Edition V02N03 | Year 2012 | Editorial Endo in Endo | Pages 10 to 20
A more refined diagnosis tends to be based on subtle signs and symptoms, requiring the specialist to be extremely judicious and knowledgeable. Occlusal trauma should be included in the differential diagnosis of apical periodontitis and dental trauma. Ideally, when a tooth presents with pulp necrosis and signs of occlusal trauma, one should conduct the interview and diagnostic tests in search of a superimposed dental trauma, even in posterior teeth. No scientific rationale is strong enough as to allow one to state that occlusal interference or occlusal overloads produce a necrotic pulp. Interferences and occlusal overloads take months or even years to induce the classic signs and symptoms of occlusal trauma as a clinical entity. It is still common to compare the effects of occlusal trauma to those resulting from orthodontic movement and dental injuries. The mechanisms underlying tissue changes induced by occlusal trauma are in no way comparable to those induced by orthodontic movement or dental trauma. In these three events the primary cause is of a physical nature, but the forces applied to dental tissues exhibit completely different characteristics of intensity, duration, direction, distribution, frequency and form of uptake by periodontal tissues.