Division of Periodontics, School of Dentistry at Bauru, University of São Paulo, Bauru, Brazil.
Periodontol 2000. 2019 Feb;79(1):129-150. doi: 10.1111/prd.12251.
This article deals with establishing a new link between trauma from occlusion and periodontal pockets based on the know-how and background gradually developed. To provide a better understanding to the reader, a historical perspective is firstly presented. The main features on the controversy of the role played by trauma from occlusion on the physiologic behavior of the periodontal structures are shown, together with how deviations from the normal characteristics of this relationship itself affect the integrity of the periodontal tissues when or associated with dental biofilm in the presence or not of periodontal pockets have arisen. The literature provides evidence showing that the very first publication to establish a strong correlation between trauma from occlusion and periodontal pockets in humans was of Latin-American origin. However, subsequently, trauma from occlusion was mostly evaluated by an American group, followed by a Scandinavian group, yet with some contributions from the Latin-American group. Basically trauma from occlusion has been correlated with periodontal pockets in view of the fact that these would render the periodontal supporting tissues more amenable to the spread of inflammation of biofilm-related periodontal pockets. This would facilitate the fast deepening of periodontal pockets, influencing the generation of infrabony periodontal pockets or suprabony periodontal pockets that are deeper than in areas without trauma from occlusion. The factors related to these different behaviors are discussed. Several clinical cases are presented showing evidence that corroborates the possibility of an actual interrelationship between trauma from occlusion and periodontitis. Theoretical evaluations based on recent advances of the mechanisms involving molecular modulation in physiological and altered occlusal functions, as well as on research data, and evaluations from data of clinical cases, support the assumption that trauma from occlusion and periodontitis may embrace the unique pathologic condition of the associated lesion trauma from occlusion plus periodontitis or act independently even if both co-exist simultaneously in a particular case. The link between both conditions that was emphasized as definitively necessary in order for an associated lesion to develop is that both lesions, namely trauma from occlusion and periodontitis, occur in their destructive stage at exactly the same time. This involvement would explain why so many different data are presented in the literature and hopefully will shed some light for development of new methodologies of research. Clinical cases were selected to present a treatment philosophy on the subject.
本文基于逐渐发展的专业知识和背景，建立了咬合创伤与牙周袋之间的新联系。为了让读者更好地理解，首先呈现了一个历史视角。展示了咬合创伤在牙周结构生理行为中的作用争议的主要特征，以及当或伴随牙菌斑存在于牙周袋中时，这种关系本身的正常特征偏离如何影响牙周组织的完整性，以及是否存在牙周袋。文献证据表明，首次在人类中建立咬合创伤与牙周袋之间强相关性的出版物源于拉丁美洲。然而，随后，咬合创伤主要由一个美国小组评估，随后是一个斯堪的纳维亚小组，但也有一些拉丁美洲小组的贡献。基本上，咬合创伤与牙周袋相关，因为这些会使牙周支持组织更容易受到与生物膜相关的牙周袋炎症的扩散。这将促进牙周袋的快速加深，影响形成比无咬合创伤区域更深的骨下牙周袋或骨上牙周袋。讨论了与这些不同行为相关的因素。呈现了几个临床病例，这些病例提供了证据，证明了咬合创伤与牙周炎之间存在实际的相互关系的可能性。基于涉及生理和改变的咬合功能的分子调节机制的最新进展的理论评估，以及基于研究数据和临床病例数据的评估，支持了这样一种假设，即咬合创伤和牙周炎可能包含与损伤相关的病变的独特病理状况，或者即使在特定病例中同时存在，也可以独立起作用。强调为了发展相关病变而必须存在的两者之间的联系是，两种病变，即咬合创伤和牙周炎，在其破坏性阶段同时发生。这种牵连可以解释为什么文献中呈现了如此多不同的数据，并希望为新的研究方法的发展提供一些启示。选择了临床病例来介绍该主题的治疗理念。
