Regarding the question of inter-relationship between occlusal trauma and periodontitis: evidence-based data analysis

Abstract

Introduction. Depending on the presence of occlusal trauma, the sequence of approaches within comprehensive rehabilitation protocol, which includes restorations supported by natural teeth or intraosseous dental implants for patients with periodontitis, may change. Considering this, it is relevant to review the relationships between the phenomenon of occlusal trauma and the development and progression of periodontitis pathology, based on current clinical and laboratory studies.Objective of the research. To analyze the features of the relationships between the phenomenon of occlusal trauma and the development and progression of periodontitis pathology, taking into account data from previous studies.Materials and methods. The selection of publications for a targeted literature review was carried out by means of an initial search within the Google Scholar system (https://scholar.google.com/). Publications that based on the text of the abstract and title could potentially be associated with the purpose of present study were subject to detailed content analysis, the categories of which were the following: changes within the structure of periodontal tissues on the background of existing occlusal trauma; changes within the course of periodontitis on the background of existing occlusal trauma; the effect of eliminating occlusal trauma on changes within the structure of periodontal tissues under normal and pathological conditions; approaches used to study the impact of occlusal trauma on periodontal tissues; approaches used to assess the role of occlusal trauma in the structure of periodontal tissues changes within clinical conditions.Results and discussions. Number of previous laboratory studies demostrated that the presence of occlusal trauma as such, without an accompanying bacterial component, cannot provoke the development of periodontitis in the classical interpretation of the symptoms’ complex of this pathology. Animal models have demonstrated that under the influence of excessive occlusal forces, but with the maintenance of proper bacterial control, occlusal trauma provokes an increase in tooth mobility and a decrease in the level of surrounding bone density, but without the accompanying loss of clinical attachment. The factors of traumatic occlusion can be considered as contributory to the extent of destruction within the supporting apparatus of tooth on the background of existing periodontal pathology. Approaches for the treatment of traumatic occlusion include occlusal corrections, management of parafunctional activity, stabilization of mobile teeth using provisional and subsequently definitive structures, orthodontic tooth movement, occlusal reconstruction (complete redesign of the occlusal scheme), extraction of teeth with a compromised prognosis.Conclusions. The analysis of the literature data allowed to summarize that, despite the fact that occlusal trauma cannot be considered as an etiological factor in the development of periodontitis, its presence on the background of periodontitis changes the pattern and progress of pathological changes, and the elimination of the excessive occlusal component improves the prognosis of targeted periodontal treatment. Factors such as the presence of premature occlusal contacts, the presence of occlusal interferences on the non-working side, the simultaneous combination of occlusal contacts on the working and non-working sides of the jaw, as well as the length of the sliding trajectory between the positions of the centric relation and central occlusion, are associated with lower values of the criteria for assessing the state of the periodontium, compared to conditions when the influence of the above factors in a patient with periodontitis was absent.