Bruxism (grinding teeth) primarily concerns the horizontal, nonfunctional grinding of teeth by patients. The forces involved are in significant excess of normal physiologic masticatory loads. Bruxism may affect the teeth, muscles, joints, bone, implants, and prostheses. These forces may occur while the patient is awake or asleep and may generate increased force on the system several hours per day.
Bruxism is a common oral habit. Sleep clinic studies have evaluated nocturnal bruxism and found approximately 10 percent of those observed had obvious movement of the mandible with occlusal contacts. More than half of these patients had tooth wear affecting esthetics. Only eight percent of these patients were aware of their nocturnal bruxism, and only one quarter of the patients’ spouses were aware of the nocturnal habit. Muscle tenderness in the morning was observed less than 10 percent of the time.
Another study on bruxing patients with implants showed 80 percent of sleep bruxism occurred during light sleep stages but did not cause problems to their implants. Therefore, patients with bruxism may or may not have obvious tooth wear affecting esthetics; may brux nocturnally, but their bed partners do not know most of the time; rarely have muscle tenderness when they are awake; and are usually unaware of their oral habit. In other words, nocturnal bruxism is sometimes difficult to diagnose.
The maximum biting force of bruxing patients is greater than average. Just as an experienced weight-lifter can lift more weight, the patient constantly exercising the muscles of mastication develops a greater bite force. A man who chews paraffin wax for an hour each day for a month can increase the bite force from 118 to 140 psi (pounds per square inch) within one week.
Chewing gum, bruxism, and clenching may accomplish the same feat. Eskimos, with a very tenacious diet and who chew their leather to soften it before fabrication of clothing, have maximum bite forces above 300 psi. A 37-year-old patient with a long history of bruxism recorded a maximum bite force of more than 990 psi (four to seven times normal).
Fortunately, the bite force does not continue to increase in most bruxing patients. When muscles do not vary their exercise regimen, their size and function adjust to the dynamics of the situation. As a result, the higher bite forces and muscle size usually do not continue in an unending spiral.
Clinical research has produced an inconclusive consensus on the definition of bruxism and its relation to implant dentistry. But methods have been developed to protect implants.
How can we protect dental implants in patients with Bruxism?
Effective protection of the implant system can be assisted greatly by the prescription of a hard, occlusal splint (night guard). Clinicians often attempt irreversible occlusal treatments or force the patient to change their lifestyle in an effort to reduce bruxism, but custom-made acrylic guards can achieve the same results.
Adjacent dysfunction and pathologic tooth wear are addressed during the fabrication of the orthotic. Achieving mutually protected occlusion within the design of the guard ensures that the implant prosthesis is not subject to the negative phenomena exhibited by bruxing patients. The unconscious pressures exerted in nocturnal bruxism are spread over the entire arch and lessened, rather than being absorbed at a single location.
Once osseointegration is achieved, the predominant factor in implant longevity is maintenance of applied force. Excessive occlusal pressure must be mitigated or even avoided by the implant. Strength is directly affected by the surface diameter created by the thread characteristics, determining the area available to dissipate force under increased tension.
Patients with bruxism require clinicians to choose the correct thread characteristics in order to create the most surface area. The strongest materials often cannot withstand bruxing, requiring the clinician to plan the final restoration in a manner that removes it from full occlusion during maximum intercuspation. Protection can also be built into the implant by reducing the overall diameter and creating a narrow occlusal table of the restoration so that it rests nearly entirely over the implant, causing the bite forces to be distributed directly through the implant itself. Employing particular design specifications will serve to increase the likelihood of successful implant treatment.
During the delivery appointment, the clinician checks the orthotic in the mouth to ensure proper fit and makes any necessary adjustments. Movements are confirmed and the appliance is adjusted to achieve clinically acceptable, mutually protected occlusion. A follow-up recall appointment a week later is required to reevaluate and adjust the occlusion of the splint.
Occlusal guards and proper implant design can negate the excessive forces exhibited by patients with bruxism, greatly improving the chances of optimal restorative outcomes. While current clinical research may not reach consensus on the effects of bruxism, the practicing clinician must exhibit a working knowledge for when this situation inevitably arises.
Successful outcomes are determined by the integration between bone and implant structure, which can be greatly impeded by undue force. Whereas occlusal guards may be less critical than proper implant design, the construction of both agents with a mind toward protection helps ensure successful treatment.
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About Omega Dental
With our variety of dental specialists under one roof, Omega Dental Specialists Houston provides patients with treatment options for any need. Our dedicated staff is experienced in several specialty divisions, including Endodontics, Oral Surgery, Pediatric Dentistry (Pedodontics), Dental Implants and Orthodontics. Our technologically advanced office is equipped with some of the most modern instruments and machinery available in dentistry. Omega Dental is open seven days a week to help you to take care of your oral health no matter what your busy schedule.