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

 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

MOBILITY CAN BE OF TWO TYPES:

PHYSIOLOGIC TOOTH MOBILITY

PATHOLOGIC TOOTH MOBILITY

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

 Normal tooth mobility varies

Incisors Canines Premolars Molars

between different types teeth:

10- 12 mm/ 100 mm 5 - 9mm/100mm 8 - 10mm/100mm 4 - 8mm/100mm

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

 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

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

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

SECONDARY STAGE :

Occurs gradually & entails defomation of alveolar bone in response to a increased horizontal forces

PATHOLOGIC TOOTH MOBILITY:

Refers to any degree of

perceptible movement of faciolingually,mesiodistaly or axially when a force is applied to tooth

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

 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

 Pathologic process of jaws that destroys

alveolar bone & roots of teeth can also result in mobility for a short period

Periodontal surgery increases tooth mobility

Tooth loss, when a large number of teeth

have been lost,remaining tooth must assume all functional demands

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

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

 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

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

 LEONARD ABRANMS & POTASHNICK S.: Class 1 : mobility less than 1mm Class 2 : mobility within 1-2mm Class 3 : mobility greater than 2mm

 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

 3 : clinical mobility greater than

2mm buccolingually in addition to

mobility in an apical direction

 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

 KIESER: Grade 0 :

physiologic mobility

Grade 1 :
Grade 2 : Grade 3 :

slight mobility
moderate mobility marked mobility

 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

METHOD OF ASSESSING TOOTH MOBILITY:

The instrument system

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

 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

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

CLINICAL IMPACTION OF TOOTH MOBILITY:

Various degrees of gingival inflammation
Loss of attachment with pocketing Gingival recession Tooth with furcation involvement

SIGNS & SYMPTOMS:

Patient awareness of mobility:
Mobility is detected quite incidentally when patients attention is brought to tooth by tenderness experienced on chewing

 Functional discomfort:

Aesthetics:

Pain may be expected following sudden tooth displacement when biting on hard foods or with inadvertent trauma
Anterior labial or lateral tooth displacement results in fanning & elongation of clinical crown with poor appearance

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

 Periodontally involved mobile units may also display funneled periodontal radiolucencies resulting from co-existing angular bony defects
Radiolucencies may endodontic lesion

be

suggestive

of

Radiolucencies may be seen with furcation at furcation involved mobile teeth

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

Differential diagnosis:
Chronic inflammatory periodontal

disease is the commonest cause of of increased tooth mobility

Treatment of increased tooth mobility:

Situation 1:

Increased mobility of tooth with increased width of periodontal ligament but normal height of alveolar bone

 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

 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

 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

 SPLINT is an appliance

designed to stabilize mobile teeth

Fabricated in the form of

joined composite fillings, fixed bridges, RPDS etc.

 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,

 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

 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