I and n-(T+I) groups., Conclusion: When inflammation was combined with occlusal trauma, immune complexes were confirmed in more expanding areas than in the area of the I group without occlusal trauma, and loss of attachment at the onset of experimental periodontitis was increased. Damage of collagen fibers by occlusal trauma may elevate the permeability of the antigen through the tissue and result in expansion of the area of immune-complex formation and accelerating inflammatory reaction. The periodontal tissue destruction was thus greater in the T+I group than in the I group., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: In orthodontics, adding restorative materials on occlusal or lingual surfaces is a common method to create a mini-biteplane to increase patients' vertical dimension temporarily to facilitate several treatment procedures. However, this method transmits excessive occlusal forces through the periodontal ligament and causes trauma. In this prospective randomized clinical trial, we measured and compared quantitatively the volumes of root resorption after 4 weeks of occlusal trauma., Methods: Forty-eight maxillary and mandibular first premolars of 12 patients (6 girls, 6 boys) comprised the sample for this study. One side of each patient was randomly selected as the control. On the contralateral side, a light-cured glass ionomer cement (Transbond Plus Light Cure Band Adhesive; 3M Unitek, Monrovia, Calif) was bonded onto the occlusal surface of the mandibular first premolar so that the cement was in contact with the maxillary first premolar. After 4 weeks, both first premolars were extracted. Each sample was imaged using a microcomputed tomography system (1172; SkyScan, Aartselaar, Belgium) and analyzed with specially designed software for volumetric measurements of resorption craters. Furthermore, pain was evaluated with a visual analog scale for 7 days., Results: There were significant differences in the amounts of root resorption between the control and the experimentally traumatized teeth. No significant difference among the buccal, lingual, mesial, and distal surfaces was found in either jaw. Furthermore, no significant difference existed in the amount of root resorption among the cervical, middle, and apical thirds of both jaws. There was no correlation between age, sex, volume of the root resorption craters, and pain., Conclusions: Restorative buildups, used to increase the vertical dimension by 2 mm for 4 weeks, caused root resorption along the sides of the teeth during the active bite-increase period., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background and Objective: Occlusal trauma (OT) and smoking are both factors that alter alveolar bone metabolism and therefore could synergistically act on alveolar bone loss. The aim of this experimental study was to evaluate the influence of short-term cigarette smoke inhalation (CSI) on inter-radicular alveolar bone loss promoted by primary OT in a rat model., Material and Methods: Forty-eight animals were randomly assigned to one of three groups based on treatment type: OT + CSI (n = 16), animals were exposed to CSI three times per day, for 8 min per exposure, and they concomitantly received unilateral vertical augmentation creating an occlusal interference inducing experimental OT; OT (n = 16), animals received only unilateral vertical augmentation; negative control (NC; n = 16), animals maintained for equal periods to achieve periodontal baseline values of periodontal ligament dimension. Each group was divided into two subgroups (n = 8) based on treatment length: 7 or 14 d., Results: After 7 d, the OT + CSI group exhibited significantly higher bone loss compared to the NC group (p = 0.0022). After 14 d, the OT (p < 0.0001) and OT + CSI (p < 0.0001) groups presented significantly higher bone loss compared to the NC group, and OT + CSI resulted in significantly higher bone loss than OT alone (p = 0.0241). The number of tartrate-resistant acid phosphatase-positive cells on the linear surface of the bone crest after 7 d was significantly higher in the OT + CSI group as compared to the NC and OT groups (p < 0.0001 and p = 0.0045, respectively) and remained significantly higher in the OT + CSI group after 14 d, compared to the OT group (p < 0.0001)., Conclusion: Short-term CSI increases early bone loss in association with OT after 7 d, and this worsens in severity after 14 d of exposure., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The first objective of this study was to retrospectively evaluate zirconia-based restorations (ZBR). The second was to correlate failures with clinical parameters and to identify and to analyse chipping failures using fractographic analysis., Methods: 147 ZBR (tooth- and implant-supported crowns and fixed partial dentures (FPDs)) were evaluated after a mean observation period of 41.5 ± 31.8 months. Accessorily, zirconia implant abutments (n=46) were also observed. The technical (USPHS criteria) and the biological outcomes of the ZBR were evaluated. Occlusal risk factors were examined: occlusal relationships, parafunctional habits, and the presence of occlusal nightguard. SEM fractographic analysis was performed using the intra-oral replica technique., Results: The survival rate of crowns and FPDs was 93.2%, the success rate was 81.63% and the 9-year Kaplan-Meier estimated success rate was 52.66%. The chipping rate was 15% and the framework fracture rate was 2.7%. Most fractographic analyses revealed that veneer fractures originated from occlusal surface roughness. Several parameters were shown to significantly influence veneer fracture: the absence of occlusal nightguard (p=0.0048), the presence of a ceramic restoration as an antagonist (p=0.013), the presence of parafunctional activity (p=0.018), and the presence of implants as support (p=0.026). The implant abutments success rate was 100%., Conclusions: The results of the present study confirm that chipping is the first cause of ZBR failure. They also underline the importance of clinical parameters in regards to the explanation of this complex problem. This issue should be considered in future prospective clinical studies., Clinical Significance: Practitioners can reduce chipping failures by taking into account several risk parameters, such as the presence of a ceramic restoration as an antagonist, the presence of parafunctional activity and the presence of implants as support. The use of an occlusal nightguard can also decrease failure rate., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

When a patient complains of orofacial pain, health care providers must make a correct diagnosis. Doing this can be difficult, since various signs and symptoms may not be specific for 1 particular problem or disorder. One initially should formulate a broad differential diagnosis that can be narrowed after analysis of the history and examination. In this article, orofacial pain is categorized as being caused by: intracranial pain, headaches, neuropathic pain, intraoral pain, temporomandibular disorder, cervical pain, pain related to anatomically associated structures, referred pain, or mental illness., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Aim: This study evaluates the relationship between occlusal interferences and premature contacts and bruxism by determining the relationship between unassisted and assisted nonworking interferences., Materials and Methods: In this study, 60 subjects (14 males and 46 females) that consisted of 30 bruxers (7 males, 23 females) and 30 nonbruxers (7 males, 23 females) were selected after completion of a questionnaire based on the exclusion criteria. Occlusal interferences in the centric relation and eccentric movements in the two groups were evaluated and recorded. Data were analyzed by SPSS software (version 16) using the Chi-square and paired t-tests., Results: The results showed a statistically significant relationship between bruxism and nonworking interferences (p < 0.05). There was no statistically significant relationship in the centric relation and other eccentric movements (p > 0.05). The number of assisted nonworking occlusal contacts was more than unassisted nonworking occlusal contacts., Conclusion: According to the results of this study, there is a relationship between certain types of occlusal interferences (nonworking interferences) and bruxism. Hence, it would be useful to examine occlusal contacts in bruxing patients to eliminate probable causative or contributing occlusal factors. Both assisted and unassisted nonworking occlusal contacts should be evaluated., Clinical Implication: Bruxism is an oral habit that consists of involuntary rhythmic or spasmodic nonfunctional gnashing, grinding or teeth clenching, other than chewing movements by the mandible. Bruxism may lead to occlusal trauma, tooth wear, fracture of the teeth and fillings, and hypertrophy of the masticatory muscles. Treatment of bruxism needs a correct diagnosis. Therefore, it is useful to determine the relationship between occlusal interferences and bruxism in order to prevent its development by adjusting for these interferences.

This practice-based retrospective study evaluated the survival of resin composite restorations in posterior teeth, focusing on the influence of potential patient risk factors. In total, 306 posterior composite restorations placed in 44 adult patients were investigated after 10 to 18 yrs. The history of each restoration was extracted from the dental records, and a clinical evaluation was performed with those still in situ. The patient risk status was assessed for caries and "occlusal-stress" (bruxism-related). Statistical analysis was performed by the Kaplan-Meier method and Cox-regression multivariate analysis. In total, 30% of the restorations failed, of which 82% were found in patients with 1 or 2 risk factors. Secondary caries was the main reason of failure within caries-risk patients, whereas fracture was the main reason in "occlusal-stress-risk" patients. The patient variables gender and age did not significantly affect survival, but risk did (p < .001). Tooth type (p < .001), arch (p = .013), and pulpal vitality (p = .003) significantly affected restoration survival. Within the limits of this retrospective evaluation, the survival of restorations is affected by patient risk factors, which should be included in survival analyses of restorations.

In planning orthodontic cases that include extractions as an alternative to solve the problem of negative space discrepancy, the critical decision is to determine which teeth will be extracted. Several aspects must be considered, such as periodontal health, orthodontic mechanics, functional and esthetic alterations, and treatment stability. Despite controversies, extraction of teeth to solve dental crowding is a therapy that has been used for decades. Premolar extractions are the most common, but there are situations in which atypical extractions facilitate mechanics, preserve periodontal health and favor maintenance of the facial profile, which tends to unfavorably change due to facial changes with age. The extraction of a lower incisor, in selected cases, is an effective approach, and literature describes greater post-treatment stability when compared with premolar extractions. This article reports the clinical case of a patient with Angle Class I malocclusion and upper and lower anterior crowding, a balanced face and harmonious facial profile. The presence of gingival and bone recession limited large orthodontic movements. The molars and premolars were well occluded, and the discrepancy was mainly concentrated in the anterior region of the lower dental arch. The extraction of a lower incisor in the most ectopic position and with compromised periodontium, associated with interproximal stripping in the upper and lower arches, was the alternative of choice for this treatment, which restored function, providing improved periodontal health, maintained facial esthetics and allowed finishing with a stable and balanced occlusion. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements for obtaining the BBO Diplomate title.

The aim of this study is to present a classification with a clinical application for root resorption, so that diagnosis will be more objective and immediately linked to the source of the problem, leading the clinician to automatically develop the likely treatment plan with a precise prognosis. With this purpose, we suggest putting together all diagnosed dental resorptions into one of these four criteria: 1) Root resorption caused by cementoblast cell death, with preservation of the Malassez epithelial rests. 2) Root resorption by cementoblasts and Malassez epithelial rests death. 3) Dental resorption by odontoblasts cell death with preservation of pulp vitality. 4) Dental resorption by direct exposure of dentin to gingival connective tissue at the cementoenamel junction gaps.

The aetiology of temporomandibular disorder (TMD) is multifactorial, and numerous studies have addressed that occlusion may be of great importance. However, whether occlusion plays a crucial role in the pathogenesis of TMD remains controversial. Study designs utilising animal models have been used to study the effects of artificial occlusal alterations. Experimental traumatic occlusion affects blood flow in the temporomandibular joint and results in changes in the condylar cartilage, and artificial occlusal interference induces masticatory muscle nociceptive responses that are associated with peripheral sensitisation and lead to central sensitisation, which maintains masticatory muscle hyperalgesia. The possibility that occlusal interference results in TMD has been investigated in humans using a double-blind randomised design. Subjects without a history of TMD show fairly good adaptation to interferences. In contrast, subjects with a history of TMD develop a significant increase in clinical signs and self-report stronger symptoms (occlusal discomfort and chewing difficulties) in response to interferences. Meanwhile, psychological factors appear meaningful for symptomatic responses to artificial interferences in subjects with a history of TMD. Thus, individual differences in vulnerability to occlusal interferences do exist. Although there are advantages and disadvantages to using human and animal occlusal interference models, these approaches are indispensable for discovering the role of occlusion in TMD pathogenesis., (© 2013 Blackwell Publishing Ltd.)

The pathological changes of subchondral bone during osteoarthritis (OA) development in the temporomandibular joint (TMJ) are poorly understood. In the present study, we investigated the longitudinal alterations of subchondral bone using a rat TMJ-OA model developed in our laboratory. Changes in bone mass were examined by micro-CT, and changes in osteoblast and osteoclast activities were analyzed by real-time PCR, immunohistochemistry, and TRAP staining. Subchondral bone loss was detected from 8 weeks after dental occlusion alteration and reached the maximum at 12 weeks, followed by a repair phase until 32 weeks. Although bone mass increased at late stages, poor mechanical structure and lower bone mineral density (BMD) were found in these rats. The numbers of TRAP-positive cells were increased at 12 weeks, while the numbers of osteocalcin-expressing cells were increased at both 12 and 32 weeks. Levels of mRNA expression of TRAP and cathepsin K were increased at 12 weeks, while levels of ALP and osteocalcin were increased at both 12 and 32 weeks. These findings demonstrated that there is an active bone remodeling in subchondral bone in TMJs in response to alteration in occlusion, although new bone was formed with lower BMD and poor mechanical properties.

Aim: Controversy over the relationship between occlusion and the progression of periodontal destruction has been ongoing since the beginning of scientific studies of dental diseases. This paper reviews the literature and explores the relationship between trauma from occlusion with periodontal disease in children, presenting recommendations for clinical practice based on the available evidence.

Objectives: This study aimed to systematically review the scientific evidence for the association between noncarious cervical lesions (NCCL) and occlusal risk factors (ORF) [occlusal interferences in excursive movements; occlusal force; premature contacts; type of guidance; skid of centric occlusion to maximum intercuspidation] in adults., Sources: Pubmed, Web of Science, Cochrane, Lilacs, Clinical Trials, National Research Register and National Institute for Health were searched., Study Selection: From 1082 potentially eligible studies, 106 were selected for full text analysis. Two independent reviewers (Kappa=0.8; p<0.001) selected the studies, abstracted information and assessed quality based on standardised scales. Six cross-sectional, two case-controls and one clinical trial were included. Several occlusal variables were analysed among the studies, but there was no standardisation of the units used in the analysis of occlusal factors. The majority of studies did not find significant associations between NCCL and ORF. Three studies found associations between NCCL and some variables (occlusal contact area, right canine guidance, premature contacts in centric relation and working side) (p<0.05). The methodological quality varied across studies, and there was high heterogeneity among them., Conclusion: Current scientific evidence does not support an association between ORF and NCCL. Further prospective studies with standardised methods are vital to strengthen the evidence., Clinical Significance: Understanding the risk factors for NCCL is important to control the causes and to help the dentist choose the best approach for the patient. The evidence does not support intervention to alter some occlusal factors for the prevention or control of the progression of NCCL., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: Occlusal adjustment as part of periodontal therapy has been controversial for years, mostly because the literature does not provide enough evidence regarding the influence of trauma from occlusion (TfO) on periodontitis. The need for occlusal adjustment in periodontal therapy is considered uncertain and requires investigation. The aim of this systematic review was to identify and analyse those studies that investigated the effects of occlusal adjustment, associated with periodontal therapy, on periodontal parameters., Data: A protocol was developed that included all aspects of a systematic review: search strategy, selection criteria, selection methods, data collection and data extraction., Sources: A literature search was conducted using MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE., Study Selection: Three reviewers screened the titles and abstracts of articles according to the established criteria. Every article that indicated a possible match, or could not be excluded based on the information given in the title or abstract, was considered and evaluated. On final selection, four articles were included., Conclusions: Although the selected studies suggest an association between occlusal adjustment and an improvement in periodontal parameters, their methodological issues (explored in this review) suggest the need for new trials of a higher quality. There is insufficient evidence at present to presume that occlusal adjustment is necessary to reduce the progression of periodontal disease., Clinical Significance: Although it is still not possible to determine the role of occlusal adjustment in periodontal treatment, adverse effects have not been related to occlusal adjustment. This means that the decision made by clinicians whether or not to use occlusal adjustment in conjunction with periodontal therapy hinges upon clinical evaluation, patient comfort, and tooth function., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

We describe the diagnosis and treatment of a class II division 1 malocclusion complicated by severe periodontal disease, tooth loss, dentoalveolar protrusion associated with tipping and extrusion of the maxillary incisors, and a traumatic occlusion. Treatment involved the use of a modified palatal arch to intrude and retract the maxillary incisors and high-pull headgear to enhance anchorage and correct the Class II relationship. After active treatment for 19 months, a good anterior occlusion was achieved, with 17° of lingual retroclination and 3 mm of intrusion at the apex of the maxillary incisors. An acceptable occlusion and periodontal status was maintained over a retention period of 2 years. With the patient's cooperation, a successful outcome was achieved with this approach.

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.

Aims: To test the hypothesis that the effects of an experimental occlusal interference differ between individuals reporting a high or low frequency of wake-time oral parafunctions., Methods: Study participants reporting very high (HFP group; n = 10) or very low (LFP group; n = 10) levels of oral parafunctions were selected by means of a questionnaire administered to 200 medical students. The selected participants wore an experimental occlusal interference in a single-blind longitudinal study, which comprised different occlusal conditions: interference free (IFC) and active occlusal interference (AIC). Assessments included clinical examination, measurements of nonfunctional tooth contacts, state and trait anxiety, and visual analog scale scores for occlusal discomfort, masticatory muscle pain, and headache. Data were analyzed by repeated measures twoway analysis of variance on ranked data, followed by calculation of within- and between-group differences using Friedman tests and Mann-Whitney tests, respectively., Results: During AIC, the frequency of nonfunctional tooth contacts significantly decreased in both groups (median [interquartile range, IQR]: in HFP from 55.3% [60.0%] to 31.1% [33.5%], P = .03; in LFP from 31.8% [32.4%] to 14.0% [22.8%], P < .01), the decrease being more pronounced in LFP than in HFP (P < .01). Trait anxiety was significantly higher (P = .01) in the HFP group (median, IQR = 22.5, 9.0) than in the LFP group (median, IQR = 19.0, 3.0). The interference caused more occlusal discomfort in the HFP group than in the LFP group (P = .02) and was associated with a significant increase of masticatory muscle pain (P = .05) and headache (P = .04) only in the HFP group., Conclusion: The application of an experimental occlusal interference has a different effect in individuals reporting a high or low frequency of oral parafunctions.

Objective: To verify a potential association between the presence of noncarious cervical lesions, parafunctional habits, and temporomandibular disorder (TMD) diagnosis., Method and Materials: Sample-size calculation provided a value of 130 participants with a confidence level of 95% and an error margin of 5%. A population of 132 volunteers (30 men: mean age, 23.7 ± 3.05 years; 102 women: mean age, 24.9 ± 5.86 years) underwent an oral examination and was interviewed by a trained dentist. The following parameters were registered: personal details, TMD diagnosis, parafunctional habits, and noncarious cervical lesion presence. The population was then divided into a noncarious cervical lesion group and a control group and subjected to the t test, chi-square test, Fisher exact test, and Spearman correlation (α = .05)., Results: Noncarious cervical lesions were present in 39% of the population, with the largest concentrations found in the maxillary premolars (32%). The data showed a significant association between noncarious cervical lesion presence, tooth clenching (P = .03), and nail biting (P = .02), as well as a relation with TMD diagnosis (Fonseca Index [P = .01] and Research Diagnostic Criteria for TMD (RDC/TMD) [P = .004] ). In the noncarious cervical lesion group, direct rank correlation was found between maxillary premolars and clenching (P = .03), mandibular canines and nail biting (P = .05), and mandibular incisors and parafunctional habits without dental contacts (P = .02)., Conclusion: Parafunctional habits and TMD presence should be taken into account in the diagnosis and treatment plan of noncarious cervical lesions.

Objective: To elucidate the effect of sympathetic nervous activity on alveolar bone loss induced by occlusal hypofunction in rat molars., Design: Occlusal hypofunction in the molar area was produced by attaching appliances to rat maxillary and mandibular incisors. In addition, a non-selective β-adrenergic receptor antagonist, propranolol, was administered orally to rats in drinking water to pharmacologically suppress sympathetic nervous activity. After 1 week, alveolar bones in all groups were examined by micro-CT, histomorphometry and histology to determine their trabecular bone phenotypes and histological changes., Results: The marrow spaces of the interradicular alveolar bone of rat mandibular first molars (M1) increased in the occlusal hypofunction group (Group H) but not in the control group (Group C), whilst these decreased in rats in the occlusal hypofunction group that were administered propranolol (Group HB). Bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th) and trabecular number (Tb.N) for interradicular alveolar bone in M1 in Group H were significantly lower than those in Group C, whereas those in Group HB remained as high as those in Group C. The number of TRAP-positive cells in Group H increased compared to that in Group C, whereas it significantly decreased in Group HB., Conclusions: These results suggest that sympathetic nervous activity may influence the alveolar bone loss induced by occlusal hypofunction., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Root fractures in immature teeth are rare because the resilience of the alveolar bone is more favorable to the occurrence of luxation. This article reports a case of traumatic injury in an immature permanent tooth that progressed to root fracture, having a parafunctional oral habit as the possible modifying factor of case evolution. A 12-year-old boy presented for treatment complaining of a defective restoration and mild pain on the maxillary right central incisor. The patient had a history of crown fracture in this tooth due to trauma 2 years before. The clinical examination showed healthy gingival tissues and no abnormal tooth mobility, whereas radiographic projections revealed healthy periradicular tissues, incomplete root formation, and no visible root fracture. As pulp necrosis was diagnosed, calcium hydroxide therapy was started for canal disinfection and subsequent obturation. However, after 4 weeks of treatment, a horizontal fracture line was observed radiographically in the root's middle third. The patient denied a new traumatic injury, but revealed the habit of chewing on a pencil. Refraining from the deleterious oral habit was strongly advised, and root canal filling with mineral trioxide aggregate was performed to treat the root fracture. After 4 years of follow-up, the tooth has normal function and no abnormal mobility. Images suggestive of remodeling at the apical end of the coronal segment and replacement resorption of the apical segment are seen radiographically. This case demonstrates the need of following cases of dental trauma and the possible influence of parafunctional oral habits as modifying factors of case progression.

Radicular cysts are commonly found odontogenic cysts in the jaws. The lesion is diagnosed mainly in young patients during the second decade of life. In the majority of cases, it is asymptomatic. This paper reports a rare case in which traumatic occlusion was identified as the etiology of a radicular cyst. Endodontic treatment was performed and the traumatic occlusion also was corrected. A six-month follow-up appointment found good healing of the periapical region.

Objective: To assess the association between secondary trauma from occlusion and the severity of periodontitis., Method and Materials: A total of 288 subjects with chronic periodontitis of varying severity and 93 healthy subjects were included in the study. Premature and balance contacts were identified by manual palpation and visualization of occlusal contacts during clenching in habitual intercuspation and lateral or protrusive movements of the mandible. Statistical analysis was performed with Kruskal-Wallis, Mann-Whitney, and Spearman correlation tests., Results: Statistically significant differences (P<.001) were found for all variables tested (ie, the total amount of trauma per patient and the number of premature and balance contacts increased significantly with the level of clinical attachment loss). The Spearman test showed a statistically significant correlation between the total amount of trauma per patient and the severity of periodontitis (P<.001)., Conclusion: The results of this study indicate that secondary trauma from occlusion (ie, premature and balance contacts) is frequently seen in periodontally compromised patients and is positively correlated with the severity of attachment loss., (© 2011 By Quintessence Publishing Co, Inc.)

Denture stomatitis, a common disorder affecting denture wearers, is characterized as inflammation and erythema of the oral mucosal areas covered by the denture. Despite its commonality, the etiology of denture stomatitis is not completely understood. A search of the literature was conducted in the PubMed electronic database (through November 2009) to identify relevant articles for inclusion in a review updating information on the epidemiology and etiology of denture stomatitis and the potential role of denture materials in this disorder. Epidemiological studies report prevalence of denture stomatitis among denture wearers to range from 15% to over 70%. Studies have been conducted among various population samples, and this appears to influence prevalence rates. In general, where reported, incidence of denture stomatitis is higher among elderly denture users and among women. Etiological factors include poor denture hygiene, continual and nighttime wearing of removable dentures, accumulation of denture plaque, and bacterial and yeast contamination of denture surface. In addition, poor-fitting dentures can increase mucosal trauma. All of these factors appear to increase the ability of Candida albicans to colonize both the denture and oral mucosal surfaces, where it acts as an opportunistic pathogen. Antifungal treatment can eradicate C. albicans contamination and relieve stomatitis symptoms, but unless dentures are decontaminated and their cleanliness maintained, stomatitis will recur when antifungal therapy is discontinued. New developments related to denture materials are focusing on means to reduce development of adherent biofilms. These may have value in reducing bacterial and yeast colonization, and could lead to reductions in denture stomatitis with appropriate denture hygiene., (© 2011 by The American College of Prosthodontists.)

Statement of Problem: Although an interaction of malocclusion, parafunction, and temporomandibular joint disorders (TMD) can be inferred from the experience of daily practice, scientific evidence to corroborate this hypothesis does not exist. However, there are indications that TMD and headaches may be intertwined., Purpose: The purpose of this study was to identify the presence or absence of an association of occlusal interferences, parafunction, TMD, or physiologic, muscular, or prosthodontic factors with the occurrence of headache., Material and Methods: In a private practice population of 1031 subjects (436 men and 595 women, mean age 49.6 years) the demographic parameters, headache and general pain history, habits and general personal information were recorded. Clinical examination for dental, muscular, and temporomandibular joint pathology was accomplished. Data were statistically analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-Square tests (α = .05). A multinomial logistic regression analysis was performed with respect to confounding variables., Results: Headache affliction was found to affect women more frequently than men (1.7:1). Students and non academics were more prone to suffer from headache. Parafunction (P=.001), TMD (P=.001) and gross differences between centric occlusion and maximum intercuspation of more than a 3 mm visible track marked with 8 μm articulation foil (P=.001) significantly influenced the presence of headache. Headache intensity and frequency decreased with age. While tension-type headache was most frequently diagnosed, the parameters studied were not significantly associated with one certain headache diagnosis more frequently than others., Conclusions: Stomatognathic factors of TMD, parafunction, and gross differences between centric occlusion and maximum intercuspation of more than 3 mm are associated with headache. These findings should be interpreted with caution due to the cross-sectional nature of this study., (Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Introduction: Cemental tears often show characteristics mimicking a periapical or periodontal lesion. This leads to difficulty in the early diagnosis of cemental tears., Methods: In this multicenter study, 71 teeth with cemental tears being confirmed by direct inspection or histological examination were included. For each case, demographic data, dental history, clinical and radiographic findings, and the results of exploratory surgery were recorded and analyzed., Results: Maxillary or mandibular incisors (76.1%) were most frequently affected by cemental tears. Univariate analysis of predisposing factors found that teeth with cemental tears occurred more commonly in men (77.5%) and patients older than 60 years of age (73.2%). Analysis of clinical characteristics showed that teeth with cemental tears were prone to have abscess formation (66.2%), a deep pocket >6 mm (73.2%), positive vitality test (65.3%), healthy antagonist teeth (84.3%), and moderate to severe attrition (77.9%). About 56.3% of cemental tears could be detected on preoperative radiographs. Further analysis of radiographic findings showed that teeth with cemental tears were more likely to have periodontal bone destruction (85.9%) or periapical bone destruction (64.8%)., Conclusions: Endodontists and dentists may avoid misdiagnosis and unnecessary treatment of teeth with cemental tears if they can properly evaluate the radiographs and pulp vitality of teeth as well as know the predisposing factors and clinical characteristics of teeth with cemental tears in advance., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: At present, there is little information available on how practicing dentists manage bruxism patients with respect to conservative, reversible techniques as compared to irreversible techniques., Purpose: The purpose of this study was to determine the most commonly applied therapies used for the management of bruxism by German general dentists (GDs) and dental specialists. In addition, efforts were made to gather information on the knowledge and opinion of GDs and specialists regarding the role of occlusal interferences, in particular, on the development of sleep bruxism., Material and Methods: A 13-item questionnaire was developed and mailed to all active members of the statutory dental insurance providers of the German North Rhine (n=5500; 2006 roster) and the German Westphalia-Lippe area (n=4984; 2006 roster). Group differences were statistically analyzed using chi-square tests for the qualitative variables and Mann-Whitney U tests for the quantitative variables (α=.05)., Results: Occlusal splints were by far the most frequently prescribed therapy for the management of bruxism, followed by relaxation techniques, occlusal equilibration, physiotherapy, and prosthodontic reconstruction. The occlusal stabilization splint with canine protected articulation was the splint type most often prescribed, whereas respondents used unadjusted soft splints for approximately 8% of their bruxism patients. Comparison of the opinions of all responding practicing dentists with that of experts in regard to the statement that "sleep bruxism is caused by occlusal interferences" showed a significant difference between the 2 groups (P=.021). Eighty-five percent of the experts disagreed with this statement, and only 47.7% of the practicing dentists had the same opinion as the experts., Conclusions: Most practicing dentists seem to concur with current scientific recommendations, and express the opinion that the management of bruxism should predominantly be conservative and reversible; however, the findings of the present survey reveal diverse differences between GDs and dental specialists concerning the most frequently prescribed therapies. Moreover, the discrepancies detected in some areas, such as the use of irreversible techniques or the use of unadjusted soft splints, emphasize the need to more promptly transfer new knowledge in the field of bruxism from researchers to practicing dentists., (Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Background and Objective: The present study was designed to investigate the influence of occlusal forces on radicular resorption in teeth with periodontal disease. The occlusal forces are a cause in the aggravation of the periodontal disease and therefore influences in the increase the extension and the depth of the radicular resorption., Material and Methods: We quantified radicular resorption, its extension across the radicular surface and its depth, in 88 teeth with periodontal disease with and without occlusal contact, pertaining to patients between 43 and 91 years of age. A histological method was used to obtain 6-μm-thick sections. The sections were observed under an Olympus BX40 optical microscope and processed by an image analysis program. Measurements of length and area were used to calculate the percentages of surface and volume of cement reabsorbed., Results: In both groups presenting periodontal pathology (groups 2 and 3) the percentages of the surface and volume of reabsorbed cement were greater in those teeth with antagonist contact. The greatest percentages of radicular resorption were observed in teeth of group 3 showing antagonism., Conclusion: The severity of periodontal disease increases the extension and the depth of the radicular resorption, and the presence of antagonist forces aggravates the resorption., (© 2010 John Wiley & Sons A/S.)