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Pathological Migration Periodontitis — ORE Part 1 MCQ

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ModeratePeriodontologyPathological Migration PeriodontitisORE Part 1

A 50-year-old patient reports gradually increasing spacing between the mandibular anterior teeth over 2 years. Periodontal examination shows generalised periodontal bone loss and probing depths of 6–8 mm around the mandibular anterior teeth. Which mechanism most likely explains the tooth movement?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Loss of periodontal support disrupting the balance of forces on the teeth

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · E = shown as D · C = shown as E

The correct answer is A. This is pathological tooth migration: periodontal attachment and bone loss reduce resistance to the usual occlusal, tongue, lip and cheek forces, allowing progressive drifting and spacing. The decisive features are increasing anterior diastemata together with deep pockets and generalised bone loss. Although the aetiology can be multifactorial, bone loss is the factor most strongly associated with pathological migration. Excessive occlusal force may contribute when support is reduced, but primary occlusal trauma requires normal support and does not explain the periodontal destruction (B). There is no orthodontic history to support relapse (C). Normal ageing-related drift is insufficient to explain marked spacing with 6–8 mm pockets (D). Tongue thrust can be contributory but is not the primary explanation in this stem (E).

Reference: Brunsvold MA. Pathologic tooth migration. Journal of Periodontology. 2005;76(6):859–866. https://pubmed.ncbi.nlm.nih.gov/15948679/