Does occlusal adjustment enhance periodontal therapy?

The benefits of occlusal adjustment as a component of periodontal treatment have not been adequately demonstrated in the clinical research to date, according to a new systematic review in the Journal of Dentistry (December 2012, Vol. 40:12, pp. 1025-1035).

"The relationship between trauma from occlusion (TfO) and periodontal disease has been discussed for more than a century," wrote the study authors from University of SĂŁo Paulo dental school. "A few observational studies reported a positive relationship between TfO and [clinical attachment loss (CAL)] and demonstrated that periodontally compromised teeth presenting TfO had less bone support and greater pocket probing depth."

Based on these studies, "if TfO had any relationship to the progression of periodontitis, then its elimination could also enhance clinical periodontal conditions," they noted.

To identify studies that investigated the effects of occlusal adjustment associated with periodontal therapy on periodontal parameters, the researchers conducted a literature review using Medline via PubMed, the Cochrane Central Register of Controlled Trials, and Embase. A total of four articles met their inclusion criteria.

"Although the four studies evaluated in this review had demonstrated a possible improvement in periodontal parameters when occlusal adjustment is associated with periodontal therapy, there are still conflicts between them," likely due to differences in methodologies and statistical analysis, according to the study authors.

Such methodological issues "suggest the need for new trials of a higher quality," they wrote.

It is important to note, however, that no adverse effects have been linked to occlusal adjustment, which means that although its benefits are not proved, it is also not detrimental, they added.

"The decision made by clinicians whether or not to use occlusal adjustment in conjunction with periodontal therapy hinges upon clinical evaluation, patient comfort, and tooth function," they concluded.

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