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Food impaction

2000-12-04 Dr. Y Kim Definition : The forceful wedging of food into the periodontium Common areas of food impaction : 1. Vertical impaction : A. Open contacts

B. C. 2.

Irregular marginal ridge Plunger cusps : cusps that tend to forcibly wedge food interproximally i. Causes : occlusal wear, shift in tooth position

Horizontal ( lateral ) food impaction : enlarged gingival embrasure (mechanism ) periodontal disease

tissue destruction

gingival recession

gingival embtrassure is enlarged

Lateral pressure from lips, cheeks, and tongue

Interproximal food impaction

***CLASSIFICATION OF FACTORS CAUSING FOOD IMPACTION *** CLASS I : Occlusal wear CLASS II : Loss of proximal contact CLASS III : Extrusion beyond the occlusal plane CLASS IV : Congenital morphological abnormality CLASS V : Improperly constructed restorations 1. CLASS I : Occlusal wear A. Type A : Wedging action produced by plaunger cusp into oblique facets

B.

Type B : Remaining obliquely worn cusp of a maxillary tooth, overhanging the distal surface of its functional antagonist

C.

Type C : Obliquely worn mandible tooth, overhanging the distal surface of its functional antagonist

2.

CLASS II : Loss of proximal support A. Type A : Loss of distal support through the removal of a distally adjacent tooth

B. C. D.

Type B : Loss of mesial support sue to extraction Type C : Oblique drifting due to non-replacement of a missing tooth Type D : Permanent occlusal openings to inter-dental spaces

i. ii. iii. iv. 3. 4.

Drifting after extraction Habits forcing teeth out of position Periodontal disease Caries

CLASS III : EXTRUSION A TOOTH RETINING CONTIGUITY WITH THE ADJACENT MESIAL AND DISTAL MEMBERS CLASS IV : CONGENITAL MORPHOLOGIC ABNORMALITIES A. B. C. D. Type A : position of a tooth in tortion Type B : emphasized embrasure between thick-neck teeth Type C : facio-lingual tilting Type D : malposition ( facial or lingual ) Type A : loss of contact point Type B : improper location of contact point Type C : improper occlusal contour Type D : improperly constructed cantilever restorations Type E : scalloped cervical bevels on the tissue-borne areas of prosthetic restorations

5.

CLASS V : IMPROPERLY CONSTRUCTED RESTORATION A. B. C. D. E.

*** SIGNS & SYMPTOMS *** 1. TROUBLE A. B. C. 2. A. B. C. D. E. Discomfort feeling of pressure Vague pain Root caries Gingival inflammation bleeding & foul tasts Gingival recession Periodontitis Periodontal abscess formation Alveolar bone loss vertical

PERIODONTAL CHANGES

*** PREVENTION AND TREATMENT *** 1. 2. PERIODONTAL TREATMENT : Scaling, TBI, flossing, stimulation of gingival, curettage OCCLUSAL ADJUSTMENT A. Plunger cusp : round these sharp cusp peaks, Especially lingual cuspe examine the study cast (lingual aspect )

B. i.

Level the occlusal height of the marginal ridges Whether to restore of grind? 1. 2. 3. ii. relation to opposing tooth structure to the overall plane of occlusion degree of discrepancy iatrogenic hazards

Consider the slope of the marginal ridge (external, internal)

iii. C.

When a marginal ridge is being leveled, the proximal fossa is generally obliterated, the fossa must be recarved

Grooves and fossa i. ii. iii. Recarve obliterated or missing fossa Distinct, but shallow, saucer-shape fossa mesially and distally with slightly extended grooves ( spillway or sluiceways) To deflect food from interproximally to buccally or lingually

3.

MAKING IDEAL CONTACT : intact, firm proximal contact relationships prevents the forceful wedging of food inter-proximally Protect interdental papilla A. Ideal contact i. ii. iii. iv. B. Location Width Height Tightness

Check carefully with dental floss Factors we should know in permanent restoration i. ii. iii. Proximal contact Contour of occlusal surface Facial & lingual contour

4.

PERMANENT RESTORATION A.

INLAY: SPLINT CROWNS