IMPLANTS IN BRUXISM

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IMPLANTS IN BRUXISM

DEPARTMENT OF PROSTHODONTICS

Dr. Sreeram.v.vijayPost-Graduate Trainee

2 Contents

Introduction Consequences Of Overload Of Dental Implants Causes Of Overload Of Implants Bruxism Occlusal Considerations For Implant Prostheses Occlusal Material For The Suprastructure In Implant Prostheses Management Of Bruxism Conclusion

3 Introduction

What Is An Implant ? “A prosthetic device made of alloplastic biomaterial, surgically implanted

into the oral tissues beneath the mucosa, and/ or within the bone to provide retention and support for a fixed or removable prosthesis”.

GPT - 8

Osseointegration The apparent direct attachment or connection of osseous tissue to an inert,

alloplastic material without intervening connective tissue.

GPT - 8

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OVERLOAD

BIOLOGICAL BIOMECHANICAL

Consequences of overload of dental implants

5 Biological complications

Early failures

Late failures

Insufficient osseointegration Pathological bone loss after complete osseointegration

Clinical Management of Implant Prostheses in Patients with Bruxism Osamu Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012

6 Biomechanical complications

Screw loosening

Implant fracture

Uncemented restoration

7 Component fracture

Porcelain fracture

Prosthesis fracture

8 Causes of overload of implants Poor bone density/quality

Inadequate number of implants

Large occlusal table

Steep cusp inclinationOcclusal consideration in implant therapy, Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl. Res. 16, 2005 / 26–35

9 Excessive premature contacts >180 µm in monkey studies >100 µm in human

Overextended cantilever >15 mm in the mandible >10–12 mm in the maxilla

Parafunctional habits/Heavy bite force

Bruxism Clenching

Occlusal consideration in implant therapy, Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl. Res. 16, 2005 / 26–35

10 What Is Bruxism ?

Bruxism is a movement disorder of the masticatory system that is expressed, among others, by tooth grinding and clenching, during sleep as well as during wakefulness.

11Bruxism - Diagnosis

Lavigne et al. proposed sleep bruxism research diagnostic criteria (SB-RDC)

A history of frequent tooth grinding occurring at least 3 nights per week for the preceding 6 months, as confirmed by a sleep partner

Clinical presence of tooth wear

Masseter muscle hypertrophy

Report of jaw muscle fatigue or tenderness in the morning

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Bruxism has also been suggested to cause excessive (occlusal) load of dental implants and their suprastructures

Bruxism is often considered as contraindication for implant treatment.

Researchers use bruxism as an exclusion criterion for the selection of their participants in clinical studies concerning treatment modalities with dental implants

Bruxism – Contraindication for implants ?

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In a study of 379 patients who had used implant prostheses for many years, occlusal wear had no statistically significant impact on vertical peri-implant bone loss

Occlusal wear was closely related to bruxism, and thus bruxism did not seem to be a risk factor for the examined variables

Bruxism – Insignificant in implant therapy !

14Occlusal considerations for implant prostheses

Natural tooth is attached through periodontal ligaments and osseointegrated implant has a rigid bone contact

A natural tooth can be intruded about 28 to100 μm by a light force (20 N) compared to only 2 to 5 μm for an osseointegrated implant


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Occlusal perception level is higher for implant prostheses than for natural teeth

Occlusal scheme for an implant prosthesis should be designed to decrease cuspal interferences, centralize forces along the long axis, and minimize lateral forces


16 Clinical trials regarding the influence of bruxism on

implant prostheses are limited


17 Authors’ views on the same

Taylor et al The damaging effects of bruxism are created through lateral friction between the occlusal surfaces of maxilla and mandible

Miyata et al The relationship between occlusal overload and peri-implant tissue and suggested that peri-implant bone resorption occurred under occlusal overload

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Heitz-Mayfield et al A period of 8 months of excessive occlusal load on titanium implants did not result in loss of osseointegration or marginal bone loss when compared with nonloaded implants in animal study

19Occlusal material for the suprastructure in implant prostheses

Materials Advantages Disadvantages

Acrylic resin Shock absorbing material No wear resistance

Metal ceramic Withstand maximum occlusal forces

Chipping or a fracture of ceramic portion

Ceramic Superior esthetics and wear resistance

Maximum forces transmitted to the implant – bone interface

Zirconia Long lasting and good esthetics

Cause friction against the root of the tooth as well as other teeth


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Management of bruxismNight Guard And Pharmacological Approach For Bruxism

Night Guard

CONSEQUENCES OF NOCTURNAL PARAFUNCTIONAL HABITS MAY BE PREVENTED BY ACRYLIC RESIN NIGHT GUARDS

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23 A night guard should promote even occlusal contacts around the arch in

centric-related occlusion

The consequences or intensity of the bruxism habit may be directly observed

Night guard is hollowed out at the implant sites so no occlusal force is transmitted to the implant prostheses

A soft material may also be placed around the crowns for stress relief and to decrease the impact force on the crowns

24 Pharmacological Approach

Low doses of the dopamine D1/D2 receptor agonist pergolide finally resulted in a substantial and lasting reduction in the bruxism

The use of acetylcholine-inhibiting formulations such as botulinum toxin

Benzodiazepam–type drugs and muscle relaxants have been prescribed by clinicians in an attempt to reduce nocturnal bruxism

Dopaminergic medication also appears to demonstrate potential utility in reducing nocturnal bruxism

[Guideline] Kato T, Thie NM, Montplaisir JY, Lavigne GJ. Bruxism and orofacial movements during sleep.Dent Clin North Am. 2001 Oct. 45(4):657-84

25 Conclusion

The lack of well-designed clinical trials regarding the consequence of bruxism on implant prostheses poses a serious problem.

At present, expert opinion and cautionary approaches are still considered the best available sources for suggesting good practice indicators.

There is an urgent need for those actively engaged in clinical research centers and university research institutes to provide evidence on whether the subjective feeling of clinicians regarding the approach of bruxism in implant patients is correct or not.

26References

T. D. Taylor, J. Wiens, and A. Carr, “Evidence-based considerations for removable prosthodontic and dental implant occlusion: a literature review,” Journal of Prosthetic Dentistry, vol. 94, no. 6, pp. 555–560, 2005

T. Haraldson, G. E. Carlsson, and B. Ingervall, “Functional state, bite force and postural muscle activity in patients with osseointegrated oral implant bridges,” ActaOdontologica Scandinavica, vol. 37, no. 4, pp. 195–206, 1979

J. van der Zaag, F. Lobbezoo, P. G. G. L. van der Avoort, D. J. Wicks, H. L. Hamburger, and M. Naeije, “Effects of pergolide on severe sleep bruxism in a patient experiencing oral implant failure,” Journal of Oral Rehabilitation, vol. 34, no. 5, pp. 317– 322, 2007

27 Occlusal consideration in implant therapy, Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl. Res. 16,

2005 / 26–35

Effects Of Pergolide On Severe Sleep Bruxism In A Patient Experiencing Oral Implant Failure, Jac. Van Der Zaag, Frank Lobbezoo, J Oral Rehabil. 2007;34(5):317-322.

Bruxism: Its Multiple Causes And Its Effects On Dental Implants – An Updated Review* F. Lobbezoo, J. Van Der Zaag & M. NAEIJE, Journal Of Oral Rehabilitation 2006 33; 293–300

[Guideline] Kato T, Thie NM, Montplaisir JY, Lavigne GJ. Bruxism and orofacial movements during sleep.Dent Clin North Am. 2001 Oct. 45(4):657-84

Does bruxism contribute to dental implant failure? Zhou Y, Gao J, Luo L, Wang Y. A systematic review and meta-analysis. Clinical Implant Dentistry and Related Research 2015

Management of Abutment Screw Loosening: Review of Literature and Report of a Case Vinod Krishnan, C. Tony Thomas & Ipe Sabu Volume 14 Number 3 J Indian Prosthodont Soc (2014) 14:208-214

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Health & Medicine

IMPLANTS IN BRUXISM