Traumatic Occlusion: Potential Etiologic Risk Factor Leading to a Destructive Periodontal Disease
Citation: Traumatic Occlusion: Potential Etiologic Risk Factor Leading to a Destructive Periodontal Disease. American Research Journal of Dentistry; 1(1): 9-15.
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The etiology of periodontal disease is multifactorial and to be treated it is necessary to diagnose, to control or to eliminate all the etiologic factors. The relevance of this study is to show the necessity to know, to diagnose, to understand all etiological factors of a determinated periodontal disease. It seems to be important, to control or to eliminate them, therefore allowing the treatment of the sequelae of periodontal disease.As a result,we analyze and discuss how, in some individuals, occlusal traumatism may act together with bacteria to produce a localized periodontal disease. This report also discusses the possibilities of treatment to control the evolution of periodontal disease.
KeyWords: Bacteria; periodontitis; etiology; dental occlusion, diagnostic, predisposing factor.
The periodontal disease etiology is multifactorial and evidences indicate that bacterial plaqueplays an essential role as primary and principal etiologic agent to induce inflammatory processes in marginal soft tissues around the teeth1-7. Althoughbacteria are critical to developing a periodontal disease,bacteria alone seem to be insufficient to induce a periodontaldisease; a susceptible host is necessary, and host susceptibilityas local and/ or general predisposing factors are essential determinants ofdisease status 8-13. Thepredisposing factor may be an intrinsic feature related with an augmented rate of a subsequentlyoccurring disease, but alone it does not induce thedisease. In periodontal disease, the predisposing factors may be defined as local factor which may facilitate accumulation of bacterial plaque and/or some damage that affect periodontal tissues leading to local low resistance and fragility. They may also be systemic factors, which may be responsible for providing interference in the inflammatory process14-15. The diagnostic of all etiologic factors is criticalto treat any disease. An accurate diagnosis is often essential to developing a well-designed and appropriate treatment plan that when implemented leads to a resolution of the patient’s periodontaldisease infection. Thus the principal aim of this study is toanalyze and discuss how, in some individuals, occlusal traumatism may act together with bacteria to produce a localized periodontal disease. This report also discusses the possibilities of treatment to control the evolution of periodontal disease.
A 35-year old male individual was referred to the private dental office with a localized periodontal disease involving the lower left first molar. The patient’s main complaint was pain in the affected region. Clinical examination showed a suppurated deep periodontal pocket in the mesial side of the affected tooth and radiographic examination showed a radiolucent area around this tooth (Figure 1). In the anamnesis the individual seems to be in health condition and the systemic evaluation was entirely normal as well as other diagnostic tests were negative.The diagnosis of this localized periodontal disease was a challenge. Normally, when the mandibles moves laterally to the left side, the lower posterior teeth leave their contact with the upper teeth and travel sideways down a path dictated by the condyles in back and by anterior guidance in the front. However, the occlusal analysis of this case showed that the incisal edge of the upper left canine was worn down exposing the dentine, compromising the anterior guidance and promoting left lateral excursion interference over the lower left first molar (Figure 2). This occlusal interference associated with bacterial plaque were diagnosed as the etiological factor that lead to a localized periodontal disease in the lower left first molar. To promote the treatment of any disease it is very important to eliminate or to control all etiological factors which conducted to the disease. After the informed consent of the patient the treatment plan was executed.In this case to treat the localized periodontal disease the first step was setting up mechanisms to ensure ongoing monitoring and evaluation of the bacterial plaque level and the reconstruction of the anterior guidance to establish control over all etiologic factors which were diagnosed (Figure 4). The second step was the treatment of the sequelae of the periodontal disease by applying regenerative periodontal surgery utilizing the autogenous bone graft, harvested from external oblique line of the mandible and guided tissue regeneration technique16 (Figure 5, 6, and 7).The individual is keeping under periodic control including periodontal and pulpal examination of the tooth involved along 2 years and 3 months (Figure 8).