(80) Management of Traumatic Occlusal Forces in treatment of Severe Periodontitis

Introduction: The rationale for our study is a case series demonstrating the importance of occlusal intervention during initial therapy in young adult patients presenting with severe periodontal disease.

Methods: Two patients, a 39 year-old male and 29 year-old female, presented to the Periodontics clinic at the University of Pennsylvania School of Dental Medicine (PDM). Comprehensive dental examinations were completed including a full series of radiographs and clinical examination. Both patients were diagnosed with Generalized Stage III, Grade C periodontitis and secondary occlusal trauma. The latter diagnosis was made as both patients presented with generalized, horizontal mobility up to 2mm in addition to fremitus and signs of occlusal wear. In both patients, initial therapy consisted of comprehensive oral hygiene instruction, non-surgical periodontal treatment with adjunctive antibiotic therapy. Both patients were referred to Orthodontics and multi-disciplinary treatment planning deemed occlusal therapy appropriate. Case report 1: Limited occlusal adjustment was performed to eliminate anterior buccal crossbite and interferences. A bite plane was provided, and the patient was advised to always wear the appliance besides mastication, approximately 22 hours per day. Case report 2: Complete occlusal adjustment was completed in addition to provision of a removable orthodontic appliance. The patient was instructed to wear the appliance for 22 hours per day.

Results: Case report 1: 6-month maintenance revealed significant reduction in probing pocket depth. Occlusal therapy eliminated the buccal, anterior cross-bite in addition to complete elimination of mobility and all signs of traumatic occlusal forces. Case report 2: 6-month maintenance reveals significant reduction in probing pocket depth. There is no evidence of fremitus or mobility and all interferences have been eliminated. Occlusal analysis reveals balanced articulation with working contacts on the supporting cusps.

Conclusions: This case series shows successful occlusal therapy in two patients presenting with severe periodontitis using bite planes in conjunction with occlusal adjustments. In cases of traumatic occlusal forces, occlusal therapy is an integral component of providing effective initial therapy in the management of periodontal disease.

Lead Author's Contributions to the Research Project. : The lead author was responsible for the composition of the abstract.