Septum syndrome
- Definition of the proximal zone:
The interproximal zone is an anatomical and functional unit consisting of dental elements: marginal pits and ridges, proximal faces, interdental contact surface and periodontal elements: gingival papilla and alveolar bone septum.
- Anatomical reminder
- Marginal dimples and ridges : marginal dimple is the hollow part of the occlusal face in the shape of a trihedron formed by the meeting of the marginal groove and the main groove “MD”
The marginal ridge is the salient “VL” located on the M and D edges of a tooth, it has 2 occlusal slopes which end in the marginal fossa limited by the contact surface.
- Proximal face : convex surface as a whole (M or D)
- Interdental contact surface : meeting of the convexity of the 2 proximal faces assimilated to a contact point on young teeth and a contact surface in older ones.
In fact, during chewing, the teeth exhibit slight mobility thanks to the periodontal ligaments, which transforms the point into a contact surface.
The interdental contact zone is located on average at the junction of the occlusal 1/3 of the coronal height and the vestibular 1/3 in the “VL” direction.
- The gingival papilla and alveolar septum : the gingival straw occupies the interproximal space in young people, it is well developed and occupies all of this space, it gradually frees it with age by the phenomenon of gingival retraction, it has a pyramidal shape at the level of the PM and M, its summit is divided into 2 papillae “V” and “L” joined by a non-keratinized and therefore fragile interpapillary neck.
The alveolar septum connects the vestibular and buccal bony tables, marked by an interdental septal crest at the top, lanceolate in shape, it is a papilla support.
III- PHYSIOLOGY OF THE PROXIMAL ZONE
- Food deflection : during chewing, the food crushed by the opposing teeth follows 2 directions:
* 1st part slides along the occlusal slope of the marginal ridge to the fossa to be crushed by the antagonist cusp.
* The other part is guided by the proximal slope towards the contact zone which slides along the “V” and “L” faces of the gingival papilla to the gingivo-mucosal cul-de-sac, from where the food is taken up by the tongue and given back to the occlusal faces of the teeth.
- Wedging of the teeth between them : the chewing forces also have a role in wedging the teeth between them, the main occlusal forces applied to the internal slopes of the marginal ridges will push the tooth towards its neighbor and vice versa, this wedging tends to compensate for physiological wear.
- Role in protection: The V and L/P embrasures reduce the forces on the teeth by the escape of food
Gingival stimulation during chewing promotes its cleaning action; the interdental papilla prevents food stagnation and the deposition of biofilm through its elasticity.
- physiological aging: the interdental space tends to become uninhabited (rounded papilla, blunted bony crest, loss of attachment) The contact point wears and becomes an elongated surface especially in the VL/P direction, this draws food out and a small part can remain stuck after meals making brushing quite difficult in these areas.
- Septal pathology:
- Definition of septum syndrome: is a particular form of alveolar osteitis affecting the interdental septum. A local irritation, caused by food compression often aggravated by iatrogenic elimination maneuvers.
- Etiologies :
- Misaligned teeth,
- Overflowing restorations,
- proximal caries and coronal destruction,
- wear of occlusal reliefs by transformation of occlusal convexities and marginal ridges into oblique facets or by oblique cusp wear which opens the interdental space during mandibular movements
- Inadequate orthodontic treatment.
- Poorly fitting prosthesis.
- Bad habits (toothpick).
- Positive diagnosis:
- Subjective signs : sharp pain during and after meals occurs until the coronal destruction of the proximal areas is sufficient to ensure automatic self-cleaning. It can be confused with pulp syndrome but the differential diagnosis is often difficult, these pains regress with analgesics, sensation of a bad smell.
- Objective signs :
- Tooth sensitive to probing
- Bleeding gums at the slightest touch
- Loss of epithelial attachment.
- Pathognomonic sign : pain on bidigital pressure of the gingival papilla +++
- Radiological signs:
- Proximal caries.
- Defective restorations
- Possible slight ligament thickening.
- The integrity or not of the alveolar zones.
Septum syndrome
- Differential diagnoses:
- Dentin syndrome (deep cavity).
- Pulp syndrome.
- Periapical lesion syndrome .
- THERAPY FOR INTERPROXIMAL LESIONS:
- Emergency therapy: after periodontal curettage of the interproximal area, a sedative is placed (on a cotton ball soaked and wrung out with eugenol or pulperyl) at the interproximal space.
b) Etiological treatment:
- Removal of the aggressor agent
- Dentin treatment
- Restoration of the contact point
- CONCLUSION The interproximal space, an important anatomical and functional entity of the dental arches, must be known and respected by practitioners in order to perform non-iatrogenic and physiological fillings.
Septum syndrome
Untreated cavities can reach the nerve of the tooth.
Porcelain veneers restore a bright smile.
Misaligned teeth can cause headaches.
Preventative dental care avoids costly treatments.
Baby teeth serve as a guide for permanent teeth.
Fluoride mouthwash strengthens tooth enamel.
An annual checkup helps monitor oral health.