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tooth-mobility-pedo
This document discusses tooth mobility, including its definition, types, assessment methods, and clinical significance. It provides details on physiologic and pathologic tooth mobility, factors that affect mobility, and methods for evaluating mobility. Treatment options are outlined for different situations involving increased tooth mobility and include occlusal adjustment, splinting, and sometimes extraction for advanced periodontal disease cases.
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Tooth mobility defined as degree of looseness, recorded during evaluations. Physiologic mobility is normal for healthy teeth.
Two types identified: Physiologic and Pathologic. Physiologic mobility is normal under healthy conditions.
Normal physiologic mobility varies among teeth: Incisors (10-12 mm), Canines (5-9 mm), Premolars (8-10 mm), Molars (4-8 mm). Variations occur throughout the day.
Stress factors like bruxism impact mobility, varying by age and gender, and changes during pregnancy.
Tooth mobility occurs in two stages: movement within periodontal ligament, followed by gradual bone deformation in response to forces.
Pathologic mobility indicates perceptible movement due to inflammation, trauma, pregnancy, surgical effects, or tooth loss.
Various classification methods for assessing tooth mobility, including scores from Miller, Caranza, Genco, and others.
Periodontometer allows reproducible assessment of horizontal mobility, employing various instruments.
Mobility indicates gingival inflammation, tooth discomfort, and aesthetic concerns. May indicate deeper issues.
Radiographic loss often correlates with varying degrees of mobility, identifying underlying periodontal issues.
Healthy periodontal support may be present despite mobility. Chronic periodontal disease is a key cause.
Treatment strategies depend on mobility causes: occlusal adjustments, splinting, and surgical interventions may stabilize teeth.
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- 2. • TOOTH MOBILITYcan be defined as ‘ the degree of looseness of a tooth’ KENRY AAP 1986 • Mobility is recorded as a part of the initial occlusal evaluation & to monitor changes overtime
- 3. • In health,physiological or functional mobility of tooth exists & every tooth with healthy periodontal support will have a physiologic range of mobility Mobility is a measurement of horizontal & vertical tooth displacement in the socket
- 4. MOBILITY CAN BEOF TWO TYPES: • PHYSIOLOGIC PATHOLOGIC TOOTH MOBILITY TOOTH MOBILITY
- 5. PHYSIOLOGIC TOOTH MOBILITY • It refers to moderate force exerted on the crown of tooth surrounded by a healthy & intact periodontium & tooth will show tipping movement until a closer contact has been established between root & marginal bony tissue MUHLEMAN,1951 KORBER,1971 LINDHE ,1989
- 6. • Normal toothmobility varies between different types teeth: Incisors - 10- 12 mm/ 100 mm Canines - 5 - 9mm/100mm Premolars - 8 - 10mm/100mm Molars - 4 - 8mm/100mm
- 7. Factors affecting physiologic tooth mobility: • Daily variations: • Teeth have a slight degree of physiologic mobility which varies for different teeth & at different times of day • It is greatest in the morning,which progressively decreases due to slight extrusion of tooth & minimal during sleep
- 8. • During walkinghours mobility is reduced by chewing & swallowing forces which intrude teeth into socket Tooth contact during deglutition: • functional forces received by teeth during deglutition resulted in tooth contact which maintains the tooth in proper positions T
- 9. Effect of stress-inducingconditions: • Habits like bruxism & clenching activities affect tooth mobility as well • Larger in children than in adults • Females > males • Increases during pregnancy
- 10. Tooth mobility occursin TWO STAGES: • INITIAL STAGE OR INTRA SOCKET STAGE: • Tooth moves within confines of periodontal ligament associated with viscoelastic distortion of ligament & redistribution of periodontal fluids, inter-bundle content & fibers
- 11. • SECONDARY STAGE: • • Occurs gradually & entails defomation of alveolar bone in response to a increased horizontal forces
- 12. PATHOLOGIC TOOTH MOBILITY: • Refersto any degree of perceptible movement of faciolingually,mesiodistaly or axially when a force is applied to tooth
- 14. CAUSES OF PATHOLOGIC TOOTH MOBILITY: • Extension of inflammation from gingiva or from periapex into periodontal ligament results in changes that increases mobility • Loss of tooth support results in tooth mobility. Amount of of mobility depends on severity & distribution of bone loss at individual root surfaces,length, shape & size of roots
- 15. • Trauma fromocclusion, injury produced by excessive occlusal forces or abnormal habits such as bruxism & clenching is a common cause of tooth mobility • Pregnancy, tooth mobility is increased in pregnancy & sometimes associated with menstrual cycle or use of hormonal contraceptives
- 16. • Pathologic processof jaws that destroys alveolar bone & roots of teeth can also result in mobility • Periodontal surgery increases tooth mobility for a short period • Tooth loss, when a large number of teeth have been lost,remaining tooth must assume all functional demands
- 18. CLASSIFICATION OF TOOTH MOBILITY: • MILLER - has described the most common clinical method in which tooth is held in between handles of two instruments & moved back & forth or with one metallic instrument & one finger
- 19. Scoring criteria: • Score 0 : no detectable mobility • Score 1 : distinguishable tooth • mobility • Score 2 : crown of tooth moves • more than 1mm in any • direction • Score 3 : movement of more than • 1mm in any direction
- 20. • CARANZA F.A.- described it as normal mobility • Grade 1 : slightly more than normal • Grade 2 : moderately more than normal • Grade 3 : severe mobility faciolingually & or mesiodistally combined with vertical displacement
- 21. • GENCO R.- assessed mobility as: • • Degree 1 : horizontal mobility of • crown is from detectable • to 1mm • Degree 2 : mobility of crown ranges • from 1-2mm horizontally • Degree 3 : mobility of crown is • observed in vertical or • apical direction
- 22. • LEONARD ABRANMS& POTASHNICK S.: • Class 1 : mobility less than 1mm • Class 2 : mobility within 1-2mm • Class 3 : mobility greater than 2mm
- 23. • SCHLUGER : •0 : clinical mobility with normal • range • {-} :clinical mobility slightly more • than physiologic but less than • 1mm buccolingually • 1 : clinical mobility 2mm • buccolingually but with no • mobility in apical direction
- 24. • 3 :clinical mobility greater than • 2mm buccolingually in addition to • mobility in an apical direction
- 25. • GRACES &SMALES: Grade 0 : no apparent mobility • Grade 1 : mobility less than 1mm buccolingually • Grade 2 : mobility between 1-2mm • Grade 3 : mobility more than 2mm buccolingually
- 26. • KIESER: • Grade0 : physiologic mobility • Grade 1 : slight mobility • Grade 2 : moderate mobility • Grade 3 : marked mobility
- 27. • Degree 1: movability of crown of • tooth less than 1mm in • horizontal direction • Degree 2 : movability of crown of • tooth more than 1mm in • horizontal direction • Degree 3 : movability of crown of • tooth in vertical direction • as well
- 29. METHOD OF ASSESSING TOOTH MOBILITY: • The instrument system {PERIODONTOMETER} permits reproducible assessment of horizontal mobility of all types of both arches
- 30. • Instruments consistsof: • A CLUTCH with a female receptable for holding carrying vehicle • A MULTIJOINTED CARRYING VEHICLE with a male attachment that supports & positioning a dial test
- 31. • A DYNAMOMETER with which a standardized force can be applied to tooth • A SENSITIVE DIAL TEST INDICATOR with a diamond coated recording point that can be positioned against facial surface of tooth to be measured
- 32. CLINICAL IMPACTION OF TOOTHMOBILITY: • Various degrees of gingival inflammation • Loss of attachment with pocketing • Gingival recession • Tooth with furcation involvement
- 33. SIGNS & SYMPTOMS: •Patient awareness of mobility: Mobility is detected quite incidentally when patient’s attention is brought to tooth by tenderness experienced on chewing • •
- 34. • Functional discomfort: • Pain may be expected following • sudden tooth displacement when • biting on hard foods or with • inadvertent trauma • Aesthetics: • Anterior labial or lateral tooth • displacement results in fanning • & elongation of clinical crown • with poor appearance
- 35. RADIOGRAPHIC CHANGES: • Markedhorizontal radiographic loss of bony support may be associated with minimal tooth mobility • Modest degree of breakdown may be associated with pronounced tooth mobility
- 36. • Periodontally involvedmobile units may also display funneled periodontal radiolucencies resulting from co-existing angular bony defects • Radiolucencies may be suggestive of endodontic lesion • Radiolucencies may be seen with furcation at furcation involved mobile teeth
- 38. OTHER FEATURES: • Amobile teeth might sometimes display a healthy periodontal support, causes of mobility are: • accidental trauma • periapical endodontic • lesion • high filling • orthodontic treatment
- 39. Differential diagnosis: • Chronicinflammatory periodontal disease is the commonest cause of of increased tooth mobility
- 40. Treatment of increased tooth mobility: • Situation 1: • Increased mobility of tooth with increased width of periodontal ligament but normal height of alveolar bone
- 41. • A propercorrection of anatomy of occlusal surfaces of tooth that is occlusal adjustment will normalize relationship between antagonizing teeth in occlusion, thereby eliminating excessive forces • Apposition of bone will occur in zones, periodontal ligament will become normalized & tooth stabilized , it assumes normal mobility
- 42. • Situation 2: • Increased mobility of tooth with increased width of periodontal ligament & reduced width of alveolar bone • - The width of periodontal ligament is increased & tooth becomes hyper-mobile • -If excessive forces are reduced by occlusal adjustment, periodontal ligament will regain its normal width & tooth will be stabilized
- 43. • Situation 3: • Increased mobility of a tooth with reduced height of alveolar bone & normal width of periodontal ligament • - This situation cannot be eliminated by occlusal adjustment • -if patient experiences tooth mobility disturbing, it can only be reduced by ‘SPLINTING’ by joining mobile tooth/teeth with other teeth in the jaw into fixed unit- SPLINT
- 44. • “ SPLINTis an appliance designed to stabilize mobile teeth “ • Fabricated in the form of joined composite fillings, fixed bridges, RPD’S etc.
- 45. • Situation 4: • Progressive{increasing} mobility of a tooth/teeth as a result of gradually increasing width of reduced periodontal ligament • - In case of advanced periodontal disease, tissue destruction may have reached a level where extraction cannot be avoided,
- 46. • Only bymeans of a SPLINT it is possible to maintain such teeth. In such a case FIXED SPLINT has two objectives: • • - To stabilize hyper-mobile • teeth • - Replace missing teeth
- 47. • Situation 5: • Increased bridge mobility despite splinting • -In case of extremely advanced periodontal disease, a CROSS-ARCH SPLINT may be regarded as an acceptable result of rehabilitation & prevention of tipping or orthodontic displacement of tooth splint