Pathologic Tooth Migration

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Pathologic migration refers to tooth displacement that results when the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease. Pathologic migration is relatively common and may he an early sign of disease, or it ma\ occur in association with gingival inflammation and pocket formation as the disease progresses.

Perunlontul Response to lixtenuil lanes ■ (I IAN IK 24 379

Pathologic migration occurs most frequently in the anterior region, hut posterior teeth may also he affected. The teeth may move in any direction, and the migration is ¡usually accompanied by mobility and rotation. Pathologic migration in the occlusal or incisal direction is termed extrusion. All degrees ot pathologic migration are encountered, and one or more teeth may be affected (Fig. 24-11). It is important to detect it in its early stages and prevent more serious involvement by eliminating the causative factors. Rven in the early stage, some degree of hone loss occurs.

Pathogenesis

Two major factors play a role in maintaining the normal position of the teeth: the health and normal height of the periodontium and the forces exerted on the teeth. The latter includes the forces of occlusion and pressure from the lips, cheeks, and tongue. I he following factors are important in relation to the forces of occlusion: tooth morphologic features and cuspal inclination; the presence of a full complement of teeth: a physiologic tendency toward mesial migration; the nature and location of contact point relationships; proximal, incisal, and occlusal attrition; and the axial inclination of the teeth. Alterations in any of these factors start an interrelated se quence ot changes in the environment ot a single tooth or group of teeth that results in pathologic migration. Thus pathologic migration occurs under conditions that weaken the periodontal support, increase or modify the forces exerted on the teeth, or both.

Weakened Periodontal Support. I he inflammatory destruction of the periodontium in periodontitis creates an imbalance between the forces maintaining the tooth in position and the occlusal and muscular forces on which it is ordinarily called to bear. I he tooth with weakened support is unable to maintain its normal position in the arch and moves away from the opposing force unless it is restrained by proximal contact. Ihe force that moves the weakly supported tooth may he created by factors such as occ lusal contacts or pressure from the tongue.

It is important to understand that the abnormality in pathologic migration rests with the weakened periodontium. The force itself need not be abnormal, forces that are acceptable to an intact periodontium become injurious when periodontal support is reduced. An example ol this is the tooth with abnormal proximal contacts. Abnormally located proximal contacts convert the normal anterior component of force to a wedging force that moves the tooth occlusally or incisally. Ihe wedging

Trauma From Occlusion Teeth Periodontics

Fig. 24-11 Stages in pathologic migration. A, Migration of the right maxillary lateral incisor. B, labial migration of maxillary central incisors and left canine, and mesial migration of the right lateral incisor. C, Migration and extrusion of maxillary and mandibular incisors. D, Severe migration of the maxillary cen tral incisor.

Fig. 24-11 Stages in pathologic migration. A, Migration of the right maxillary lateral incisor. B, labial migration of maxillary central incisors and left canine, and mesial migration of the right lateral incisor. C, Migration and extrusion of maxillary and mandibular incisors. D, Severe migration of the maxillary cen tral incisor.

force, which can be withstood by the intact periodontium, causes the tooth to extrude when the periodontal support is weakened by disease. As its position changes, the tooth is subjected to abnormal occlusal /vices, which aggravate the periodontal destruction and the tooth migration.

Pathologic migration may continue after it tooth no longet contacts its antagonist. Pressures from the tongue, the food bolus during mastication, and proliferating granulation tissue provide the force.

Pathologic migration is also an early sign of localized aggressive periodontitis. Weakened by loss of periodontal support, the maxillary and mandibular anterior incisors dnlt labiallv and extrude, creating diastcmata between the teeth (see Chapter 2N).

Changes in the forces P.xerted on the Teeth.

Changes in the magnitude, direction, or frequency of the forces exerted on the teeth can induce pathologic migration of a tooth or group of teeth, fhese forces do not have to be abnormal to cause migration if the periodontium is sufficiently weakened. ( hanges in the forces may occur as a result of unreplaced missing teeth, failure to replace first molars, or other causes.

UNREPLACED MISSING TEETH. Drifting of teeth into the spaces created by unreplaced missing teeth often occurs. Drifting differs from pathologic migration in that it does not result from destruction of the periodontal tissues. However, it usually creates conditions that lead to periodontal disease, and thus the initial tooth movement is aggravated bv loss of periodontal support (fig. 24-12).

Drifting generally occurs in a mesial direction, combined with tilting or extrusion beyond the occlusal plane. Fhe premolars frequently drift distally (fig. 24-13). Although drifting is a common sequela when miss ing teeth are not replaced, it does not always occur (Fig. 24-14).

FAILURE TO REPLACE FIRST MOLARS. file pattern of changes that may follow failure to replace missing first molars is characteristic . In extreme cases it consists of the following:

I Ihe second and third molars tilt, resulting in a decrease in vertical dimension (fig. 24-I S). 2. fhe premolars move distally, and the mandibular incisors tilt or drift linguallv. While drilling distally, the mandibular premolars lose their intercuspating relationship with the maxillary teeth and may tilt distally.

'>. Anterior overbite is increased. I he mandibular incisors strike the maxillary incisors near the gingiva or traumatize the gingiva.

4. fhe maxillary incisors are pushed labiallv and laterally (Fig. 24-16).

5. fhe anterior teeth extrude because the incisal apposition has largely disappeared.

(>. Diasteinata are created by the separation of ihe anterior teeth (see Fig. 24-15).

Labialy Inclined Maxillary Incisor

Fig. 24 1 3 Maxillary first molar tilted and extruded into the space created by a missing mandibular tooth.

Mandibular Molar Proximal Contact

Fig. 24 12 Calculus and bone loss on the mesial surface of a canine that has drifted distally.

Fig. 24 1 3 Maxillary first molar tilted and extruded into the space created by a missing mandibular tooth.

Fig. 24 12 Calculus and bone loss on the mesial surface of a canine that has drifted distally.

Fig. 24-14 No drifting or extrusion despite 4 years' absence of mandibular teeth

Periodontal Response to t xteruul I on es ■ < MAPI I R 24 381

The disturM proximal contact relationships lead to /(mil impaction, gingival inflammation, and pocket formation, followed by hoiic loss and tooth mobility. Occlusal disharmonies created by the altered tooth positions traumatize the supporting tissues of the periodontium iiml aggravate the destitution caused by the inflammation. Reduction in periodontal support leads to further migration of the teeth ami mutilation of the occlusion.

OTHER CAUSES. Trauma from occlusion may cause a shift in tooth position either by itself or in combination with inflammatory periodontal disease. The direc-tionof movement depends on the occlusal force.

Pressure from the tongue may cause drifting ol the teeth in the absence of periodontal disease or may contribute to pathologic migration ol teeth with reduced periodontal support <1 ig. 24-17).

In tooth support weakened by periodontal destruction, pressure from the granulation tissue of periodontal pockets has been mentioned as contributing to pathologic migration.tH I he teeth may return to their original positions after the pockets are eliminated, but it more destruction has occurred on one side of a tooth than the other, the healing tissues tend to pull in the direction ol the lesser destruction.

Fig. 24-15 A-C, Mutilation ol occlusion associated with unreplaced missing teeth. Note pronouncei pathologic migration, disturbed proximal contacts, and functional relationships with closing of the bite

Mandibular Molar Proximal Contact
Fig. 24-16 Maxillary incisors pushed labially in patient with bilateral unreplaced mandibular molars. Note extrusion of the maxillary molars.

Fig. 24-1 7 Pathologic migration associated with tongue pressure

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Responses

  • prisca
    What causes tooth migration?
    8 years ago
  • max
    How to treat pathological tooth migration?
    8 years ago
  • hugo
    Why pathological migration of tooth is towards mesial side?
    8 years ago
  • mantissa
    What is pathologic migration in anterior teeth?
    5 years ago
  • henriikka
    What is Pathological destruction teeth?
    4 years ago
  • Deodata Pisano
    How pathological migration related with tfo?
    2 years ago
  • florian
    Where teeth migration usually occur?
    4 months ago

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