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BACKGROUND: Excessive occlusal forces and occlusal trauma have been implicated as co-destructive factors for periodontitis in animal models. The objective of this study was to assess the association between occlusal trauma and periodontitis. METHODS: A total of 167 cases and 205 controls were included for analysis. Occlusal trauma was the exposures of interest and was registered for cases and controls. Additional clinical co-variables were registered as well for further analysis. The association of the exposure and periodontitis was determined by the odds ratio and logistic regression analysis adjusted for confounders. RESULTS: Amalgam restorations, pathogenic occlusion and occlusal trauma were more frequent in cases as compared to controls (P ≤ 0.05). The distribution of pathogenic occlusion and occlusal trauma was similar according to the stage and class of periodontitis. Logistic regression analysis showed a significant association for cigarette smoking, systemic conditions, amalgam restorations, pathogenic occlusion, and occlusal trauma with periodontitis (P ≤ 0.05). After adjusting for confounding variables in the model, amalgam restorations and occlusal trauma remained strongly associated with periodontitis (P ≤ 0.05). CONCLUSIONS: Occlusal trauma is strongly associated with periodontitis. Additional long-term prospective studies are necessary to further understand the impact of the occlusal condition and periodontitis.

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BACKGROUND: The aim of this study was to measure the dental pulp inflammatory response through neuropeptides (SP and CGRP) as a response to occlusal trauma, orthodontic movements and a combination of both, as well as the angiogenic defense mechanism through VEGF expression, which could be the initial step to mineralized tissue formation. METHODS: Forty human dental pulp samples were collected from healthy first premolars with extraction indicated due to orthodontic reasons from a sample of 20 patients. Patients were divided into four groups with 10 premolars each (1 mandibular and 1 maxillary premolar from each patient): healthy pulp control group, occlusal trauma group, moderate orthodontic forces group; and occlusal trauma plus moderate orthodontic forces group. Stimuli were applied for 24 h before tooth extraction in all experimental groups. All samples were processed, and SP, CGRP, and VEGF were measured by radioimmunoassay. The Kruskal-Wallis test was performed to assess significant differences among groups and Mann-Whitney's U post hoc pairwise comparisons were also performed. RESULTS: The highest increase in SP, CGRP, and VEGF expressions was found in the occlusal trauma plus orthodontic forces group, followed by the moderate orthodontic forces, the occlusal trauma and the control groups, with statistically significant differences between all groups for each of the 3 peptides analyzed (Kruskal-Wallis p < 0.001). All possible pairwise post-hoc comparisons were also significant for each peptide analyzed (Mann-Whitney's U p < 0.001). CONCLUSION: SP, CGRP, and VEGF expressions significantly increase in human dental pulps when stimulated by occlusal trauma combined with moderate orthodontic forces, as compared with these two stimuli applied independently. Name of the registry: Importance of Neurogenic Inflammation in the Angiogenic Response of the Dental Pulp as a Defensive Response. TRIAL REGISTRATION NUMBER: NCT03804034. Date of registration: 01/15/2019 Retrospectively registered. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03804034?term=NCT03804034&draw=2&rank=1 .

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As fendas palatinas são comuns em felinos e necessitam na sua grande maioria de correção cirúrgica, já que o defeito pode causar alterações clínicas que diminuem a qualidade de vida do paciente. O presente relato tem por objetivo relatar o caso de uma paciente felina, dois anos e seis meses, atendida pela equipe de odontologia veterinária especializada do centro odontológico veterinário ODONTOVET - Unidade Hospital Veterinário Anhembi Morumbi, que apresentava fenda palatina traumática. A correção cirúrgica foi realizada através da técnica de retalho de transposição do palato associado ao retalho de mucosa jugal, havendo recidiva parcial do defeito devido ao trauma oclusal dos dentes antagonistas, sendo necessário a realização de uma nova correção cirúrgica associada a extração dos dentes inferiores envolvidos no trauma oclusal. Por fim, alertar o leitor sobre a necessidade de checar a oclusão após a realização da correção e caso haja contato oclusal com o retalho, deve-se proceder a extração dos dentes em questão.

Palatine clefts are common in felines and mostly require surgical correction, as the defect can cause clinical changes that decrease the patient's quality of life. This report aims to report the case of a feline patient, two years and six months, attended by the specialized veterinary dentistry team of the ODONTOVET veterinary dental center - Anhembi Morumbi Veterinary Hospital Unit, which had traumatic cleft palate. Surgical correction was performed through the palate transposition flap technique associated with the jugal mucosa flap, with partial recurrence of the defect due to occlusal trauma of the antagonist teeth, requiring a new surgical correction associated with extraction of the involved lower teeth. in occlusal trauma. Finally, warn the reader about the need to check the occlusion after correction and if there is occlusal contact with the flap, the teeth in question should be extracted.

Las hendiduras palatinas son comunes en los felinos y en su mayoría requieren corrección quirúrgica, ya que el defecto puede causar cambios clínicos que disminuyen la calidad de vida del paciente. Este informe tiene como objetivo informar el caso de un paciente felino, de dos anos y seis meses, atendido por el equipo especializado de odontología veterinaria dei centro dental veterinario ODONTOVET - Unidad Hospital Veterinario Anhembi Morumbi, que tenía paladar hendido traumático. La corrección quirúrgica se realizó a través de la técnica de colgajo de transposición del paladar asociada con el colgajo de la mucosa yugal, con recurrencia parcial del defecto debido al trauma oclusal de los dientes antagonistas, que requiere una nueva corrección quirúrgica asociada con la extracción de los dientes inferiores involucrados en trauma oclusal Finalmente, advierta al lector sobre la necesidad de verificar la oclusión después de la corrección y si hay contacto oclusal con el colgajo, se deben extraer los dientes en cuestión.

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As fendas palatinas são comuns em felinos e necessitam na sua grande maioria de correção cirúrgica, já que o defeito pode causar alterações clínicas que diminuem a qualidade de vida do paciente. O presente relato tem por objetivo relatar o caso de uma paciente felina, dois anos e seis meses, atendida pela equipe de odontologia veterinária especializada do centro odontológico veterinário ODONTOVET - Unidade Hospital Veterinário Anhembi Morumbi, que apresentava fenda palatina traumática. A correção cirúrgica foi realizada através da técnica de retalho de transposição do palato associado ao retalho de mucosa jugal, havendo recidiva parcial do defeito devido ao trauma oclusal dos dentes antagonistas, sendo necessário a realização de uma nova correção cirúrgica associada a extração dos dentes inferiores envolvidos no trauma oclusal. Por fim, alertar o leitor sobre a necessidade de checar a oclusão após a realização da correção e caso haja contato oclusal com o retalho, deve-se proceder a extração dos dentes em questão.(AU)

Palatine clefts are common in felines and mostly require surgical correction, as the defect can cause clinical changes that decrease the patient's quality of life. This report aims to report the case of a feline patient, two years and six months, attended by the specialized veterinary dentistry team of the ODONTOVET veterinary dental center - Anhembi Morumbi Veterinary Hospital Unit, which had traumatic cleft palate. Surgical correction was performed through the palate transposition flap technique associated with the jugal mucosa flap, with partial recurrence of the defect due to occlusal trauma of the antagonist teeth, requiring a new surgical correction associated with extraction of the involved lower teeth. in occlusal trauma. Finally, warn the reader about the need to check the occlusion after correction and if there is occlusal contact with the flap, the teeth in question should be extracted.(AU)

Las hendiduras palatinas son comunes en los felinos y en su mayoría requieren corrección quirúrgica, ya que el defecto puede causar cambios clínicos que disminuyen la calidad de vida del paciente. Este informe tiene como objetivo informar el caso de un paciente felino, de dos anos y seis meses, atendido por el equipo especializado de odontología veterinaria dei centro dental veterinario ODONTOVET - Unidad Hospital Veterinario Anhembi Morumbi, que tenía paladar hendido traumático. La corrección quirúrgica se realizó a través de la técnica de colgajo de transposición del paladar asociada con el colgajo de la mucosa yugal, con recurrencia parcial del defecto debido al trauma oclusal de los dientes antagonistas, que requiere una nueva corrección quirúrgica asociada con la extracción de los dientes inferiores involucrados en trauma oclusal Finalmente, advierta al lector sobre la necesidad de verificar la oclusión después de la corrección y si hay contacto oclusal con el colgajo, se deben extraer los dientes en cuestión.(AU)

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OBJECTIVES: The goal of this study is to propose a standard protocol of experimental occlusal trauma to evaluate the inflammatory hyperalgesia induced by metallic crowns on orofacial tissues of rats. MATERIALS AND METHODS: Thirty animals were randomly divided into six groups (n = 5 per group). Detailed methodology on the manufacturing of metallic crowns is described. The inflammatory hyperalgesia induced by occlusal interference was evaluated by intra-articular injection of a low dose of 0.5% formalin (30 µl) or vehicle (saline) into temporomandibular joint, 21 or 28 days after metallic crown cementation. Posteriorly, pro-inflammatory cytokines were evaluated by enzyme-linked immunosorbent assay to assess the effect of occlusal interference on periodontium. RESULTS: The cementation of metallic crowns with dental anatomy on the lower molar of rats does not show signs of stress and lack of feeding. Metallic crown-induced occlusal trauma results in a temporomandibular joint inflammatory hyperalgesia (P < 0.05: ANOVA, Tukey's test). Otherwise, it was observed that occlusal trauma results in the increase of protein level of pro-inflammatory cytokines TNF-alpha and IL-1beta in the gingival tissues (P < 0.05). CONCLUSION: This study demonstrates in detail a methodology of occlusal trauma resulting from the cementation of metallic crowns in the lower molars of rats, mimicking occlusal interferences commonly evaluated in the dental clinic. This methodology makes new studies to better understand the mechanisms involved in the occlusal trauma of orofacial tissues possible. CLINICAL RELEVANCE: The standardization of an experimental occlusal interference model will allow us to understand the deleterious effect and mechanisms that affect the orofacial tissues.

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Angiogenesis is the formation of new blood vessels based on a pre-existing vasculature. It comprises two processes, sprouting of endothelial cells and the division of vessels due to abnormal growth of the microvasculature. It has been demonstrated that substance P (SP) can induce angiogenesis either by modulating endothelial cell growth (direct mechanism) or by attracting cells with angiogenic potential to the injury site (indirect mechanism). Therefore, the purpose of this article is to review the angiogenic mechanisms that regulate mineralized tissue formation in human dental pulp tissue and their relationship with SP expression as a defence response to stimuli such as the masticatory function and occlusal trauma. Articles included in this review were searched in PubMed, Scopus and ISI Web of Science databases, combining the following keywords: human dentine pulp, angiogenesis, angiogenic growth factors, neuropeptides, substance P, neurogenic inflammation, dentine matrix, dentinogenesis, occlusal trauma and dental occlusion. It is concluded that human dental pulp tissue responds to occlusal trauma and masticatory function with a neurogenic inflammatory phenomenon in which SP plays an important role in the direct and indirect mechanisms of angiogenesis by the action evoked via NK1 receptors at different cells, such as fibroblasts, endothelial and inflammatory cells, leading to new blood vessel formation which are needed to stimulate mineralized tissue formation as a defence mechanism.

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Introducción: la oclusión traumática se define como una alteración en las relaciones oclusales del sistema masticatorio, lo cual podría ser un factor conducente a un proceso inflamatorio en el ligamento periodontal, en la pulpa dental, y en tejidos blandos sensitivos. Objetivo: identificar las afecciones pulpares de origen no infeccioso en órganos dentarios con oclusión traumática en pacientes de un hospital del sector público de Mérida, Yucatán, México. Métodos: se realizó un estudio observacional y analítico, en un hospital del sector público de Mérida, Yucatán, México (2014). La muestra estuvo constituida con un total de 156 órganos dentarios de 82 pacientes, de 20 y más años de edad, que presentaron oclusión traumática en dientes permanentes y que mostraron alguna afección en tejido pulpar de origen no infeccioso, de acuerdo con la clasificación de la Academia Americana de Endodoncia. También se incluyó a los pacientes que presentaban caries, fracturas, fisuras, obturaciones, endodoncia, ortodoncia o trauma dentoalveolar. Se empleó un muestreo No probabilístico, por conveniencia. Se obtuvo el consentimiento informado y voluntario, historia médica y dental, y se realizó la evaluación de los signos y síntomas de dolor, pruebas pulpares (térmicas y eléctricas), palpación y percusión y abordaje diagnóstico con tinción/transiluminación, así como pruebas oclusales con papel de articular y examinación e interpretación de radiografías periapicales. Se utilizó estadística descriptiva. Resultado: hubo ausencia de dolor en 53 por ciento de los 156 órganos dentarios estudiados. Las alteraciones radiográficas se presentaron en 63 por ciento: entre ellas los nódulos pulpares tuvieron el mayor porcentaje (25 por ciento). La pulpitis fue reversible en 37 por ciento (n= 58); la oclusión traumática más frecuente fue la maloclusión (n= 49). En los 156 órganos dentarios estudiados, el signo clínico que mostró mayor frecuencia fue el desgaste en esmalte (n= 56). Conclusiones: las afecciones pulpares de origen no infeccioso se presentaron en alto porcentaje de dientes permanentes de pacientes con oclusión traumática(AU)

Introduction: Occlusal trauma is defined as an alteration in the occlusal relationships of the masticatory system, which may lead to inflammation of the periodontal ligament, the dental pulp and sensitive soft tissues. Objective: Iidentify non-infectious pulpal disorders in dental organs with occlusal trauma of patients from a public hospital in Mérida, Yucatán. Methods: An observational analytical study was conducted at a public hospital in Mérida, Yucatán, Mexico (2014). The study universe was 156 dental organs of 82 patients aged 20 years and over with occlusal trauma in permanent teeth and some degree of non-infectious pulp tissue disorder, based on the classification of the American Academy of Endodontics. Patients were also included who presented caries, fractures, fissures, fillings, endodontic treatment, orthodontic treatment or dentoalveolar trauma. Convenience non-probability sampling was applied. Voluntary informed consent was obtained. Medical and dental records were examined. An evaluation was carried out of pain signs and symptoms. Thermal and electric pulp tests were performed, as well as palpation, percussion and diagnostic staining/transillumination. Occlusal testing was conducted using articulating paper. Periapical radiographs were examined and interpreted. Descriptive statistics were used. Result: There was no pain in 53 percent of the dental organs studied. Radiographic alterations were present in 63 percent; the most common were pulp nodes (25 percent). Pulpitis was reversible in 37 percent (n= 58), and the most frequent occlusal trauma was malocclusion (n= 49). In the 156 teeth studied, the most common clinical sign was enamel wear (n= 56). Conclusions: Non-infectious pulpal disorders were present in a large number of permanent teeth of patients with occlusal trauma(AU)

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Agentes patogênicos presentes no biofilme dental têm sido considerados como fator etiológico primário das doenças periodontais. Entretanto, não existe um consenso sobre o efeito das forças oclusais no periodonto. O objetivo desse trabalho é avaliar a influência do trauma e da sobrecarga oclusal sobre a ocorrência de periodontite e peri-implantite respectivamente. Além disso, avaliar se há diferença na resposta tecidual entre dentes e implantes submetidos a tais discrepâncias. A partir da literatura estudada, pode-se concluir que apesar do trauma e da sobrecarga oclusal influenciarem negativamente a severidade da periodontite e da peri-implantite respectivamente, uma relação de causalidade ainda não está definida. Quando submetidos à sobrecarga oclusal, implantes são mais susceptíveis à perda da crista óssea alveolar quando comparados a dentes sob trauma.

Pathogens present in the dental biofilm have been considered as primary etiological factor of periodontal diseases. However, there is no consensus on the effect of occlusal forces in the periodontium. The aim of this review was to evaluate the influence of occlusal trauma and occlusal overload on the occurrence of periodontitis and periimplantitis respectively, and if there is a difference on tissue responses between theeth and implants subjected to such discrepancies. From this literature review it may be concluded that despite occlusal trauma and occlusal overload negatively influence the severity of periodontitis, causal relationship is not yet defined. When submitted to occlusal overload, implants are more likely to loss of bone crest than teeth submitted to occlusal trauma.

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The mechanisms of tissue changes induced by occlusal trauma are in no way comparable to orthodontic movement. In both events the primary cause is of a physical nature, but the forces delivered to dental tissues exhibit completely different characteristics in terms of intensity, duration, direction, distribution, frequency and form of uptake by periodontal tissues. Consequently, the tissue effects induced by occlusal trauma are different from orthodontic movement. It can be argued that occlusal trauma generates a pathological tissue injury in an attempt to adapt to new excessive functional demands. Orthodontic movement, in turn,performs physiological periodontal bone remodeling to change the position of the teeth in a well-planned manner, eventually restoring normalcy.

Os mecanismos das alterações teciduais induzidas pelo trauma oclusal não são minimamente comparáveis aos do movimento ortodôntico. Embora ambos os eventos tenham uma causa primária de natureza física, essas forças aplicadas sobre os tecidos dentários têm características completamente distintas na intensidade, tempo, direção, distribuição, frequência e forma de absorção pelos tecidos periodontais. Por consequência, os efeitos teciduais induzidos no trauma oclusal são diferentes do movimento ortodôntico. Pode-se afirmar que o trauma oclusal gera uma lesão tecidual de natureza patológica, na tentativa de se adaptar a novas demandas funcionais excessivas. Por sua vez, o movimento ortodôntico utiliza-se da remodelação óssea periodontal fisiológica para mudar o dente de posição, de forma planejada e com posterior restabelecimento da normalidade.

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As imagens oferecem uma linguagem que revela o dinamismo tecidual ósseo. A densidade óssea e a configuração espacial variam em suas estruturas e indicam uma menor ou maior reação e capacidade de adaptação às demandas funcionais, como cargas mastigatórias nos dentes naturais ou nos implantes osseointegrados. No planejamento de um tratamento reabilitador, é fundamental planejar a distribuição de carga e avaliar as condições dos dentes remanescentes e sua relação com o osso vizinho. Detectar a resposta óssea ao trauma oclusal preexistente pode favorecer uma avaliação mais precisa das condições mastigatórias e dos vícios parafuncionais: uma verdadeira história prévia funcional dos dentes remanescentes. Ressalta-se que as interferências e sobrecargas oclusais demoram meses, ou anos, para induzir os sinais e sintomas clássicos do trauma oclusal enquanto entidade clínica. Quando o dente apresenta-se com necrose pulpar e com sinais de trauma oclusal, o ideal será direcionar a anamnese e exames para um diagnóstico de traumatismo dentário superposto, mesmo em dentes posteriores. Não há fundamentação científica segura para afirmar-se que interferências ou sobrecargas oclusais provocam necrose pulpar. Um questionamento muito comum: até que ponto as forças ortodônticas de ancoragem podem ser aplicadas nos implantes osseointegrados? As forças ortodônticas não superam, em qualquer situação, a intensidade, amplitude e variabilidade das forças oclusais. Se um implante pode receber cargas mastigatórias, o mesmo pode se aplicar às forças ortodônticas de ancoragem.

Images provide a language to describe the dynamics of bone and tissue. Bone density and space distributionvary and indicate greater or lower reaction and adaptation to functional demands, such as masticatory loads,on natural teeth or osseointegrated implants. In rehabilitation, load distributions have to be planned, and theremaining teeth and their relation with neighboring bone should be evaluated. The detection of bone responsesto pre-existing occlusal trauma may provide a more accurate evaluation of masticatory conditions and parafunctionalhabits, that is, a true functional history of remaining teeth. Occlusal interference and overloads takemonths or years to induce classical signs and symptoms of occlusal trauma as a clinical entity. When a toothhas pulp necrosis and signs of occlusal trauma, the evaluation of history, as well as all tests, should be directedto the diagnosis of superposed dental trauma even when posterior teeth are affected. There is no scientific basisto confirm that occlusal interferences and overloads lead to pulp necrosis. A frequent question: Up to whatpoint should orthodontic forces be applied to osseointegrated implants? Orthodontic forces are not greater, inany situation, than occlusal forces in terms of intensity, amplitude and variability. If an implant can bear masticatory loads, it may also receive orthodontic forces resulting from anchorage.

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