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INTERNATIONAL JOURNAL
OF CURRENT RESEARCH
International Journal of Current Research
Vol. 10, Issue, 08, pp.72253-72256, August, 2018

ISSN: 0975-833X
RESEARCH ARTICLE

CORONOPLASTY: AN UNEXPLORED TREATMENT MODALITY IN PERIODONTAL THERAPY

*Dr. Malvika Singh MDS

Department of Periodontics, Himachal Institute of Dental Sciences, Paonta Sahib, H.P, India

ARTICLE INFO ABSTRACT

Article History: The study of dental occlusion has been a subject of major interest since the time of emergence of
Received 27th May, 2018 modern dentistry and can be attributed to the fact that it is often less understood and and perhaps
Received in revised form ignored by alot of clinicians. Inhibition of occlusal sur
surfaces
faces causes occlusal trauma to the individual
22nd June, 2018 and thus require its treatment. Cornoplasty is the procedure of selectively reducing the supracontacts
Accepted 08th July, 2018 thus relieving the patient of the same.
Published online 30th August, 2018

Keyword:
Occlusion, Supracontacts,
Occlusal trauma,
Treatment, Coronoplasty.

Copyright © 2018, Malvika Singh. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: Malvika Singh, 2018. “Coronoplasty: An therapy International Journal of Current Research
n unexplored treatment modality in periodontal therapy”, Research, 10,
(08), 72253-72256.

INTRODUCTION Occlusion: According to Ash &Ramfjord,

&Ramfjord “occlusion is
defined as the manner in which the upper and lower teeth
“Occlusion” takes on an almost mystic importance and attracts intercuspate between each other in all mandibular positions
a cult like devotion and has been rightly described as “The “ and movements. It is a result of neuromuscular control of the
t
heart of dentistry”. According to Ash and Ramfjord, components of the masticatory systems namely: teeth,
“occlusion is defined as a manner in which the upper and periodontal structures, maxilla and mandibular,
ma
lower teeth intercuspate between each other in all mandibular temporomandibular joints (TMJ’s) and their associatedas
positions and movements. It is a result of neuromuscular muscles and ligaments”(Ash, (Ash, 1982). Generally, the term
control of the components of the masticatory systems namely: occlusion in itself includes following two subtypes:
teeth, periodontall structures, maxilla and mandibular,
temporomandibular joints (TMJ’s) and their as associated Centric occlusion: Also known as intercuspal position (ICP),
muscles and ligaments” (Ash, 1982). Any tooth contact that it is the tooth-tooth
tooth relationship with maxillary contact,
inhibits the remaining occluding surfaces from achieving irrespective of the condylar position and it is the position
stable and harmonious contacts is known as occlu occlusal composed on the neuromuscular system to avoid cuspal
interference (Francová, 2014), and it poses a potential of interference. Generally, individuals in this position tend to
changing the occlusion. Selective grinding or coronoplasty is a position of the best” (Wise, 1984).
close their teeth in “a
the mechanical elimination of occlusal supracontacts that may
be present during functional movements. It also deals with Centric Relation (CR): It is the only position which is both
selectively reducing occlusal areas with the primary purpose reproducible and stable, with or without teeth present
influencing the mechanical contact, conditions and the neural (Andrews, 1972). The significance of centric relation is that
patterns of sensory output in addition to establishing an ideal this position is reproducible irrespective of the guidance that
occlusion, premature contacts and neural patterns of sensory the occlusal surfaces of the teeth may provide.
input. This article aims at highlighting the need and importance
of coronoplasty and also attempts to throw light on the Occlusal interferences: In clinical terms, an occlusal contact
procedures and importance of same in the field of dentistry relationship must interfere with something
mething to be considered as
with emphasis in the field of periodontics. an occlusal interference. Bernhard el al. investigated the
potential associations between dynamic occlusal interferences
*Corresponding author: Dr.Malvika Singh MDS
and signs of periodontal disease in posterior teeth based on a
Department of Periodontics, Himachal Institute of Dental Sciences, Paonta
Sahib, H.P, India. cross- sectional epidemiologic study titled, “Study of Health in
DOI: https://doi.org/10.24941/ijcr.31609.08.2018 Pomerania” and demonstrated a weak relationship between
72254 Dr. Malvika Singh, Coronoplasty: an unexplored treatment modality in periodontal therapy

non-working side contacts and increased probing depth and Steps for coronoplasty: Coronoplasty can be accomplished
attachment loss (Bernhardt, 2006). Conditions predisposing using a variety of different sequences, particularly if the area to
occlusal interferences are lack of harmony, unilateral be corrected involves only a few teeth. However, when a
mastication, loss of teeth and centric relation traumatising comprehensive coronoplasty is to be accomplished, a step-by-
interferences. step approach is required, although experienced clinicians tend
to blend the steps (Carranza, 1975). The series of steps are
Coronoplasty: It is defined as the selective reduction of normally accomplished over two or more appointments, with
occlusal areas with the primary purpose of influencing the each visit lasting no more than 30 minutes. The sequence in
mechanical contact conditions and the neural pattern of which coronoplasty is performed can be enumerated in
sensory output”. It is the direct and irreversible change of following steps:
occlusal scheme (Krogh-Poulsen, 1968). It can also be defined
as the mechanical elimination of the supracontacts that may be Gross adjustment and elimination of occlusal
present during functional movements and the selective disharmonies:
reduction of occlusal areas to establish functional relationship According to Clyde Schuyler, occlusal adjustment can be
favourable to the periodontium by reshaping, restoring, divided into two main headings: gross adjustment and fine
application of intraocclusal appliance therapy and orthodontic adjustment. Gross adjustment can be performed prior to soft
movement &orthognathic surgery of teeth (Malathi, 2014). tissue therapy, but fine adjustment usually follows the
The objective of coronoplasty is to mechanically eliminate the elimination of inflammation and infection. Where teeth are
occlusal supracontacts that are involved in function and very loose (as a result of secondary occlusal trauma) or have
parafunction (Bernhardt, 2006). The principle behind gross interferences, occlusal adjustment is carried out as soon
performing coronoplasty is to eliminate the undesirable as possible.It is a simple and uncomplicated procedure where
occlusal forces that cause the tissue damage and tooth mobility striking changes, both in appearance and function, are achieved
and it should be done by mechanically eliminating all occlusal in one or two 15 minute grinding sessions.
supracontacts which are in function and parafunction.
It is generally used to correct:
Treatment planning: While planning the treatment for a
patient, following points should be kept in mind:  Extruded teeth
 Plunger cusps
Sequencing coronoplasty in treatment planning: Prior to  Uneven adjacent marginal ridges
adjusting occlusion, gingival inflammation and pockets are  Rotated, malposed and tilted Teeth
eliminated due to following reasons:  Facets and flat occlusal wear
 Flat occlusal wear
 Inflammation is eliminated first as evidence related to the
pathogenesis and healing aspects of trauma from occlusion Removal of retrusive prematurities and elimination of
(Polson, 1976 and Polson, 1976), suggests that the benefits deflective shift from retruded contact position (RCP) to
of coronoplasty are not complete if same is not eliminated intercuspal position (ICP):
first.
 Teeth are periodontally treated first as the ones having The purpose of this step is to reduce supracontacts that
same tend to migrate. This sequence is however modified interfere with posterior border closure of the mandible to a
under the conditions such as infrabony pockets, stable retruded contact position (RCP). This step results in the
mucogingival surgery, excessive tooth mobility and elimination of retruded contact position (RCP) to intracuspal
cracked tooth (Agar, 1988). position (ICP) shift and it neutralises or removes the shifts
from retruded contact position (RCP) to intracuspal position
Occlusal analysis: Prior to extensive coronoplasty, casts from (ICP).
dental impressions are made so that a well rehearsed planned
adjustment is carried out with the greater confidence and Adjustment of intercuspal position to achieve stable,
efficiency (Carranza, 1998). simultaneous, multipointed widely distributed contacts:
The aim behind performing this step is to achieve a stable
Armamentarium: These are the materials that are used to intercuspal position (ICP) and to refine occlusal anatomic
identify and mark tooth contacts for specific application in relationships. The main feature of this step is the identification
coronoplasty. These include contra-angled handpiece, inked of supracontacts without the guidance by the operative
marking ribbons, mylar strips, abrasive disks, ribbon holder, adjustment of same during one or more visits. The posterior
blotting paper, abrasive disk and wheel, cutting and abrasive teeth are adjusted first, followed by conservative adjustment of
burs (tapered fissure bur, tapered fissure diamond bur, straight the anterior teeth, if necessary. Among the alterations that are
bur, round bur, football diamond bur, round diamond bur), commonly made in conjunction with this step are:
arkansas stone, rubber polishing cones, occlusal registration
strips, occlusal indicator wax, marking and articulating paper  Reduction of cuspal size.
(Carranza, 1998).  Alteration of occlusal table width.
 Lessening of plunger cusp height.
Informed consent: Patients are often concerned about whether
coronoplasty will change their appearance, causing tooth
Test for excessive contact (fremitus) on the incisor teeth:
decay, or increase tooth sensitivity. Hence it is the duty of the
The basic purpose of the step is to slightly take or move incisor
clinician to explain to them the fact that teeth are not going to
teeth out of contact or in light contact over the maximum teeth
be ground down, but reshaped so that they will function better. so that the firmness of contact can be detected by using mylar
72255 International Journal of Current Research, Vol. 10, Issue, 08, pp. 72253-72256, August, 2018

occlusal strips that are usually held in hemostat. Also closing any direction and the muscles are in complete state of spasm.
contacts should be tested for fremitus,hence a vibration or Some also complain of discomfort in the temporomandibular
displacement perceptible on the palpation the facial tooth joints (TMJ’s).
surface is felt with a moistened forefinger during repeated firm
closure to interproximal contacts (ICP).  Cotton roll technique
 Occlusal Interventions
Removal of posterior protrusive supracontacts and
establishing contacts that are bilaterally distributed on the This category aims at achieving harmonious relationship
anterior teeth: The objective of this step is to attain bilateral, between occluding surfaces but there exist controversies
well-distributed contact on the incisal edges of the maxillary among dental clinicians and researchers. Butler described an
and mandibular incisor teeth. occlusal adjustment procedure for the treatment of bruxism
without a proper theoretical basis. Greene et al. stated that
Removal or lessening the mediotrusive (balancing) occlusal rehabilitation further mutilates the dentition beyond
interferences: The objective of this step is to remove what bruxism has created.
mediotrusive (balancing) supracontacts that complicate
correction of the laterotrusive (working) guidance in order to Occlusal Appliances
facilitate dominant disclusion on the laterotrusive side. These are the most commomly and widely used orthodontic
appliances for the treatment of bruxism. They include acrylic
Reduction of excessive cusp steepness on the laterotrusive bite plane and Hawleys retainer:
(working) contacts: In this step, the canines causing
disclusion are removed as they lead to a single tooth molar Conclusion
supracontact and eventually result in trauma from functional
and parafunctional movement (Reynolds, 1975 and Scaife, Occlusion acts as a central pillar in our working lives and to be
1961). of such a systemic import to the well-being of the patients that
it takes almost mystic importance and attracts cult like
Rechecking the tooth contact relationships: Under this devotion. This can lead some dentists to advocate occlusion as
procedure, tooth contact relationships in all positions and being the key to resolving or preventing a range of disorders
movements are rechecked to verify the guidelines that to help far removed from the masticatory system. Occlusion cannot be
determine the feasibility of achieving a satisfactory result by fully evaluated or treated in isolation. Instead, each component
means of occlusal adjustment. of the masticatory system must be fully understood according
to its potential for adaptation and pathophysiology as well as
Finishing technique and patient instructions: In this step, interactions with the other components therefore its
the occlusal surfaces are smoothed and polished so that they relationship to the function of the stomatognathic system has
feel “comfortable” to the patient. Many situations in been widely studied in dentistry since many decades. The
periodontal therapy require coronoplasty of only one or two relation between periodontal disease and occlusion has been
teeth and comprehensive occlusal adjustment is not warranted. long debated. Occlusal trauma can alter the periodontium
In these cases, localised coronoplasty is often limited to (gingiva, cementum, periodontal ligament and alveolar bone).
intraborder reduction of supracontacts on the involved teeth Due to this effect, it is ideal to manage occlusal trauma prior to
(i.e. steps 2, 4 and 5 are only performed). The decision to any definitive periodontal therapy. Occlusal therapy can be
include retruded contact position adjustments (RCP) is usually used to decrease loading of the teeth that have lost bone due to
based on the use of retruded contact position (RCP) as a periodontal disease with the main to maintain or achieve
reference position rather than as the occlusal end point occlusal stability. Thus, coronoplasy is used to provide better
position. Following steps are used for coronoplasty: stability and occlusion in a permanent dentition non-
invasively. Coronoplasty has remained as an ignored and
Bruxism and appliance therapy: The term ‘la bruxomanie’ perhaps overlooked procedure by clinicians. The opportunities
was first introduced by Marie Pietkiewicz in 1907. It was later for oral health care in the twenty first century are enormous.
adopted as ‘bruxism’ to describe gnashing and grinding of the The convergence of the biological and digital revolution with
teeth occurring without a functional purpose.Bruxism is clinical dentistry and medicine is changing and transforming
defined as a diurnal or nocturnal parafunctional activity that diagnostics, treatment planning, procedures, techniques,
includes clenching, bracing, gnashing and grinding of teeth. therapeutics, biomaterials and predictable outcome of therapy.
Glossary of Prosthodontic Terms (GPT-8) defines bruxism as The clinicians should be made aware about the importance of
“parafunctional grinding of teeth or an oral habit consisting of coronoplasy in dentistry specially in periodontics so that it can
involuntary rhythmic or spasmodic non-functional gnashing, be exploited for the betterment of the patients.
grinding or clenching of teeth in other than chewing
movements of the mandible which may lead to occlusal Conflict of interests: None to declare.
trauma”. It can be caused due to psychic stress, irritation from
periodontal pockets, bruxing habit and prolonged periods of
occlusal trauma eventually leading to formation of facets,
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