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| REVIEW ARTICLE |
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| Year : 2021 | Volume
: 13
| Issue : 1 | Page : 60-64 |
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Unraveling coronoplasty in periodontics
Malvika Singh
Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Jammu, Jammu and Kashmir, India
| Date of Submission | 20-May-2020 |
| Date of Decision | 12-Jul-2020 |
| Date of Acceptance | 22-Aug-2020 |
| Date of Web Publication | 15-Feb-2021 |
Correspondence Address:
Malvika Singh
Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Jammu, Jammu and Kashmir
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jorr.jorr_18_20
The study of dental occlusion often considered mysterious has been a subject of major interest since the time of the emergence of modern dentistry due to the fact that good clinical practice excels only after having proper knowledge about occlusion. Occlusal surfaces, if and when inhibited, cause trauma to the individual, becoming a matter of attention and concern for clinicians as well as patients. Coronoplasty is the procedure that selectively reduces the supracontacts, thus relieving patient of the same. It is used to provide better stability and occlusion in a permanent dentition noninvasively. The aim of this article is to throw light on occlusion, occlusion interferences, and treating of the same so that it can be applied by clinicians, especially periodontists, for treatment of the same.
Keywords: Coronoplasty, occlusion, supracontacts, trauma from occlusion, treatment
How to cite this article:
Singh M. Unraveling coronoplasty in periodontics. J Oral Res Rev 2021;13:60-4 |
| Introduction | |  |
Dental occlusion seems like a mystery to a lot of clinicians as well as students partly because it is not easily understood and partly because very few literatures are available, making it inaccessible to study. Although often described as the heart of dentistry and rightly so (because all branches of dentistry are in some form of the other dependent of correct/right occlusion), it has been described as a manner in which the upper and lower teeth intercuspate between each other in all mandibular positions and movements and is a result of neuromuscular control of the components of the mastication systems namely: teeth, periodontal structures, maxilla and mandible, and temporomandibular joints and their associated muscles and ligaments.[1] Any tooth contact that inhibits the remaining occluding surfaces from achieving stable and harmonious contacts is known as occlusal interference[2] and poses a potential of changing the occlusion. It often leads to trauma and poses a matter of grave concern both for patients and clinicians, thus laying foundation for a treatment procedure that selectively grinds or reduces those supracontacts. Hence, the procedure coronoplasty comes into play and defined as the the mechanical elimination of occlusal supracontacts and dealing with selectively reducing occlusal areas with the primary purpose of influencing the mechanical contact, conditions, and the neural patterns of sensory output in addition to establishing an ideal occlusion, premature contacts, and neural patterns of sensory input.[3] For writing this article, books by Carranza 8th edition were consulted and Medline and PubMed databases were searched under the following key terms: dental occlusion, occlusal interferences, trauma from occlusion, and coronoplasty. Only highly relevant articles from manual and electronic databases were selected for the present review. This article aims at highlighting the need and importance of coronoplasty in dentistry with special emphasis on periodontics so that the same can be clinically applied by professionals and students.
| Occlusion | | |
The term occlusion is divided into two subtypes:
- Centric occlusion: Also known as intercuspal position (ICP), it is the tooth–tooth relationship with maxillary contact, irrespective of the condylar position, and is the frequently required position composed on the neuromuscular system to avoid cuspal interference. It can be achieved by asking patients to close their mouth (intercuspate) by saying the alphabet “a”[4]
- Centric relation (CR): It is the only stable as well as clinically reproducible position irrespective of guidance provided by teeth in the presence or absence of teeth.[5]
Occlusal interferences
From the clinical point of view, an occlusal contact relationship must interfere with something to be considered an occlusal interference.[6] It is predisposed by conditions such as lack of harmony, unilateral mastication, loss of teeth, and centric relation traumatizing interferences. These have been demonstrated by Bernhard et al. who found a weak relationship between nonworking side contacts and increased probing depth and attachment loss.[7]
| Coronoplasty | | |
It can be defined as the selective reduction of occlusal areas with the primary purpose of influencing the mechanical contact conditions and the neural pattern of sensory output. It is the direct and irreversible change of occlusal scheme.[3] However, some authors have also defined it as the mechanical elimination of the supracontacts that may be present during functional movements and the selective reduction of occlusal areas to establish functional relationship favorable to the periodontium by reshaping, restoring, application of intraocclusal appliance therapy, and orthodontic movement and orthognathic surgery of teeth.[8] The objective of coronoplasty is to mechanically eliminate occlusal supracontacts (which are involved in function and parafunction).[7] It is primarily done to eliminate the undesirable occlusal forces that cause tissue damage and tooth mobility and should be done by mechanically eliminating all occlusal supracontacts which are in function and parafunction.
Treatment planning
While planning the treatment for a patient, the following points are kept in mind:
- Sequencing coronoplasty in treatment planning [Figure 1]: This procedure is done prior to the adjustment of occlusion. In this step, gingival inflammation and pockets are eliminated as gingival inflammation has been related to the pathogenesis and healing aspects of trauma from occlusion,[9],[10] therefore the benefits of coronoplasty are deemed as incomplete if the same is not eliminated first. Furthermore, teeth are periodontally treated first as the ones having same tend to migrate. This sequence can however be modified under the conditions such as infrabony pockets, mucogingival surgery, excessive tooth mobility, and cracked tooth[11]
- Occlusal analysis: After sequencing coronoplasty and prior to planning treatment, the casts in the form of dental impressions are made so that a well-rehearsed planned adjustment can be carried out with greater confidence and efficiency[12]
- Armamentarium: It includes materials that are used to identify and mark tooth contacts for specific application in coronoplasty. These include contra-angled handpiece, inked marking ribbons, mylar strips, abrasive disks, ribbon holder, blotting paper, abrasive disk and wheel, cutting and abrasive burs (tapered fissure bur, tapered fissure diamond bur, straight bur, round bur, football diamond bur, and round diamond bur), Arkansas stone, rubber polishing cones, occlusal registration strips, occlusal indicator wax, marking, and articulating paper[12]
- Informed consent: Patients are often concerned about the benefits and/or the harmful effects of coronoplasty. Hence, it is the duty of the clinician to explain to them the fact that teeth are not going to be ground down, but reshaped to make them function better. For this reason, a duly signed informed consent is taken.
Steps for coronoplasty?
The steps of performing coronoplasty has been enumerated in the following [Figure 2]. These steps, when performed sequentially, normally take over two or more appointments, with each visit lasting no more than 30 min.
- Gross adjustment and elimination of occlusal disharmonies: It is a simple and uncomplicated procedure used to correct extruded teeth; plunger cusps; uneven adjacent marginal ridges; rotated, malposed, and tilted teeth; and teeth with facets and flat occlusal wear. Following this procedure, striking changes, both in appearance and function, are achieved in one or two 15-minute grinding sessions. It further includes gross adjustment and fine adjustment. Gross adjustment can be performed prior to soft-tissue therapy, but fine adjustment usually follows after the elimination of inflammation and infection. However, in the cases of loose teeth (primarily due to secondary occlusal trauma), this step should be carried out immediately
- Removal of retrusive prematurities: The purpose of this step is to reduce supracontacts (that interfere with posterior border closure of the mandible) to a stable retruded contact position (RCP). This step results in the elimination of RCP to intercuspal position (ICP) shift by neutralizing shifts from RCP to intracuspal position (ICP) [Figure 3].
- Adjustment of intercuspal position: This step is performed to achieve a stable intercuspal position (ICP) and refined occlusal anatomic relationships. In this step, the posterior teeth are adjusted first, followed by conservative adjustment of the anterior teeth [Figure 4]
- Test for excessive contact on the incisor teeth: In this step, incisors are moved out of light contact over the maximum teeth, thus enabling detection of firmness of contact by using mylar occlusal strips.[13] Furthermore, closing contacts should be tested for fremitus, hence a vibration or displacement perceptible on the palpation the facial tooth surface is felt with a moistened forefinger during repeated firm closure to interproximal contacts (ICP)
- Removal of posterior protrusive supracontacts: The objective of this step is to attain a bilateral, well-distributed contact on the incisal edges of the maxillary and mandibular incisor teeth
- Removal of mediotrusive interferences: In this step, the mediotrusive or balancing supracontacts that complicate the laterotrusive guidance are removed in order to facilitate dominant disclusion on the laterotrusive side
- Reduction of excessive cusp steepness on the laterotrusive contacts: In this step, the canines causing disclusion are removed as they lead to a single tooth molar supracontact, resulting in trauma from functional and parafunctional movement[14]
- Rechecking the tooth contact relationships. Under this procedure, tooth contact relationships in all positions and movements are rechecked to verify the guidelines that helps determine the feasibility of achieving a satisfactory result by means of occlusal adjustment
- Finishing technique and patient instructions: This step is done by smoothening and polishing the occlusal surfaces so that they feel comfortable to the patient.
 | Figure 4: Replacement of retruded contact position with intercuspal position
Click here to view |
Many situations in periodontal therapy require coronoplasty of only one or two teeth and comprehensive occlusal adjustment is not warranted. In these cases, localized coronoplasty is often limited to intraborder reduction of supracontacts on the involved teeth (i.e., steps 2, 4, and 5 are only performed):
| Clinical Applications | | |
- Trauma from occlusion: It is defined as the injury to the attachment apparatus as a result of excessive occlusal forces. If not treated, it leads to greater probing depths, loss of attachment, increased bone loss, and ultimately periodontitis. Coronoplasty is widely used to treat patients suffering from the same
- Before orthodontic treatment: Presence of supracontacts hampers orthodontic treatment and poses threat for tooth loss, hence it is always advised to reduce the presence of supracontacts by coronoplasty
- Prosthesis placement: While placing any kind of fixed prosthesis, it is advised to check the presence of supracontacts in the oral cavity and treating the same for maintaining the long life of the prosthesis
- Bruxism: Patients suffering from bruxism often complain of trauma from occlusion, hence application of coronoplasty is strongly recommended in such cases [Figure 5].
| Conclusion | | |
Occlusion acts as a central pillar in our working lives and to be of such a systemic importance to the well-being of the patients that it takes almost mystic importance and attracts cult-like devotion. This can lead some dentists to advocate occlusion as being the key to resolving or preventing a range of disorders far removed from the masticatory system. Occlusion cannot be fully evaluated or treated in isolation. Instead, each component of the masticatory system must be fully understood according to its potential for adaptation and pathophysiology as well as interactions with the other components, therefore its relationship with the function of the stomatognathic system has been widely studied in dentistry since many decades. The relationship between periodontal disease and occlusion has been long debated.
Occlusal trauma can alter the periodontium (gingiva, cementum, periodontal ligament, and alveolar bone). Due to this effect, it is ideal to manage occlusal trauma prior to any definitive periodontal therapy. Occlusal therapy can be used to decrease loading of the teeth that have lost bone due to periodontal disease with the main aim to maintain or achieve occlusal stability. Thus, coronoplasty is used to provide better stability and occlusion in a permanent dentition noninvasively. Coronoplasty has remained as an ignored and perhaps overlooked procedure by clinicians. The opportunities for oral health care in the 21st century are enormous. The convergence of the biological and digital revolution with clinical dentistry and medicine is changing and transforming diagnostics, treatment planning, procedures, techniques, therapeutics, biomaterials, and predictable outcome of therapy. Clinicians should be made aware of the importance of coronoplasty in dentistry, especially in periodontics, so that it can be exploited for the betterment of the patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Ash MM, Ramjford SP. Am introduction to functional occlusion. In: Ramjford SP, editors. Occlusion. 3 rd ed.. Philadelphia: Saunders; 1982. p. 240.  |
| 2. | Francová K, Eber M. Occlusal interference-part two. Czech Dent J 2014;144:27-34. |
| 3. | Poulsen WG, Olsson A. Management of the occlusion of teeth. In: Schwartz LS, Chayes CM, editors. Facial Pain and Mandibular Dysfunction. 1 st ed.. Philadelphia: Saunders; 1968. p. 236-80. |
| 4. | Wise MD. Occlusion and restorative dentistry for the general practitioner. Br Dent J 1984;152:197-202. |
| 5. | Andrews LF. The six keys to normal occlusion. Am J Orthod 1972;62:296-309. |
| 6. | Nelson SJ. Occlusion. In: Nelson SJ, Ash, editors. Wheeler's Dental Anatomy, Physiology and Occlusion. 9 th ed. St. Louis, Missouri: Saunders Elsevier Inc; 2010. p. 302. |
| 7. | Bernhardt O, Gesch D, Look JO, Hodges JS, Schwahn C, Mack F, et al. The influence of dynamic occlusal interferences on probing depth and attachment level: Results of the study of health in Pomerania (SHIP). J Periodontol 2006;77:506-16. |
| 8. | Malathi K, Anand AJ, Karthikeyan R, Garg S. Coronoplasty; IOSR J Den Med Sci 2014;13: 64-7. |
| 9. | Polson AM, Meitner SW, Zander HA. Trauma and progression of marginal periodontitis in squirrel monkeys. III Adaption of interproximal alveolar bone to repetitive injury. J Periodontal Res 1976;11:279-89. |
| 10. | Polson AM, Meitner SW, Zander HA. Trauma and progression of marginal periodontitis in squirrel monkeys. IV Reversibility of bone loss due to trauma alone and trauma superimposed upon periodontitis. J Periodontal Res 1976;11:290-8. |
| 11. | Agar JR, Weller RN. Occlusal adjustment for initial treatment and prevention of the cracked tooth syndrome. J Prosthet Dent 1988;60:145-7. |
| 12. | Carranza FA, Newman MA. Coronoplasty. In: Newman MA, Carranza FA, editors. Clinical Periodontology. 8 thed. Philadelphia: W. B. Saunders Co; 1998. p: 539-44. |
| 13. | Watt DM, Sharkey SW, Saberi M, Likeman PR. A study of the average duration of occlusal sounds in different age groups. Br Dent J 1975;138:385-8. |
| 14. | Scaife RR Jr., Holt JE. Natural occurrence of cuspid guidance. J Prosthet D 1961;22:225-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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