Periodontal conditions of teeth presenting pathologic migration

Abstract

ABSTRACT:The aim of the present study was to evaluate the periodontal conditions of anterior teeth that presented pathologic migration in patients with chronic periodontitis and to compare periodontal destruction in migrated versus non-migrated teeth. The sample included 32 patients of both sexes (mean age: 46.0 ± 11.6 years) diagnosed with generalized chronic periodontitis and selected on the basis of the presence of pathologic migration in one or more anterior teeth. This migration was classified according to the following categories: facial flaring, diastema, proximal tilting, rotation or extrusion. The periodontal parameters recorded were clinical attachment loss (CAL) and percentage of radiographic bone loss (BL). Mean CAL of 5.50 ± 2.20 mm and mean BL of 41.90 ± 15.40% were found in 115 teeth assessed. The most frequent type of migration was facial flaring (34.80%), followed by diastema (27.00%). Extrusion was hardly observed in the sample (4.30%). However, greater severity of BL and CAL were observed in teeth with this type of migration (59.44% and 8.42 mm, respectively), and in teeth with facial flaring (45.17% of BL and 6.07 mm of CAL). Kruskal-Wallis test indicated that BL presented by teeth with extrusion or facial flaring was greater than that observed in rotated or tilted teeth (p < 0.05), while there was no difference between groups regarding CAL (p = 0.11). It was observed that anterior teeth with pathologic migration presented greater CAL and BL (5.1 mm and 40%) than non-migrated teeth (4.1 and 31%). The study indicated that the most prevalent kind of pathologic migration is facial flaring, which was associated to higher level of bone loss. DESCRIPTORS: Tooth migration; Periodontal attachment loss; Alveolar bone loss. RESUMO:O objetivo deste estudo foi avaliar as condições clínicas periodontais de dentes anteriores com migração patológica (MDP) em pacientes com periodontite crônica generalizada e comparar a severidade de destruição periodontal entre dentes migrados e não-migrados. Foram selecionados 32 pacientes, de ambos os sexos, apresentando média de idade de 46,0 anos (± 11,6), com perda clínica de inserção em dentes anteriores e presença de algum tipo de MDP, a saber: vestibularização, diastema, inclinação proximal, giroversão ou extrusão. Os parâmetros avaliados foram a perda clínica de inserção (PIC) e o percentual de perda óssea radiográfica (PO). Os resultados mostraram, em média, uma PIC de 5,50 mm (± 2,20 mm) e uma PO de 41,90% (± 15,40%) do comprimento radicular, em 115 dentes selecionados. Os tipos mais freqüentes de migração foram vestibularização (34,80%) e presença de diastemas (27,00%). A extrusão foi a menos freqüente (4,30%). Maiores valores de PO e PIC foram registrados nos dentes com extrusão (59,44% e 8,42 mm) e vestibularização (45,17% e 6,07 mm). Esses valores de PO foram superiores aos observados nos dentes com giroversão ou inclinação proximal (p < 0,05 -Kruskal-Wallis). A PIC não apresentou diferenças significativas entre os diferentes tipos de migração (p = 0,11). Cons...

A study on clinical attachment loss and gingival inflammation as etiologic factors in pathologic tooth migration

“…Another study by Costa [5] also shows similar results in which it was observed that anterior teeth with pathologic migration presented greater attachment loss and bone loss than non-migrated teeth. Although patient factor was kept constant but tooth type (and hence tooth size and position and root surface area) was not constant as against our study in which tooth type was also kept stable by including contralateral non migrated teeth as done by Towfighi.…”

“…The prevalence of pathologic migration is not known precisely but has been reported to be between 30.03% and 55.8% [3][4][5][6] in various studies. It may manifest in the form of incisor flaring, diastema formation, rotation, extrusion, tipping into edentulous spaces or a combination of any of these.…”

“…The etiology of pathologic tooth migration is multifactorial as well as complex [3] that includes periodontal attachment loss, [7,8] inflamed tissues, [9,10] bone loss, [5][6][7] occlusal factors, [11,12] loss of teeth without replacement, [5,13] labial frenum, and iatrogenic dentistry. Specific behaviors associated with it include bruxism, tongue thrusting, lip and finger sucking habits and playing of wind instruments.…”

Introducing a new type of pathologic tooth migration in a patient with periodontal disease

“…The position of the tooth in the dental arch depends on the healthiness and height of the periodontal compartments. It is also dependent on the forces exerted on the tooth, mainly from occlusion, lips, tongue, and cheeks [1]. Migration of a tooth is defined as the tooth movement from its primary position to another position in relation to the basal bone of the alveolar process, the opposing and the adjacent teeth [2].…”

“…The main etiology of PTM is not clear, however, a wide variety of conditions have been suggested to be in association with this phenomenon, including periodontal and periapical inflammation, bone loss, occlusal interferences, traumatic occlusion, class II malocclusion, habits (lip biting, tongue thrusting, pipe smoking, playing of wind instruments, bruxism, grinding, protrusive pattern of mastication and mouth breathing), soft tissue pressure, position of the tongue, shortened dental arch, missing teeth, extended lip frenula, and gingival enlargement due to pharmacotherapy [4][5][6][7]. More than one of these conditions may be present in a patient with PTM and a single tooth or a group of teeth can be affected [1,3]. In periodontal cases, the inflammatory destruction of the periodontium and pressure from the granulomatous tissue of the infra-bony periodontal pocket, bring about an imbalance between maintenance and migratory forces of the tooth [4].…”