Occlusal Trauma has a Primary Role in the Etiology of Site-Specific Periodontitis/ Perimplantitis

Abstract

An in media preponderant school of thought considers the onset from the very beginning of the periodontal/periimplant disease due to an infection. In other words the disease begins when pathogenic bacteria infect a tissue which is wholly healthy thanks to saprophyte bacteria. We will consider occlusal trauma as well as cause of the disease. The aim of the work is to demonstrate how the long-lasting mechanical stress over gingival-tooth/implant apparatus can induce the change of bacterial flora from saprophyte to opportunistic pathogenic one capable of causing periodontal/perimplant infection. Two cases are presented referring to two different patients, one affected by periodontitis, the other by perimplantitis, in which periodontitis/perimplantitis occurred only on a single tooth/implant, both in evident occlusal trauma, sparing all contiguous elements. Since periodontal/perimplant disease is a multifactorial syndrome with hypothetical causes from infectious to genetic ones, or related to internal medicine and biomechanics,this research proposes to understand the causes of the periodontal/perimplant disease moving away from conventional schemas based on the insufficient hygiene with consequent build-up of dental plaque which is considered “the only “cause of the disease. In fact we must consider both teeth and implants not as static elements but as a dynamic complex which during its function can undergo a very heavy load according to precise biological laws. In addition to all the best-known risk factors the causes that displace mandible and therefore modify occlusion must deserve specific attention. Considerable overloading on teeth and/or implants involved can contribute to the pathogenesis of the tooth/implant and its supporting tissue too. The two clinical cases of the work present site-specific periodontitis and perimplantitis. Both cases show that occlusal trauma with its consequent chronic mechanical stress is the initial cause of the disease. Later the subsequent inflamed tissue becomes an easy road to the periodontal-perimplant infection as final stage. Following the evolution of the two cases it becomes apparent that it is important to know the diseases due to occlusal trauma. Only through that knowledge we can prevent the diseases described above.