www.fourthmolar.

com
• TOOTH MOBILITY can 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

www.fourthmolar.com
• 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

www.fourthmolar.com
 MOBILITY CAN BE OF TWO
TYPES:
•

PHYSIOLOGIC PATHOLOGIC
TOOTH MOBILITY TOOTH MOBILITY

www.fourthmolar.com
 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

www.fourthmolar.com
• Normal tooth mobility varies
between different types teeth:

Incisors - 10- 12 mm/ 100 mm

Canines - 5 - 9mm/100mm
Premolars - 8 - 10mm/100mm
Molars - 4 - 8mm/100mm

www.fourthmolar.com
 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

www.fourthmolar.com
• During walking hours 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

www.fourthmolar.com
Effect of stress-inducing conditions:
• Habits like bruxism & clenching activities affect
tooth mobility as well

• Larger in children than in adults

• Females > males

• Increases during pregnancy

www.fourthmolar.com
 Tooth mobility occurs in
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
www.fourthmolar.com
• SECONDARY STAGE :
•
• Occurs gradually &
entails defomation of
alveolar bone in response to
a increased horizontal forces

www.fourthmolar.com
PATHOLOGIC TOOTH
MOBILITY:
• Refers to any degree of
perceptible movement of
faciolingually,mesiodistaly or
axially when a force is applied
to tooth

www.fourthmolar.com
www.fourthmolar.com
 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

www.fourthmolar.com
• Trauma from occlusion, 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

www.fourthmolar.com
• Pathologic process of 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

www.fourthmolar.com
www.fourthmolar.com
 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

www.fourthmolar.com
 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

www.fourthmolar.com
• 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

www.fourthmolar.com
 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
•

www.fourthmolar.com
• LEONARD ABRANMS & POTASHNICK S.:

• Class 1 : mobility less than 1mm

• Class 2 : mobility within 1-2mm

• Class 3 : mobility greater than 2mm

www.fourthmolar.com
• 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

www.fourthmolar.com
• 3 : clinical mobility greater than

• 2mm buccolingually in addition to

• mobility in an apical direction

www.fourthmolar.com
 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

www.fourthmolar.com
• KIESER:

• Grade 0 : physiologic mobility

• Grade 1 : slight mobility

• Grade 2 : moderate mobility

• Grade 3 : marked mobility

www.fourthmolar.com
 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
•

www.fourthmolar.com
www.fourthmolar.com
 METHOD OF ASSESSING
TOOTH MOBILITY:

• The instrument system

{PERIODONTOMETER} permits
reproducible assessment of
horizontal mobility of all types
of both arches

www.fourthmolar.com
• Instruments consists of:

• A CLUTCH with a female

receptable for holding carrying vehicle

• A MULTIJOINTED CARRYING VEHICLE

with a male attachment that
supports & positioning a dial test indicator

www.fourthmolar.com
• 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

www.fourthmolar.com
CLINICAL IMPACTION OF
TOOTH MOBILITY:
• Various degrees of gingival inflammation

• Loss of attachment with pocketing

• Gingival recession

• Tooth with furcation involvement

www.fourthmolar.com
 SIGNS & SYMPTOMS:
• Patient awareness of mobility:

Mobility is detected quite incidentally

when patient’s attention is brought
to tooth by tenderness experienced
on chewing
•
•

www.fourthmolar.com
• 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

www.fourthmolar.com
RADIOGRAPHIC CHANGES:

• Marked horizontal radiographic loss of

bony support may be associated with
minimal tooth mobility

• Modest degree of breakdown may be

associated with pronounced tooth mobility

www.fourthmolar.com
• Periodontally involved mobile 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

www.fourthmolar.com
www.fourthmolar.com
 OTHER FEATURES:
• A mobile teeth might sometimes display
a healthy periodontal support, causes
of mobility are:
• accidental trauma
• periapical endodontic
• lesion
• high filling
• orthodontic treatment

www.fourthmolar.com
 Differential diagnosis:

• Chronic inflammatory
periodontal disease is the
commonest cause of of
increased tooth mobility

www.fourthmolar.com
 Treatment of increased
tooth mobility:

• Situation 1:
• Increased mobility of
tooth with increased width of
periodontal ligament but normal
height of alveolar bone
www.fourthmolar.com
• A proper correction 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

www.fourthmolar.com
• 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

www.fourthmolar.com
• 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

www.fourthmolar.com
• “ SPLINT is an appliance designed
to stabilize mobile teeth “

• Fabricated in the form of joined

composite fillings, fixed bridges,
RPD’S etc.

www.fourthmolar.com
• 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,

www.fourthmolar.com
• Only by means 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

www.fourthmolar.com
• 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

www.fourthmolar.com