Occlusal adjustment in the treatment of secondary traumatic injury

Abstract

The success of the rehabilitation treatment is associated with the relationship between occlusion and periodontal status. When occlusal loads exceed the ability of the periodontium to resist and distribute the resulting forces, injuries may develop, leading to failures in dental practice. A 35-year-old female patient presented at the Occlusion and Orofacial Pain Research Center at the School of Dentistry, Universidade Federal de Goiás, Brazil, complaining of pain and mobility in the maxillary central incisors and sensitivity in the mandibular left incisors and canine. Symptoms began after cast metal restoration was performed in tooth #27. Clinical examination revealed a significant difference of 1 mm between centric relation and habitual occlusion, presence of a periodontal pocket 5 mm deep in the mesial aspect of tooth #11, and an increased vertical dimension of occlusion caused by occlusal interference between teeth #27 and #37. Radiographic examination detected vertical bone loss between teeth #21 and #11, on the mesial aspect of tooth #33 and between the lower incisors. The lower teeth also showed radiographic evidence of periapical lesions. Occlusal interference caused anterior projection of the mandible to the right, overloading the incisors. Treatment by occlusal adjustment was performed to promote an equal incidence of forces on all aspects of the teeth. Twelve sessions were required to achieve a balanced occlusion and restore the physiological vertical dimension of occlusion. Six months after treatment, there was radiographic evidence of newly formed bone tissue between teeth #11 and #21, regression of apical periodontitis in the lower teeth, and a decrease in mobility and all associated symptoms. Secondary traumatic injury may be responsible for changes in apical tooth structures. Occlusal adjustment may favor the direction of occlusal forces to the long axis of the teeth.