Comparative Analysis of Occlusal Force Distribution Using T-Scan in Chronic Periodontitis Patients before and after Periodontal Therapy: A Randomized Controlled Trial

Background: The role of occlusal force in the progression of periodontal disease was explored for several years. Occlusal adjustment is commonly recommended for patients with periodontitis and traumatic occlusion. However, the scientific evidence linking occlusal adjustment and improvement of periodontal parameters is limited. Aim: The study aimed to find whether excessive occlusal force has any influence on severity of periodontal disease and the occlusal correction done based on T-Scan evaluation has any influence on healing after periodontal therapy. Materials and Methods: A total of 30 generalised chronic periodontitis patients contributing 692 teeth were selected for this prospective study. All the patients were subjected to occlusal force analysis using T-Scan (Tekscan version 9.0 T-Scan™) and based on the occlusal force distribution, 538 teeth presented with high occlusal force among 30 patients. Then the patients were randomly assigned as either flap surgery (Group A) or flap surgery with coronoplasty (Group B). Group A included 262 teeth and Group B included 276 teeth. The clinical parameters assessed were probing pocket depth (PPD), clinical attachment level (CAL) and teeth mobility. Based on the clinical attachment loss, teeth were categorized into mild (5-6mm), moderate (6.1-7mm) and severe (7.1-8mm). The clinical parameters and T-Scan analysis were recorded in follow-up examination at the end of 3 months. ANOVA was done to compare the pre-operative occlusal force between teeth with mild, moderate and severe clinical attachment loss. Paired t test was done to compare PPD, CAL and occlusal force between baseline and 3 months within two groups. Independent t test was done to compare PPD, CAL and occlusal force between two groups.Mann-Whitney U test was done to compare the differences in mobility between the groups and Wilcoxon signed rank test was done to compare the differences in mobility within the groups. Pearson’s correlation was used to analyze the correlation between pre-operative occlusal force and clinical attachment loss and between post-operative occlusal force and clinical attachment level. Results: Occlusal force was high among the teeth with severe clinical attachment loss as compared to mild and moderate clinical attachment loss. Inter group comparison showed that there was significant reduction in occlusal force and teeth mobility in teeth where periodontal flap surgery along with coronoplasty was done as compared to periodontal flap surgery alone. Within group comparison showed that there was significant reduction in occlusal force and all the clinical parameters assessed. There was a weak positive correlation between occlusal force and severity of periodontitis after periodontal flap surgery along with coronoplasty. Conclusion: This study marks the step in analysing the relationship betweenocclusal trauma and severity of periodontal disease and the influence of occlusal adjustment on healing after periodontal therapybased on T-Scan evaluation among generalised chronic periodontitis patients. The results revealed that there was a significant relationship between occlusal force and severity of periodontitis and occlusal adjustment results in reduction in periodontal parameters but not statistically significant.