1. Tooth mobility

2. definition
Movement of the tooth in a horizontal or vertical plane of space

3. It is divided into
Physiologic mobility
Pathologic mobility

4. Physiologic mobility
All teeth have certain degree of mobility related to width of pd ligament ,root attachment area and function of tooth.
Single rooted teeth more mobile than multirooted.
Mobility of single tooth varry from day to day and even hour to hour.
Mobility is normally greatest in morning immediately on arising from sleep and decrease in the day after the teeth have received considerable functional forces from mastication .
Physiologic range of tooth mobility 0.15 mm.

5. Pathologic tooth mobility
Causes of elevated tooth mobility are quantitative loss of teeth supporting structure due to periodontitis and qualitative changes in pdl due to occlusal trauma .

6. Tooth mobility can be Stable increase (adaptation)
Progressive increase un stable )pathological)

7. Mobility may be due to para functions related to patients occupation

8. Occlusal trauma
Defined as:microscopic alteration of periodontal structures in the area of periodontal ligament which become manifested clinically in reversible elevation of tooth mobility ,periodontal ligament space adaptice to the trauma by becoming wider.

10. All radiographs show signs of occlusal trauma to different degrees
Discontinuity and thickening of lamina dura
Widening of periodontal ligament space ('funnelling or saucerisation')
Radiolucency and condensation of alveolar bone/or root resorption.

12. Histological alteration in periodontium and elevated tooth mobility are reversible if the cause of trauma eleminated.

13. Adaptation to un physiologic forces
Periodontium adapt to long standing occlusal trauma (pdl space remain wide but regains its normal histological appearances.tooth mobility remains elevated but does not increase in severity.

14. Progressive mobility
heavy abnormal acclusal force may lead to a progressively increase tooth mobility
Trauma may be eliminated by bite plates ,selective grinding ,splinting or occlusal reconstruction

15. Degrees of tooth mobility
Grade 1 : mm in horizontal direction
Grade 2: 1 mm in horizontal direction
Grade 3: mobility in vertical direction

16. Tooth mobility can be measured manually or with mechanical device
The manual method (bidigital)
By using the handle of two instrument one is placed bucally and the other lingually and the teeth are rocked back and forth individually .
Mechanical method:
1-periotest
2-periodontometer

17. Periodontometers
A periodontometer was a research tool used in the 1950s and 1960s to standardise the measurement of even minor tooth displacement. To date, this instrument has been used in a few clinical studies and has limited practical use

18. periotest
The periotest device measures the reaction of periodontium to a defined percussion forces which is applied to the tooth.
Tooth delivered by a tapping instrument ,a metal rod is acelerated to a speed of 0.2m/sec with the device and mentained at constant velocity .upon impact the tooth is deflected and the rod decelerated .the contact time between the tapping head and the tooth varies between 0.3 and milliseconds and is shorter for stable than mobile teeth

19. Periotest figure

20. Periotest scale Periotest scale ranges from -8 to +50
-8 to 9 clinically firm teeth (physiologic)
10 to 19 is the first sign of movement
20 to 29 is crown deviates within 1 mm of its normal position
30 to 50 is severe mobility

21. Periotest values correlates with
Tooth mobiliy assessed with a metric system
Degree of periodontal disease and alveolar bone loss

22. treatment .
the lower anteriors have been temporarily immobilised by a labial splint in order to be able to identify the premature contacts and subsequently equilibrate the teeth in order to reduce the trauma from occlusion.

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