Interrelationship of inflammation and tooth mobility (trauma) in pathogenesis of periodontal disease

A series of studies has investigated interactions between periodontal trauma and marginal periodontitis in relation to the initiation, progression and treatment of periodontal disease. Lesions of trauma in the periodontal ligament consequent to either single or jiggling displacing forces result in morphologic alterations in the ligament and alveolar bone. These changes do not initiate the loss of connective tissue attachment characteristic of marginal periodontitis. Studies conducted in squirrel monkeys and beagle dogs in which jiggling forces have been produced subjacent to an established marginal periodontitis reported increased loss of alveolar bone, but the accelerated loss of attachment which occurred in the dog model did not occur in the monkey model. To clarify the relative importance of inflammation and tooth mobility in the treatment of advanced periodontal disease, periodontal response was evaluated after removing traumatic and/or inflammatory components. Elimination of trauma in the presence of existing marginal inflammation did not reduce tooth mobility or increase bone volume. Osseous regeneration and decreased tooth mobility occurred after resolving both components, however, similar findings occurred after resolving inflammation in the presence of continued tooth mobility. Resolution of marginal inflammation is of prime importance in the management of periodontal disease. After resolution of inflammation, bone regeneration may occur around mobile teeth and, furthermore, any residual tooth mobility does not result in increased loss of connective tissue attachment.